“It can save your life,” says Patrick Donovan.
By Rita Ross
As seen in the January/February 2020 Issue of Advancing Care
Patrick Donovan went to his doctor one day to check out what he assumed was just a minor chest cold.
“I didn’t think it was anything serious,” says Donovan, who lives in Cold Spring. “I keep active, and I’ve gone swimming nearly every day for 40 years, so I didn’t think much of it.”
On that day, about eight years ago, his primary care doctor initially recommended an X-ray for Donovan, who is now in his 70s. Afterward, she also suggested a CT scan “to make sure I didn’t have a hernia or anything,” he recalls.
A few days later, he got a call from the doctor. “The results showed an enlargement in my abdomen,” Donovan says. “It turned out to be a weakening in the aorta, the large artery that carries blood from the heart to the rest of the body.”
Known as an abdominal aortic aneurysm, this condition occurs when a weakness develops in a portion of the wall of the aorta, causing the wall to enlarge.
“Abdominal aortic aneurysms aren’t too common; there’s about a 4 percent to 9 percent occurrence rate in patients, usually over age 60,” says Joseph Fulton, MD, Chief of Vascular Surgery at MidHudson Regional Hospital in Poughkeepsie. “The condition is found most commonly in males with a history of smoking, or those with a first-degree relative who has also been diagnosed.”
Donovan was referred to Jayesh Modi, MD, a vascular surgeon at MidHudson Regional Hospital.
Since Donovan’s aneurysm was small, he didn’t have any pain, and he was in overall good health, the recommended course of action was to hold off on immediate surgery, while monitoring to ensure continued cessation of smoking and optimal blood pressure control.
“Naturally, I was worried about the aneurysm,” says Donovan. “But Dr. Modi calmed me down and told me that in my case, all that was needed at that point was to monitor it.”
Says Dr. Modi: “Patients may think they have a ticking time bomb and want it fixed right away. But in a case like Patrick’s, the aneurysms are often small when diagnosed, and we may not perform an immediate procedure. But we will carefully monitor them. In the meantime, we urge patients to relax and get on with their life.”
Dr. Modi ordered a follow-up abdominal ultrasound to be done approximately every six months.
“For a long time, the aneurysm stayed stable in size,” said Donovan. “Then, over several years, it gradually enlarged.”
After Donovan’s ultrasound in October 2018, Dr. Modi determined that the aneurysm had enlarged to a point where treatment was recommended.
Physicians generally opt for either open surgery, or a less-invasive treatment known as an endovascular aneurysm repair, or EVAR, which was deemed the best choice in Donovan’s case.
“These have been performed for about two decades,” says Dr. Modi. “Nowadays, it’s a relatively common, tried-and-true procedure.”
During an EVAR, a long, tiny catheter tube is inserted through a small incision in the groin and threaded into the aorta.
The catheter carries an expandable stent graft that the surgeon guides into place and attaches along the wall of the aorta. This reinforces the artery’s weak spots and helps keep the damaged area from rupturing. The catheter is then gently removed.
Donovan’s procedure, performed by Dr. Modi and Dr. Fulton in January 2019, took about an hour and a half, followed by an overnight hospital stay. “Eventually it will likely become an outpatient procedure,” says Dr. Fulton.
“The whole process is remarkable,” adds Donovan, a married Navy veteran, the father of two grown sons and grandfather of two. “I said to the doctors afterward, ‘I don’t see how you do things like this!’”
“But it’s like a car — an old engine hose will gradually weaken and start to balloon; when a new one is installed, it’s the proper size and fits better,” says Donovan.
Although few people have heard of aortic aneurysms, Dr. Modi says, “Certain people are at higher risk and should be screened, just like it’s suggested that women get annual mammograms after a certain age.”
He emphasizes that male smokers over 65 and anyone with high blood pressure should speak with a doctor about possible screening. The U.S. Preventive Services Task Force recommends one-time screening for abdominal aortic aneurysm for men ages 65-75 who have ever smoked.*
Today, Donovan says he feels terrific. Shortly after the procedure, as soon as his small incision healed, he was back to enjoying his favorite sport.
“I swim at All Sport Health & Fitness Center in Fishkill nearly every day; I usually do about half a mile, for about 45 minutes,” he says.
Donovan’s eight-year medical journey inspires him to encourage others to heed their doctor’s advice.
“If they tell you to follow up on something, just do it! At first you may not want to keep going back for tests, but it’s important,” he says. “It can save your life.”
*Check with your insurance provider for screening coverage details.
Visit us at MidHudson Regional Hospital, a member of Westchester Medical Center Health Network, to learn more. Advancing Care. Here.
Photo by John Halpern