Quick Action by Doctor Saves a Life:
Beating the Odds with Life-Saving Vascular Operation

Long-time Palo Alto Medical Foundation (PAMF) patient Jim Black, 73, takes good care of himself—keeping his weight stable, staying in shape and getting regular physicals. He leads an active life, which includes taking regular fishing trips to remote parts of Mexico. His health has been something he could rely on, until one Friday when his health took a dramatic turn for the worse.

"My first symptom was a tremendous fainting spell, and I literally collapsed on the floor,” said Jim. “I was able to reach a telephone and call 911. That triggered the entire response from paramedics to the hospital and to Dr. Robert Mitchell, to whom I owe my life.”

Jim woke up three and a half days later in intensive care. It turns out that he had an undetected abdominal aortic aneurysm, a bulge in a section of the aorta, the body’s main artery. The aneurysm had ruptured, a condition that is fatal 70 to 80 percent of the time. The fact that his aneurysm went undetected is common: aortic aneurysms usually have no symptoms: doctors find them while performing tests for other conditions.

PAMF surgeon Dr. Mitchell met the ambulance at the local hospital. With ruptured aneurysms, the only chance of survival is to repair the aneurysm without delay. Fortunately, Dr. Mitchell suspected Jim had an aortic aneurysm and took him right from the ambulance to operating room to repair it. He spent six hours on the operating table, had 25 units of blood and fluids transfused, and had his blood pressure dropped to zero at least twice.

"Dr. Mitchell told my family I had a 50/50 chance of reaching the hospital alive, a 10 percent chance surviving after the operation," said Jim. "He then said I had a 50/50 chance of making it through the night, and finally a 50 percent chance of getting out of intensive care with my organs intact and functioning."

After the surgery, Jim found out he’d probably had the aneurysm for at least eight years. The exact cause of aortic aneurysms is unclear, but the risk factors include:

• Hardening of the arteries (arteriosclerosis/atherosclerosis)
• Genetics
• Aging
• Infections
• Injury to the chest or abdomen
• Inflammation

Since he didn’t have arteriosclerosis, hadn’t suffered an injury, and didn’t have a genetic predisposition to aneurysms, Dr. Mitchell suspected Jim might have picked up an infection during one of his Mexican fishing trips. Based on this, infectious disease specialist Dr. Carol Kemper ran tests to see if he had picked up an infectious disease. They all came back negative.

Jim was discharged with a clean bill of health. Among his friends and neighbors, however, his has become a cautionary tale. “My friend had the scan,” said Jim. “They found a small aneurism and operated on it. In his case, it was two incisions in his thigh.” In Jim’s case, his incision runs the length of his abdomen.

How do you know if you have an aneurysm? The best way to detect one is with an abdominal aortic ultrasound. According to Tej Singh, M.D., a vascular and endovascular surgeon and director of the Vascular Surgery, Mountain View Center, abdominal aortic aneurysm (AAA) screening lowers the death rate in the at-risk population by as much as 50 percent.

Who should undergo screening? Men and women over 60 years old who have these risk factors:

• A history of smoking (more than 100 cigarettes in their life especially heavy smokers)
• Diabetes
• Cardiovascular disease (high cholesterol, heart problems, stroke history, high blood pressure)
• Obesity
• Family history of AAA

"Four years ago, we set the goal of creating a center of excellence unrivaled on the Peninsula in both state-of-the-art services and compassion,” said Dr. Singh. “Positive results like Mr. Black’s reflect our commitment and success in improved outcomes for our patients. Our continued goal for all of the cases and categories of care is to persistently investigate what can be done to improve the outcomes. This is very important for future patient care and quality."