Spring 2007

Dennis’ Menace

Thoracic Endograft ends 30 Years of Uncertainty and Risk

Dennis Gregory OF Glen Burnie has been living with a tiny time bomb in his chest since being thrown from a car in a horrific accident in 1966. Doctors believe his aorta was injured by a bone fragment from a spine fracture he suffered when he smacked into a guardrail, causing a traumatic thoracic pseudoaneurysm, an injury to the largest artery, deep inside his chest.

Mr. Gregory, shown here with vascular surgeon Dr. Mark Peeler, had no idea he had a condition that put him at minute-by-minute risk of nearly instantaneous death.

But for 10 years, Mr. Gregory had no idea he had a condition that put him at minute-by-minute risk of nearly instantaneous death, if the aneurysm ruptured. He only became aware of the aneurysm in 1976 when he had an X-ray taken for a back injury. “After that, doctors watched me every six months,” Mr. Gregory said. “A doctor at another hospital said if he cut me open, there was a significant danger of paralysis. He thought I might be able to outlive it.”

Half of the people with thoracic abdominal aneurysms have no symptoms. Others may experience pain in the jaw, neck and upper back; chest pain; coughing; hoarseness; or have difficulty breathing. Mr. Gregory had no symptoms.

As recently as 2005, the standards of care available to Mr. Gregory were open surgery or a wait-and-see approach. For the last 30 years his doctors encouraged him not to do any heavy lifting, advice he says he never followed. “I don’t have any sons, so I had to do all the heavy work around the house myself,” jokes the 63-yearold elevator mechanic. “I just decided to live and not worry about it.” But it remained a daily concern for him.

During a checkup with primary care physician Jeffrey Schmidlein, M.D., of Severna Park, Mr. Gregory learned of a relatively new minimally invasive procedure called a thoracic endograft. Dr. Schmidlein referred Mr. Gregory to Mark O’Brien Peeler, M.D., an AAMC vascular surgeon, to discuss this new option.

“Mr. Gregory had a four-centimeter pseudoaneurysm that we’ve been watching for a while,” said Dr. Peeler. “We decided to go forward with the surgery because it started to grow. We didn’t want it to get to the point where he wouldn’t be a good candidate for minimally invasive surgery.”

“I told Dr. Peeler I didn’t want to hold off any longer. I have a wife, a daughter, and two beautiful granddaughters, with a third on the way, to live for,” Mr. Gregory said.

Noting that AAMC “has long been a leader in advancing minimally invasive treatment of vascular diseases,” Dr. Peeler says this technology “opens up a whole new arena where we can take our experience and safely deliver care to patients who have these problems. We have the experience. We’ve been doing minimally invasive procedures safely long before many surrounding hospitals here.”

During the procedure, Dr. Peeler threaded an endoprosthesis or synthetic stent-graft through blood vessels in Mr. Gregory’s groin and into the chest to the site of the aneurysm, where the stent-graft was deployed. The stentgraft allows blood to flow through the aorta without putting pressure on the damaged wall of the aneurysm, keeping the aneurysm from rupturing. Over time, the aneurysm, without the full pressure of arterial bloodflow, will shrink and be less likely to rupture.

After two days in the hospital, Mr. Gregory was home. And back to work two weeks later, his “time bomb” diffused.

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