Back in the swing

Rey Buack is one of the lucky 10 percent of patients who survive a ruptured abdominal aortic aneurysm

His beloved Lakers were up nine points on June 8 when Rey Buack stood up from his couch to stretch. Out of nowhere, the 58-year-old start-up company executive was felled by excruciating stomach pain as the second quarter began.

“Something is ripping my stomach,” Buack shouted to his wife, Shirdellah. “Call 911!”

Paramedics arrived at his Yorba Linda home within five minutes. On the way to the nearest hospital, Buack kept urging them to drive faster. From the first, the emergency room physician at the community hospital suspected a rupture of the aorta, the body’s largest artery.

“The doctor said, ‘I think I know what it is, but let’s get him a CT scan and let’s get ahold of UC Irvine Medical Center,'" Buack recalls. The scan confirmed a ruptured aortic aneurysm, as did a glance at his darkening abdomen, which had ballooned with pooling blood.

“An aortic aneurysm is a silent killer,” says UC Irvine surgeon Dr. John S. Lane, who specializes in vascular and endovascular surgery. “Once you’ve ruptured, about 90 percent of the time it’s fatal when it happens outside of a medical setting.”

Yet 32 days later, Buack was back on the golf course, thanks to the stent Lane quickly implanted to patch his patient’s torn blood vessel with minimally invasive surgery. “With all the delays enroute to UC Irvine Medical Center, they were still able to save me,” he says of Lane and the cardiovascular surgical team that treated him.

Lane also was riveted to game three of the NBA finals when he got the call about Buack and quickly determined that the patient was stable enough to make the 10-mile ambulance ride to UC Irvine Medical Center in Orange.

“It’s a credit to our clinical team that there was no further delay—he went straight up to the operating room where everybody was ready and waiting,” says Lane, who arrived in UC Irvine Douglas Hospital’s state-of-the-art surgical suite at the same moment.

While the surgical team quickly connected the necessary lines and monitors, Lane checked the CT scan and Buack’s vitals. He decided that the patient was strong enough and the rupture was in an optimal spot to insert a stent graft through the femoral artery in his groin.

Before such minimally invasive techniques were perfected, repairing abdominal aortic aneurysms involved major surgery and a long incision down the abdomen, opening the area to infection as well as risking a deadly loss of blood pressure. Patients could count on lengthy hospital stays, considerable pain and many weeks of recuperation. But community hospitals rarely have an on-call cardiovascular surgeon skilled in the minimally invasive procedures, which have proven safer for patients with abdominal aortic aneurysms.

“Open abdominal surgery has a 50 percent chance of mortality because you have a hole in a major blood vessel,” says Lane, who performs at least 50 such repairs each year. “If you open the containment area, his blood pressure drops and his organs fail. We’ve found that mortality is much less, down to an order of 15 percent, with minimally invasive procedures.”

Many local hospitals also cannot afford to stock expensive stent grafts in a variety of sizes, especially one long enough to close the more than three-inch tear in Buack’s blood vessel. His stent graft is a wire cage made of a titanium alloy and sheathed in a fabric that protects the lining of the aorta. It resembles a pair of pants that, once expanded to snugly fit the aorta, directs blood through the “waist” segment above the rupture and down through its two legs, which feed into each femoral artery, Lane says.

After the stent surgery, which took 90 minutes instead of an expected five hours, Buack was wheeled to the intensive care unit where doctors and nurses watched for possible leaks at the stent site and to ensure that his body would begin reabsorbing the roughly nine units of blood that had pooled in his torso and thighs.

When Buack was discharged nine days later, directly from the intensive care unit, “I had a 44-inch waist—it’s normally 33,” he says. “I was purple and black all over, like I’d been pummeled. But my kidneys and organs were all functioning well, and because I had no underlying disease, my prognosis is real good. They tell me my stent will outlast me!”

“His life expectancy is back to what it was before the aneurysm,” agrees Lane, who says his patient is recovering so well that a second postoperative scan was scheduled in six months instead of three. 

Buack is rebuilding his strength on the links and trying out various techniques to channel stress before he returns to his start-up software venture in Irvine. He’s back to his normal pant size and he cherishes the really important things: his wife and their three grown daughters, all of whom came to be with him during his hospitalization and the early weeks of his recovery at home.

Most of all, Buack is grateful to Lane and the entire hospital team. “I can’t say enough about the excellence of the medical staff and the facilities at UC Irvine. They even allow family to stay with you in the intensive care unit. I’ve never seen that before.”