Emerson Hospital Specialist Provides Life-Saving, Emergency Repair for Ruptured Abdominal Aortic Aneurysm

When Bob Graham of Shirley recently developed steady pain in his abdomen, he attributed it to a muscle strain from raking leaves the previous day. It was only until a few nights later, when the intensity kept him from sleeping, that he asked his wife, Pat, to take him to the Emerson Hospital Emergency Department in Concord.

After the couple arrived at Emerson around 3:00 a.m., Graham underwent a CT scan that led to a grave diagnosis: a ruptured abdominal aortic aneurysm, or vessel wall that has weakened and burst. While the condition causes serious internal bleeding that can lead to shock or death within minutes to hours, Graham’s rupture had temporarily sealed itself. The pain he felt was caused by the blood that had already leaked into his back from the abdominal aorta, the largest blood vessel in the body which carries blood from the heart to the rest of the body.

“A very small clot was acting as a dam, holding back the tide of blood,” recalled Emerson Hospital vascular surgeon Stephen J. Hoenig, MD. “If it broke, he would die.”

Although he was “petrified,” Graham said that Dr. Hoenig’s openness and reassuring manner had a calming effect as he prepared for surgery within just hours of arriving at Emerson. Dr. Hoenig and the experienced team of interventional and operating room staff performed the latest treatment available, one that only a few community hospitals provide: percutaneous endovascular aneurysm repair (PEVAR).

This minimally invasive procedure, which Dr. Hoenig began offering last year, uses a slim catheter to insert a custom-made stent graft (or fabric tube) within the aneurysm through which blood is safely routed. Only a tiny incision in each groin is required along with light sedation, and patients typically go home the next day pain-free. This is a far different scenario from the traditional, “open” surgical repair that required a one- to two-foot-long incision under general anesthesia, transfusion of blood products and seven days in the hospital, followed by a lengthy rehabilitation with risk for postoperative complications. That major surgery, for which the overall recovery time is three months or longer, is not well tolerated by all patients.

“With PEVAR, on the other hand, there is minimal patient discomfort and far fewer complications,” said Dr. Hoenig, who has performed endovascular aneurysm repairs since 2004.

Following the two-hour surgery, Graham spent two nights in the hospital, due to nausea from the blood that had leaked into his back prior to surgery. He left feeling only mild soreness, with no restrictions on his activity.

“When I got home,” Graham said, “a few visitors told me I didn’t even look like I was sick. But there is no doubt in my mind that I would not be here today without Emerson Hospital and the prayers of friends and family.”

Having beaten a diagnosis that carries a 90 percent mortality rate, Graham said he is dedicated to spending quality time with his wife and planning more of the day trips to Maine and New Hampshire that they enjoy so much. A retired U.S. Marine MedEvac pilot and high school teacher, he is happy now to be “taking it easy and enjoying life.”

Dr. Hoenig said he is proud to be part of the team utilizing a procedure that has truly revolutionized the field of vascular surgery.

“It’s exciting to be able to apply advanced technology to patients at Emerson,” he said.