“When Dr. Wang explained the surgery to me, it was the first time I didn't have any questions. All I wanted to know was, 'when can we do it?'”
A Lifesaving Repair Without a Single Incision
Since having an abdominal aortic aneurysm repaired in 2007, James "Jim Bob" Golden has always had an annual physical to check his heart and vascular health. "But last year, I decided I was going to skip it because nothing ever changes," he says.
Jim Bob's wife wouldn't hear it: she could tell her husband of 46 years wasn't himself lately. His stamina was waning, and the 73-year-old had pulled back from much of his philanthropy, which represented a significant part of his life.
During the physical, Jim Bob's doctor detected a life-threatening problem: a new aneurysm had developed on another part of his aorta. More specifically, it was a thoracoabdominal aortic aneurysm, a bulging in the aorta that extends from the chest to the abdomen and is often one of the most complex aortic aneurysms to treat due to its location. This type of aneurysm involves the part of the aorta where important branches originate to supply blood to the abdominal organs. Treating it would require an invasive surgery and a lengthy recovery period.
There was a potential alternative, though, that his doctor was just learning about. Jim Bob was referred to Grace Wang, MD, MSCE, FACS, a vascular surgeon and director of the vascular lab at the Hospital of the University of Pennsylvania, to see if he was a candidate.
A Revolutionary Solution
Endovascular aneurysm repair has been around for a long time, but it's usually used to treat simple aortic aneurysms. Complex aortic aneurysms that involve critical branches of the aorta that need to be preserved – like Jim Bob's – are more challenging to repair.
But a clinical trial led by Darren B. Schneider, MD, chief of Vascular Surgery and Endovascular Therapy for Penn Medicine, is using minimally invasive techniques to fix complex aortic aneurysms by threading a specially designed stent graft through an artery in the groin or arm – all without any incisions.
The stent graft is a fabric tube reinforced by metal mesh that, once it's expanded in the weakened segment of the aorta, provides a stable channel for blood flow, preventing the aneurysm from rupturing. The trial uses special branched and fenestrated stent grafts that have branches or holes designed to be connected with the branches of the aorta to provide essential blood flow to the abdominal organs.
And the recovery time is shorter: less than a month compared to the usual six to 12 months of recovery after a traditional open surgery.
Currently, there are only 10 investigators, including Dr. Schneider, at 10 centers around the country using this technology, which is not yet commercially available. Penn Medicine is the only site testing it the Mid-Atlantic region.
When Can We Do It?
"When Dr. Wang explained the surgery to me, it was the first time I didn't have any questions. All I wanted to know was, 'when can we do it?'" Jim Bob says.
On January 27, he became one of the first patients at Penn Medicine to undergo this new procedure. He was home from the hospital five days later. The recovery time was remarkable to Jim Bob, who worked as a pipe-fitter for almost three decades and has undergone numerous surgeries on his hands, feet, knees, and shoulders.
For Jim Bob's procedure, Dr. Schneider custom-designed a fenestrated stent graft that extends beyond Jim Bob's original stent, creating better seals at the top and bottom. The holes are there to maintain blood flow to the vessels that branch off the aorta. Commercially available stent grafts can't accommodate the branch vessels, according to Dr. Schneider.
"This is the future," he says of the treatment.
The technology is already commercially available outside of the United States, and in those places, "it's become the dominant form of treatment," Dr. Schneider explains. "It's clear the outcomes are far superior to traditional surgery. So it's not a matter of if, but when, this technology replaces traditional surgery for patients who are candidates."
He estimates it could be five years before the stent grafts, currently made by two companies in the US, receive approval from the Food and Drug Administration. Until then, he plans to continue offering the minimally invasive procedure on a trial basis.
On the Road Again
A devout Christian, Jim Bob filled his post-retirement time with philanthropy. Even before retiring, Jim Bob had helped found the Motorcycle Accident Victims Association: a nonprofit that helps affected families with household and insurance bills.
Since 2013, he's organized an annual clothing drive for the homeless around Christmas. He's also actively involved with the Christian Motorcyclists Association, which marries two of his greatest passions: volunteering and riding motorcycles.
While Jim Bob's heart health never forced him to give these activities up, he did withdraw to a great extent when he didn't have the energy.
That's changed since his surgery. "My energy level has been way up since then," he says. "I'm back to doing everything I was doing before and then some."
On the first spring-like day in April this year, Jim Bob climbed onto his motorcycle for the first time since his surgery. The moment overwhelmed him with gratitude – before his time at Penn, he hadn't been sure when he would be able to ride again.