by KATHY WATSON
Texas Heart Institute
Houston [2006]
John Williams was always a sickly child. Doctors told his parents he would never live to adulthood. Perhaps that is why – more than 80 years later – Mr. Williams seemed unfazed when doctors told him there was nothing they could do for the thoracic aneurysm which threatened his life.
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| Dr. Neil Strickman visits with John Williams and his wife, Dorothy, a few days after the patient's life-saving surgery. |
An aneurysm occurs when the pressure of blood passing through part of a weakened blood vessel forces the vessel to bulge outward, forming what may be compared to a thin-skinned blister. If bulging stretches the aorta (the large vessel that carries blood from the heart to other parts of the body) too far, it may burst, causing a person to bleed to death very quickly.
Only 20 percent of patients with aneurysms make it to an emergency room after a rupture, and then they have just a 50 percent chance of survival. Even as he approached his 87th birthday, Mr. Williams would once again defy all odds.
The Mississippi resident was enjoying his 21st winter as a "snowbird" in Texas' Rio Grand Valley when he passed out in his home in February. What initially appeared to be pneumonia turned out to be something quite different – and perilous. Close to his heart, a thoracic aneurysm had ruptured, bleeding into his left chest. He was spitting up blood and a lung collapsed. Remarkably, the rupture walled itself off, but blood was still leaking into the lungs. Given Mr. Williams' advanced age and the complexity of several other medical problems, his doctors felt traditional surgery was out of the question.
"The doctors were so nice. They came in and prayed with us. We started talking about burial plans and no one could understand why Papa was so calm about it," says Dorothy Williams of her husband. "A little while later a doctor came in and told us everything would be all right. Before we knew it, we were on a medical plane to Houston to see a specialist who might be able to repair the broken artery without having to undergo surgery! We realized, however, that he might not live through the trip."
Mr. Williams' physicians in the Valley had consulted doctors at the Texas Heart Institute and St. Luke's Episcopal Hospital. Cardiologist Neil E. Strickman, M.D., and cardiovascular surgeon Igor Gregoric, M.D., recognized that despite long odds, Mr. Williams still had a viable option.
"When the Valley doctors told me their surgeon was predicting 90 percent mortality, my first thought was – we can do better than that," says Dr. Strickman. "I knew there was a new procedure in early clinical trial involving covered stent grafts (a metallic mesh covered with surgical material to prevent any leakage). We had performed one such procedure five years ago with the approval of the FDA, however that patient was not as critically ill as Mr. Williams was. But we were about to begin a new trial here at THI and St. Luke's and had everything ready to go, so we received a compassionate use exemption for Mr. Williams."
The experimental procedure is usually conducted under general anesthesia however doctors here will soon be using local anesthesia. It is less invasive than traditional surgical means. Cardiovascular surgeons usually access the aneurysm through an incision in the back whereas interventional cardiologists can access the aneurysm through an arterial opening in the groin using a catheter. The interventional cardiologist then threads the covered stent graft into the aorta and deploys the stent which essentially excludes the aneurysm from the circulation and reinforces the weakened aorta.
Within days of the operation, Mr. Williams was back in high spirits and good humor. The Williams have since returned to the Valley and look forward to celebrating their 55th wedding anniversary in Mississippi.
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