Ron's Story: Aneurysm Repair

Seventy-seven-year-old Ron Mongeon says he's always enjoyed good health. When he woke up with severe stomach cramps, he knew something wasn’t right. “As the day went on I was feeling worse and worse,” explains Ron. “My wife told me that it was time to go to the emergency room. When you’ve been married as long as I have you listen to your wife!” 

When Ron arrived at an emergency room in western Massachusetts, they discovered that his gallbladder was leaking fluid and he needed emergency surgery. They were able to take care of the gallbladder issue, but during his procedure the surgeon discovered that Ron had an abdominal aortic aneurysm.

As the largest artery, the aorta carries oxygen-rich blood throughout the body from the heart. When it reaches the abdomen, this artery is known as the abdominal aorta, which supplies blood to the lower areas of the body. In the abdomen, the aorta splits into two branches (the iliac arteries) carrying blood into each leg. When an area of the abdominal aorta becomes weak and expands or bulges, it is called an abdominal aortic aneurysm (AAA). Because the aorta is the body’s main supplier of blood, a ruptured abdominal aortic aneurysm can cause life-threatening bleeding. Depending on the size and the growth rate treatment may vary from watchful waiting to emergency surgery.

In Ron’s case it was determined that surgery would be necessary. “I was so surprised to hear about the aneurysm,” says Ron. “I knew it was something I needed to get taken care of and wanted to find the best person for the job.”

With the help of his daughter, Ron found Christopher Kwolek, MD, Chair of the Department of Surgery and Chief of Vascular Surgery at Newton-Wellesley Hospital. A leader in the fields of vascular and endovascular surgery, Dr. Kwolek’s career has focused on improving the minimally invasive treatment of vascular disease. He has been the principal investigator of several pivotal clinical trials and is considered an innovator of new techniques in endovascular surgery.

“We have access to the newest devices available to treat abdominal aortic aneurysms,” says Dr. Kwolek. “We are constantly evaluating the latest options and working to make these advanced tools available to patients here at Newton-Wellesley. Patients have access to an outstanding anesthesia team, specialized nursing care and advanced operating room facilities.”

Dr. Kwolek performs numerous high-level interventional vascular procedures at the Elfers Cardiovascular Center at Newton-Wellesley. The Elfers Cardiovascular Center is a robust, multidisciplinary disease center dedicated to the prevention, early diagnosis, treatment and rehabilitation of patients with cardiovascular disease. It expands the interventional and diagnostic procedures offered at Newton-Wellesley Hospital and provides patients and referring clinicians unparalleled access and customer service. The Center is a clinical collaboration between the Cardiology and Vascular Surgery divisions at Newton-Wellesley and Massachusetts General Hospital and Newton-Wellesley’s Radiology Department.

“We are pleased to be able to provide these new services at Newton-Wellesley,” says George Philippides, MD, Chief of Cardiology at Newton-Wellesley. “Through our collaboration with Mass General, we provide a well-coordinated approach to ongoing care in the community that will require fewer trips downtown to the major academic medical centers, even for emergency care.”

Patients have access to expert medical teams, including cardiologists, vascular surgeons, electrophysiologists and interventional radiologists from both Newton-Wellesley Hospital and Mass General—all in one convenient location, close to home.

When Ron met Dr. Kwolek he knew that he was in good hands. “Dr. Kwolek was so knowledgeable and explained the operation and my condition in a way I could understand,” says Ron. “He is really easy to get along with and I never felt nervous around him, which is saying something when you are talking about having surgery.”

Ron’s surgery was scheduled for May 2 and a quick recovery was very important! “I’ve been a Shriner for more than 10 years with the Melha Temple in Springfield and I’m very active within the organization,” explains Ron. “I lead a percussion ensemble and had a drum presentation scheduled that I didn’t want to miss.”

Ron’s son and grandson were both treated at Shriner’s Hospitals and he has made it his life’s work to give back to the organization. “My percussion ensemble plays many different venues including exhibitions, parades and we’ve even done a USO show at a nightclub! We are a brotherhood and it’s been great to be a part of this group. I knew my surgery couldn’t hold me back from participating in our scheduled events. I chose Newton-Wellesley because they offered a minimally invasive approach with a shorter recovery time.”

Ron’s surgery went very well. Dr. Kwolek was able to repair the aneurysm using a less invasive procedure. Endovascular aneurysm repair (EVAR) is a relatively new procedure that was developed as a less-invasive alternative to open surgery for patients with abdominal aortic aneurysms. Surgeons insert a catheter (a thin, flexible tube) through small incisions in the groin and into the blood vessel to navigate to the weakened area. A man-made fabric tube called a stent graft is then inserted into the artery and positioned inside the aorta.

“This graft seals off the aneurysm, relines the blood vessel and creates a new path for the blood to follow,” says Dr. Kwolek. “Because we use smaller incisions, patients typically have a shorter recovery time, remaining in the Hospital for one day instead of a week to 10 days. They are also able to return to their everyday activities more quickly, usually within two to four weeks instead of three to six months. We are currently able to perform minimally invasive surgery in about seven out of every 10 patients. During the procedure, we use live X-ray images to guide the tube to the aneurysm to strengthen the artery. Both surgical methods are effective in preventing a lifethreatening ruptured aneurysm.”

After surgery, patients return for frequent follow-up visits to ensure that their graft is functioning properly. With the proper diagnosis and treatment, patients with abdominal aortic aneurysms can return to active and healthy lifestyles. The risk of developing an AAA increases with age and is more common in men than women. Some risk factors that can increase the chance of an abdominal aneurysm include:

• Being a male older than 60 years
• Having an immediate relative with an AAA
• High blood pressure
• Smoking
• High-fat diet
• Presence of other aneurysms (behind the knee, in the chest)
• Obesity
• Heart disease
• Hyperlipidemia (high levels of certain fats in the blood)
• Pulmonary disease

“It important that we create awareness about abdominal aneurysms since many patients do not present with symptoms,” says Dr. Kwolek. “At Newton-Wellesley, we have an outstanding vascular team and the technology available to diagnose and treat this condition and allow patients to quickly return to an active lifestyle.”

Ron spent one night in the Hospital and within a couple weeks was back to his every day activities.

“It wasn’t long at all before I was mowing my lawn, washing cars and most importantly, marching in the Shrine parade and leading my drum ensemble,” says Ron. “I had a great experience at Newton-Wellesley and with Dr. Kwolek. I would go back to Newton-Wellesley in a second and I share that with everyone I know!”

Christopher Kwolek, MD

Chair of the Department of Surgery, Newton-Wellesley Hospital

Dr. Kwolek received his medical degree at the University of California, San Francisco Medical School and completed an internship and residency in general surgery at the New England Deaconess Hospital/Harvard Medical School. He completed a clinical fellowship in angioscopy and a research fellowship within the Division of Vascular Surgery at New England Deaconess Hospital/Harvard Medical School followed by a clinical and research fellowship in vascular surgery at MGH. He received additional training in endovascular surgery at the Arizona Heart Institute.

George Philippides, MD

Chief of Cardiology, Newton-Wellesley Hospital

Dr. Philippides received his medical degree from Albert Einstein College of Medicine. He completed his residency at Boston City Hospital followed by a cardiology fellowship and a cardiac catheterization fellowship at Boston Medical Center. He has served as the Director of the Coronary Care Unit at Boston Medical Center and, since 2008, has been the Associate Chair of Clinical Affairs and Chief Quality Officer of the Cardiology Section at Boston Medical Center. Since 2010 he has also been the Medical Director of their Cardiovascular Outpatient Unit.