A ruptured abdominal aortic aneurysm (AAA) is one of the most critical medical emergencies there is, as Eugene Goff of Savannah learned this spring. Statistically speaking, odds were good he wouldn’t see another summer. Instead, the tall, outgoing, white-haired retiree has picked up his life where it was interrupted that day this past March.
“I had been out in the yard just doing some ordinary stuff, and I came in and was getting ready to take a shower,” Goff said, looking back to March 24, which turned out to be a surprisingly eventful day for the retired Hercules employee. “I noticed down in my groin area some swelling and a little bit of pain. I decided against taking a shower after I broke out in a cold sweat.”
Goff spread a big towel out on the bed so that his sudden heavy sweat wouldn’t soak the bedspread and stretched out, but he didn’t feel any better. Fortunately, his wife, Betty, was home and came in to check on him. They decided to call for an ambulance, since Betty thought perhaps her husband had appendicitis. Turns out, that would have actually been good news, compared to what was really happening.
The 86-year-old Goff was suffering from an abdominal aortic aneurysm – a ballooning of the major blood vessel that carries blood from the heart to the lower body. The weakened blood vessel can begin to leak blood or – worst case scenario, as it was with Goff – even rupture, creating an immediate life-threatening emergency. Half of the people who suffer a full-scale ruptured abdominal aortic aneurysm never make it to the hospital; nearly half of those who do still don’t survive.
“He came into the emergency department with abdominal pain and very low blood pressure,” said Anthony Avino, M.D., FACS, a board-certified vascular surgeon with Savannah Vascular and Cardiac Institute, practicing at Memorial University Medical Center. “In the past, we would rush him off to surgery and do a really big open repair of the aneurysm, but now we treat most such ruptures with a minimally invasive approach.” Memorial is the only facility in southeast Georgia with the inventory and dedicated ruptured AAA program in place to treat such aneurysms urgently.
Traditional abdominal aortic aneurysm surgery would have been particularly hard on a man of Goff’s age. Instead, Avino, in conjunction with one of his interventional radiology partners, Kirstin Nelson, M.D., deployed a Gore Excluder Endograft device which was placed into the ruptured segment of his aorta and secured, essentially bridging the blown-out portion of the blood vessel with a stent. Instead of the gaping surgical incision of the previous technology, Goff wound up with only two small incisions in his groin.
Goff lost eight units of blood in the incident when his blood leaked outside his artery into his belly. But, since his sudden illness back in March, he’s back to his routine and the same activity level as before.
Who is at risk of developing an abdominal aortic aneurysm? A family history of aneurysms is among the strongest risk factors, Avino said, along with a significant history of smoking or high blood pressure. The risks correlate very strongly with increasing age, and even with risk factors, screenings aren’t considered necessary until a person reaches at least age 50, the surgeon pointed out. The condition itself presents no symptoms unless it begins to leak or rupture, he said, and many cases are discovered incidentally when people undergo scans or tests for other medical reasons. The condition is most common among men, but is not rare among women, either, he said.