Aortic endograft infection initiates life-saving surgery


Jack and Debbie Sargent.  His UCHealth photo by Cyrus McCrimmon.
Jack and Debbie Sargent at their home in Denver. Jack underwent complex surgery to replace his abdominal aorta. Photo by Cyrus McCrimmon for UCHealth.

Fixing a fix is ​​often much more complicated than the original fix. That was exactly the case with Jack Sargent.

Sargent, 73, was enjoying an active retirement playing golf and spending time with his wife, Debbie, when a routine checkup at a local hospital revealed an abdominal aortic aneurysm in 2016. From the heart, it descends between the kidneys and branches around the navel to the iliac arteries that supply blood to the legs. AAA is often asymptomatic until it ruptures, at which point the chance of surviving to hospital is about 2 in 10.

The main AAA treatment involves inserting a wire-reinforced plastic sleeve (called an endograft) into the balloon portion of the aorta. This is done using a catheter inserted into one of the iliac arteries near the groin. This procedure is called endovascular aneurysm repair (EVAR). Blood then flows through the graft, relieving pressure in the dilated aorta.

Sargent had an endograft and spent three years playing golf and spending time with Debbie as before. But on July 2, 2019, Sargent fell ill while preparing for his usual Fourth of July picnic and parade. Debbie found him unconscious on the floor of the master bathroom. Paramedics took his blood pressure, which was about half normal and had a fever of 105 degrees. They rushed him to the University of California, Colorado Health College Hospital on the Anschutz Medical Campus.

Best place for heart care

Dr. Max Wallauer, a vascular surgeon at the University of Colorado School of Medicine, was waiting at UCH that day. CT scans, blood work, and other tests showed that Sargent’s graft had become infected (a rare case that probably occurs once every 1,000 EVAR procedures) and that the infection had reached his bloodstream. Suspicion confirmed. That is sepsis, a deadly threat.

Over the next few days, the UHealth team’s goal was to control Sargent’s sepsis until surgery was possible.Dr. Molly Eaton, an infectious disease specialist at the University of California School of Medicine, said the culprit was Bacteroides fragilisis an anaerobic worm commonly found in the lower gastrointestinal tract.

A rare infection led to Jack Sargent undergoing complex vascular surgery.  His UCHealth photo by Cyrus McCrimmon.
Jack Sargent after abdominal aortic replacement surgery. Photo courtesy of Cyrus McCrimmon, courtesy of UCHealth.

Antibiotics worked, but the source of infection had to be removed. If not, the aorta will eventually become infected and rupture, especially with: bacteroidesHe was therefore at risk of dying from an aneurysm rupture or sepsis. ”

EVAR-related infections are rare, but UCH is an aortic referral center, and doctors there probably treat more infections than any other hospital in the area, Wallauer said. Such care requires a multidisciplinary team. Sargent’s care includes a vascular surgical team including Wallauer, Eaton, and other infectious disease specialists, intensivists, critical care physicians, hospital physicians, gastroenterologists, not to mention nurses, medical Technician, case manager, respiratory therapist, nutritionist.

replace part of the aorta

On July 12, Dr. Wallauer operated on Sargent, removing the heavily infected endograft and surrounding tissue, and replacing a four-inch section of the aorta with one from a cadaveric donor. Surgery took up a good portion of my day. When that was done, Dr. Wallauer came out into the waiting room where Debbie, her son Aaron Sargent, and Debbie’s sister were waiting.

“Would you like to meet Jack?” he asked.

The family followed the surgeon to the ICU, where various lines and ventilators saved the surgeon’s life. He was swollen and his blood pressure was still low. Debbie had planned to spend another night in the hospital, but her nurses advised her to go home and rest.

“One of us is going to stay with him all night,” one told her. “Jack needs you in the morning.”

Jack and Debbie take a walk on the golf course near their house.  His UCHealth photo by Cyrus McCrimmon.
Jack and Debbie Sargent near their home. Photo courtesy of Cyrus McCrimmon, courtesy of UCHealth.

Four days later, Jack was transferred to a lower unit. There, in the days that followed, Debbie and paramedic technician Aaron proved so adept at keeping his stapled surgical incision clean that the UHCealth team returned to the hospital a few days later. We were able to discharge him in peace on his July 22nd. Patio to watch the golfers on the green behind the house.

He and Debbie returned to UCH every day for several weeks. Sargent was put on an antibiotic drip to prevent the infection from returning. I was still in a wheelchair for the first few weeks. “Everyone there started clapping and cheering,” Debbie said when she walked into a room with a walker one day.

I will pay you in advance as a thank you for your help.

A year after her surgery, Debbie took a picture of her and her husband in their backyard with the golf course in the background. They framed it and gave it to Wallauer, who hung it up in his office.

Since Jack’s recovery, the Sargent family has added volunteer work to the Colorado Children’s Hospital on the Anschutz Medical Campus. They spend hours in the surgery waiting room every Tuesday and Thursday. This is their way of paying for treatment at UCHealth, Sargent said.

Jack and Debbie Sargent and Dr. Max Wallauer.Photo courtesy of Jack Sargent and Debbie Sargent
Jack and Debbie Sargent and Dr. Max Wallauer.Photo courtesy of Jack Sargent and Debbie Sargent

“That hospital is amazing, and those people are saving lives every day,” he said. “It was just amazing. It’s kind of emotional just sitting here talking about it and remembering some of the things they did.”

Debbie said she wrote down the names of people she wanted to thank one day, from domestic staff, nurses, residents, medical technicians, and doctors, until she lost track of them.

“I would like to sincerely thank all these people,” she said. “The teamwork, the camaraderie, and the skill sets they have, in my opinion, they are all miracle workers.”



Source link

Leave a Reply

Your email address will not be published. Required fields are marked *