Vascular surgeons save patient’s life after car accident causes aortic arch tear

Debra Reals still remembers lying on a gurney with her father and sister at her side as trauma surgeons explained the emergency procedure they needed to perform to save her life.

Earlier in the evening, Reals had been driving home to Oakley after a nice dinner with friends. As she turned onto Eight Mile Road in Stockton, another car slammed into her vehicle — knocking it into a dry canal.

Reals was airlifted to UC Davis Medical Center, the area’s only level 1 trauma center. She had fractured ribs, a bruised hip and, most critically, a tear in her ascending aorta and aortic arch.

That’s the top part of the main artery carrying blood away from the heart.

“Apparently, my seat belt caused a tear in my aorta,” Reals shared.

Seat belts and airbags save lives. They can prevent most injuries, but sudden deceleration can still cause organ damage or severe injuries like an aortic tear. If not quickly recognized and treated, these injuries can be life-threatening.

Dual branched device deployment

When Reals arrived at UC Davis Health, Andrew Barleben, vascular surgeon and director of the UC Davis Aortic Center, got to work immediately. He consulted the UC Davis Health cardiothoracic team to determine the best way to help her.

Based on Reals’ condition and the location of her injury, the team decided on a novel procedure: an aortic arch repair with dual branched device deployment. 

For the procedure, the stent graft bridges the gap from the tear in the aortic arch. It has only been done a handful of times and had never been done in Northern California. 

“Repairing an injury to the aortic arch presents many challenges due to the size, shape and location of the injury,” Barleben explained. “Current treatment is typically open surgical repair. That requires sternotomy [opening of the chest] and hypothermic circulatory arrest [suspending blood flow under very cold body temperatures]. Despite major advances, open chest surgical aortic arch repairs can have relatively high death and complication rates in traumatic injuries, and for these reasons, many patients aren’t eligible.”

He added, “We are fortunate enough to have a strong cardiothoracic team whom we regularly collaborate with, including in this case.”  

Reals’ repair involved incisions smaller than the width of a finger and took just under two hours. The surgeons accessed her artery at the top of the legs and delivered branch stents through upper extremity artery access to circulate blood to the brain and arms. 

Following the delivery of all the stents, an angiogram showed successful repair of the severe blunt aortic injury. 

“This novel approach is designed to make a minimally invasive repair possible for more patients, while potentially reducing the risks of surgery. It adds to the more standard open and hybrid procedures offered at UC Davis,” Barleben added. “This type of procedure could reduce procedure time and hospital stays, as well as potentially improve outcomes for patients.”

Thankful and recovering

Prior to discharge, an early CT scan revealed significant healing of Reals’ aortic injury. Now, a few weeks after her procedure, she is home and already moving around. Reals still has pain in her ribs and hip and is recovering from her other injuries, but no issues related to the tear in her artery.

“I am just so thankful to UC Davis Health for the care they provided,” Reals reflected.

Despite the novel approach to her surgery, Reals and her family said they never felt nervous or concerned about the procedure. 

“The surgeons were very open about what would happen and provided all the details on why it was necessary,” she shared. “It gave us confidence in their approach and plans for treating my injury.”