New aneurysm repair procedure cuts recovery time

Lt. Col. (Dr.) Todd Rasmussen (left) and Dr. Maureen Sheehan watch Rob Gonzalez respond to a question at a news conference at University Hospital recently. The vascular surgeons performed the first use of a thoracic aortic stent in San Antonio. (U.S. Air Force photo by Dewey Mitchell)

By Dewey Mitchell
Wilford Hall Medical Center Public Affairs

LACKLAND AIR FORCE BASE, Texas -- San Antonio fireman Rob Gonzalez was struck by an SUV while riding his motorcycle in late June, then was run over by the same vehicle.

Normally assigned to the rescue team, this time it was Gonzalez’s turn to be rescued. His severe injuries brought him to the Trauma Center at Wilford Hall Medical Center, where he would spend the next 33 days recovering.

His injuries included a broken leg, broken ribs, bruised lung and a severe concussion, according to Lt. Col. (Dr.) Todd Rasmussen, chief of vascular surgery at Wilford Hall.

It was two months after the accident, when Gonzalez faced his final major hurdle to a complete recovery, a torn thoracic aorta, which is one of the major arteries pumping blood out of the heart to the lower extremities. Caused by the traumatic accident, a tear in the lining of the blood vessel allowed blood to pool and formed a bubble that could have ruptured.

The standard procedure would have required opening the chest and sewing in a new prosthetic graft, resulting in a lengthy hospital stay and recovery period.

But a new stent device approved by the Food and Drug Administration in March and a collaborative approach by Wilford Hall, University Hospital and the University of Texas Health Science Center is leading to a much quicker recovery by the young firefighter.

The 90-minute procedure was performed Aug. 22 at University Hospital by Rasmussen and Dr. Maureen Sheehan, assistant professor of surgery at UTHSC. Sheehan had recently arrived from the University of Pittsburgh, where she had learned the new procedure while in a vascular surgery fellowship there.

“The new catheter-based technologies allow us to go up inside the aorta and place this covered self-expanding stent, which is squeezed down to the size of a pencil,” Rasmussen said.

“When we get it perfectly placed, it pops out to the size of the aorta, sealing it and allowing it to heal. It is meant to be there forever.”

“The remarkable thing about the technology is how minimally invasive it is,” he said. “The patient had a small incision in the right groin to place the stent and a small puncture in the left groin to insert a catheter for angiography.”

With this procedure marking the first time it has been performed in San Antonio, Rasmussen believes the group’s expertise also is now able to offer treatment of aortic aneurysm disease related to aging and atherosclerosis. “The new surgeons not only augment the trauma system in San Antonio, but can treat the elderly who before might have died of a ruptured aortic aneurysm within six months of detection.”

Having served at the Air Force hospital in Balad, Iraq, earlier this year, Rasmussen said his goal is to take parts of this technology to the in-theater management of wartime vascular injury.

“We are more likely to succeed if we grow in an academic vascular surgery practice such as has been established here in San Antonio.”

As for Gonzalez, he and his wife, Jenia, are thankful for a much quicker recovery time.

Jenia Gonzalez paid high praise to the nurses and technicians in the Wilford Hall Intensive Care Unit.

"The staff there was awesome, trying to keep me sane, trying to be sympathetic and giving me any information I needed. I would love to thank them all by name; I could name a few, but I wouldn’t want to leave anyone out,” she said.

(Mr. Will Sansom, Office of External Affairs, University of Texas Health Science Center, contributed to the writing of this story)