Back from the Brink
When stabbing pain caused him to collapse while on the phone with a friend, Fred Salo says he somehow knew he was dying.
The 62-year-old retiree and lifelong musician was pale, couldn't breathe and could hardly speak. The frenzied barking of his dogs alerted his wife Bobbie, who called 911. The paramedics struggled to find his blood pressure and pulse.
Although he didn't know it at the time, Salo was suffering from one of the most life-threatening medical conditions there is – a ruptured abdominal aortic aneurysm, or AAA. As he lay in the ambulance, all he could think was "hurry...hurry..."
An aneurysm is an abnormal bulge in the wall of an artery, usually where a weak area has developed. Although aneurysms can form in any blood vessel, they occur most commonly in the aorta. The aorta is the largest artery in the body, and carries blood from the heart to the rest of the body. Aortic aneurysms can occur where the aorta passes through the abdomen or, less commonly, where it passes through the chest cavity.
The most common causes of aortic aneurysms are smoking or family history, or a combination of both.
The larger the aneurysm, the greater the danger it will rupture and cause internal bleeding. The vast majority of those who undergo a rupture like Salo's die – nearly 15,000 people per year in the U.S.
Northwest Hospital & Medical Center emergency physician and chief medical officer Dr. Gregory Schroedl was in the ER and got the call from the paramedics. He instructed them to bring Salo to Northwest Hospital. While many AAA patients go to a trauma center, Dr. Schroedl knew Salo needed immediate help and wouldn't survive the longer trip to another hospital. It would take Northwest Hospital's expert emergency and cardiovascular care to save his life.
Before Salo even got to the hospital, Dr. Schroedl had called in vascular surgeon, Dr. Benjamin Lerner. A vascular surgeon is a specialist who deals with both chronic and acute blood vessel conditions, ranging from simpler things like clots, varicose veins and chronic wound care, to complex conditions like carotid artery disease and aneurysms.
"Mr. Salo had the classic symptoms of a ruptured AAA, including low blood pressure and acute back pain," says Dr. Lerner, who saw Salo when he arrived in the emergency room.
"Dr. Lerner was so calm and he gave me so much peace," says Salo. He explained what would happen. I wanted it straight from the hip, and I appreciated his professionalism and frankness. But the way he said things was gentle and positive. He has a gentle spirit."
Time was of the essence. Salo was immediately taken for a CT scan to confirm the diagnosis and then taken for surgery. As he was wheeled into the operating room, he held his son's hand and told him that if he didn't make it, he was confident his son could be the man of the family.
Traditional surgery for repairing ruptured aneurysms is invasive, requires a large incision and is traumatic to an already shocked system. Dr. Lerner, who completed a full endovascular fellowship, is highly skilled in using newer, minimally-invasive techniques to work within blood vessels to repair problems that would have once required traditional surgery.
In Salo's case, he used a procedure called endovascular aneurysm repair (EVAR). Through a tiny incision in the groin, Dr. Lerner guided a catheter wire up the aorta, securing a stent, or tube, that replaced the vessel walls and acted as a new conduit for blood flow.
EVAR is most often used to repair aneurysms before they rupture, but Dr. Lerner is experienced in using them to repair ruptures as well. "EVAR has not been used in ruptures for very long, but we're getting much better at it as we use it more often. If you can do it, it's so much better for the patient's outcome," he says. "Patients perform better and the risk of death post-surgery is much lower compared to traditional procedures."
"There are so many exciting new technologies and techniques in vascular surgery that we have in our toolbox now," says Dr. Lerner. "Even 10 years ago, Mr. Salo would have gotten a very different surgery and his risk of death would have been much higher."
Dr. Lerner says repairing a ruptured aneurysm takes a highly skilled surgical team, working smoothly together. "We had at least 15 people on the team, and it was extremely delicate," he says. "I was very proud of everyone because this is as critical as it gets and they were all at the top of their game. Everything just came together like it was supposed to."
Salo believes it was all divine intervention. "I heard they almost lost me during surgery, and I actually had a near-death experience," he says. Salo remembers seeing his parents, who were young and walking hand in hand. Just before embracing him, they turned and walked away instead. "When I woke up," Salo says, "I told my wife, 'the light didn't want me yet.'"
Salo's recovery was more rapid than anyone could imagine. He went home after only five days in the hospital. "Everyone said it was a miracle," he says. "I could have lost the use of my legs, I could have been on dialysis, I could have died. But none of those things happened."
According to Salo, Northwest Hospital is his favorite place to go when he's sick. "There's a bedside manner there that you don't see anywhere else, and I've been a lot of places," he says. "Laughter is a great part of healing, and whenever anyone came into my room, there was always laughter. My treatment was superlative."
Dr. Lerner says the important thing to learn from Salo's case is to be aware of the causes of aneurysm and get screened if you're at risk. About 90 percent of aneurysms are currently discovered by accident, when a physician is testing for other conditions. "Northwest Hospital has worked hard to develop a program to screen and monitor aneurysms," he says. "If you've been a long-term smoker or have a family history, the simplest first test is an ultrasound."
Screening for patients who are identified as high-risk begins in their mid-sixties. "Aneurysms can be monitored and fixed before they rupture. These are preventable deaths," says Dr. Lerner.
Today, Salo is writing, walking and losing weight. A professional songwriter, he has even written songs about his experience. He and his wife volunteer at a local skilled nursing facility and often come to Northwest Hospital to comfort residents when they are hospitalized. "It just feels like something I'm supposed to do," he says. "I feel the need to share my story to give others hope. After you almost die, you become a believer."
For more information on aneurysm screening and vascular services at Northwest Hospital & Medical Center, contact Dr. Lerner's office at (206) 368-1070 or visit seattlepacificsurgeons.com.