With its positive connotation, serendipity, or finding something unexpected while searching for something else, is generally not a word associated with health care. Finding money in your pocket while hunting for your car keys, yes. But when it comes to health, science rules, not chance. Nonetheless, there are times when a diagnosis is made serendipitously.
Consider abdominal aortic aneurysm, or AAA. A bulge that occurs in the large artery that leads from the heart to the lower body, AAA is often detected through an X-ray or CT scan ordered for an unrelated condition. There are generally no noticeable symptoms with AAA, but if the ballooning area grows too large, it can burst and prove fatal.
In June 2019, Peter Steinert, DDS, a Sheboygan dentist, was hospitalized for an E. coli blood infection. Among the routine tests administered during his stay was a CT scan, which revealed the presence of AAA entering into the iliac artery, which is located in the pelvis. The condition was not immediately life-threatening, and Peter required some time to digest this latest bit of medical news.
“I felt like I needed to recover from the infection before I could wrap my head around figuring out how to deal with the aneurysm,” Peter said. “After meeting with a local doctor, I learned that there could be some post-surgical side effects, including erectile dysfunction, incontinence and muscle weakness. I needed to get all the facts.”
Minimally Invasive AAA Repair
When he was ready to move forward, Peter chose the Froedtert & the Medical College of Wisconsin health network. He consulted with Peter Rossi, MD, vascular surgeon and MCW faculty member, at Froedtert Hospital.
“Dr. Rossi walked me through the treatment options and made it really easy for me to process the information and make a decision,” Peter said. “Before I left his office that day, we scheduled surgery.”
Before minimally invasive treatments were available, the primary option for aneurysms was open repair, which involved a large, abdominal incision, a week in the hospital and six weeks to recover. For years, Froedtert & MCW vascular surgery and interventional radiology experts have used endovascular aneurysm repair (EVAR), a minimally invasive procedure in which stent grafts are inserted through the groin and guided by X-ray imaging via a catheter to the location of the aneurysm, where they are released to expand and line the wall of the aorta.
“The difference with the EVAR technique is that we are not removing the aneurysm but simply reinforcing the aorta with a new lining so the aneurysm cannot burst,” Dr. Rossi said.
Dr. Rossi performed Peter’s procedure alongside William Rilling, MD, vascular and interventional radiologist and MCW faculty member.
“Vascular interventional radiologists specialize in using imaging guidance and minimally invasive approaches for multiple disease states and patient populations,” Dr. Rilling said. “This is a complex procedure, which requires advanced endovascular skills from experts working on both the patient’s left and right side. We do this procedure in a state-of-the-art, hybrid operating room/interventional radiology suite with a specialized robotic imaging system that optimizes our visualization and precision during the procedure.”
While an abdominal aortic aneurysm usually presents with no major symptoms, there are risk factors for the disease, including family history, atherosclerosis (hardening of the arteries), peripheral artery disease, high cholesterol, high blood pressure and smoking. Men are more likely to develop abdominal aortic aneurysms than women, and the risk increases with age. Screening is recommended for people over the age of 65 who have any of the risk factors. For eligible patients, Medicare will cover a one-time AAA ultrasound with a referral from a health care provider.
“Finding these aneurysms is important because when they rupture, most people die before ever making it to the hospital,” Dr. Rossi said.
Peter doesn’t smoke, keeps active and, at 55, is relatively young to have experienced AAA. Dr. Rossi considers his a “spontaneous aneurysm.”
Following a night in the hospital, Peter was back home. After taking it easy for a week, he was soon back to his regular routine. Initially, while out for a long walk, he experienced fatigue and noticed what felt like a spasm in his backside.
“That was probably the worst of my side effects and I can still feel that sometimes, but I have to be getting quite a workout,” Peter said. “So I’m back to running and doing everything that I normally did.”
“I think it’s important for patients to understand — and it’s why Dr. Steinert came to Froedtert Hospital — that if you need AAA treatment, you want it done in a hospital that does this procedure often and has excellent results,” Dr. Rossi said.