Alexander Mejia was driving home from work when a hit-and-run-car accident caused life-threatening injuries to his brain and heart. He was transported to Ryder Trauma Center at UM/Jackson Medical Center, where an initial evaluation showed severe damage to the aortic arch just above his heart near all the arteries that supply blood to the brain.
“I remember driving home and having an accident, and after that I remember nothing.” said Mejia, a Miami resident who was 39 at the time of the 2016 accident. “When I woke up in the emergency room, I heard the doctors saying my life was over.”
Fortunately, Mejia received innovative, life-saving treatment from Jorge Rey, M.D., an experienced vascular surgeon with UHealth – the University of Miami Health System, and three years later he is enjoying life with his family.
After seeing Mejia in the trauma center on the day of the accident, Dr. Rey was determined to keep his patient alive. “When I met Alex, he had a rare and critical injury to his thoracic aorta and significant bleeding in his brain,” said Dr. Rey. “He was deemed as either high risk versus not treatable at all because of the severity of both conditions. It was almost impossible to do it the standard way without thinking outside the box. I felt that I could not let him die.”
Working quickly in a life-or-death situation, Dr. Rey led a UHealth vascular surgery team that performed a first-of-its-kind emergency thoracic endovascular aortic repair (TEVAR). To control the bleeding in Mejia’s chest, he had to cover the arteries that feed the brain temporarily while the repair procedure was completed. To do that, Dr. Rey connected a femoral artery from the leg as a temporary bypass to both carotid arteries in the neck. Then he used an endovascular procedure to deliver a standard stent from the groin to the injured aortic arch, at the point where the aorta turns down after leaving the heart.
“The stent was designed to be placed in the artery at a point where there are no branches,” said Dr. Rey. “But in Alex’s case, the aortic artery was damaged right where there were major branches, so simply placing the stent would have closed off the blood flow to the brain.”
After placing the stent over the entire aortic arch, Dr. Rey used a laser catheter to open holes in the device and allow blood to flow to the arteries that feed the brain. He was also able to do the procedures without using blood thinners – another innovative aspect of Mejia’s treatment.
“Our team has deep expertise in doing these kinds of traumatic aorta procedures without blood thinners,” said Dr. Rey. “That’s important, because blood thinners could have made his injuries worse.”
Due to the unusual nature of Mejia’s treatment, Dr. Rey was the lead author of a case report, “Successful Revascularization of Aortic Arch in a 39-Year-Old Blunt Trauma Patient with Acute Diffuse Axonal Injury without the Use of Systemic Anticoagulation,” published May 9, 2017, in the Annals of Vascular Surgery.
In the report, Dr. Rey noted that blunt traumatic aortic injury is the second leading cause of death in trauma patients age 4 to 34, and mortality rates as high as 40 percent have been reported. “Traditionally, on pump, cardiopulmonary bypass with systemic anticoagulation has been used to repair these injuries,” he wrote. “This case demonstrates the viability of a hybrid vascular repair of a complex aortic disruption without the use of systemic anticoagulation. Further research is warranted on whether anticoagulation can be performed in a similar fashion to safely reduce the morbidity and mortality associated with aortic disruptions.”
Thanks to Dr. Rey’s quick thinking, willingness to try an experimental approach and ability to treat highly challenging vascular problems, Mejia got a new lease on life. “When I wake up in the morning and see my daughter, I say ‘thank God’ and ‘thank you Doctor,’” he said. “Without Dr. Rey, I wouldn’t be here today.”