First-Ever Aortic Procedure Performed at LRMC Published May 9, 2011 By Chuck Roberts Landstuhl Regional Medical Center Public Affairs LANDSTUHL REGIONAL MEDICAL CENTER, Germany -- The international and collaborative nature of medicine at Landstuhl Regional Medical Center resulted in a first-ever procedure that also prevented the need for open heart-bypass surgery on April 1. Dr. Paul B. Haser, a vascular surgeon from the University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School, repaired a hole in the aorta of a patient injured in a training incident by inserting a wire through the groin area, threading it through his body to the aorta just outside his heart, and inserting an aortic graft to cover the hole. The incident began in Africa where a metal fragment entered the back of the patient and led to his medical evacuation to LRMC where a CAT Scan revealed a blood clot in the aorta. However, LRMC doctors were uncertain how the metal fragment travelled to the opposite side of the body from where it entered the body, so the patient was sent to a German hospital in Homburg that LRMC partners with for cases requiring specialized care not available at LRMC. Doctors at Homburg advised against immediate surgery and recommended placing the patient under observation. The patient was placed on blood thinner because of concern the clot might travel to the kidneys, intestine or other sites causing injury. As a result, the clot disappeared but revealed a hole in the aorta. The wound did not present an urgent life-threatening situation to the patient, but it presented the LRMC staff with three basic choices, said Air Force Lt. Col. (Dr.) Raymond Fang, LRMC Trauma Medical Director. Because LRMC serves as the evacuation center for all servicemembers injured in Afghanistan and Iraq, the medical evacuation process is designed for patient stays of an average of three to five days or until the patient is stable enough for a medical flight to the U.S. Fang said that this option was ruled out because doctors felt wary of placing the patient on an aircraft where emergency hospital resources would be unavailable for the duration of flight should a rapidly life-threatening complication develop. The second option was open chest surgery but Fang said that because of the location of the injury, it could have unnecessarily placed the patient at risk for potential paralysis or circulatory arrest. "The injury wasn't so bad, but getting to the location of that hole meant having to move mountains," said Fang. The third option did not exist at LRMC until the arrival of Haser for a two-week stint as part of the Society for Vascular Surgery's Visiting Vascular Surgeon Program. A requirement doesn't currently exist for a full-time military vascular surgeon at LRMC, so stateside civilian surgeons voluntarily serve at LRMC during times of need. "If it weren't for our Visiting Vascular Surgeon Program, it wouldn't have been an option at all," Fang said. And not only did Haser possess the skill for the procedure, but he also knew the contacts for the German companies to access the necessary surgical supplies. Haser said the endovascular aortic graft implantation procedure has been around for about a decade, but that it is primarily performed in the civilian setting for the treatment of disease such as aortic aneurysms and injuries such as an aortic tear sustained in vehicle accident. It is an uncommon procedure for penetrating injuries and it was a first for Haser. With the assistance of two LRMC physicians, Haser said the two-hour procedure proceeded uneventfully. The patient was medically evacuated a few days later to the U.S. where his is expected to make a full recovery. The patient, Haser said, expressed a clear desire for the internal procedure versus open surgery. As a result of the shared experience, LRMC will keep supplies available in case the procedure should be required on an emergency basis in the future. The procedure was a first for LRMC as well as for Haser, but it wasn't the first time for the surgeon to practice medicine at LRMC. He served a similar two-week stint two years ago. Although a veteran surgeon, Haser describes LRMC as a "learning experience" where he said the level of trauma far exceeds the amount and severity seen at stateside civilian hospitals. And because of the continued experience in treating battle wounds such as severe chest and lung injuries, military trauma medicine is able to provide lifesaving care to Wounded Warriors not found in many civilian hospitals. LRMC is the largest American hospital outside of the United States and the only American College of Surgeons verified Level II Trauma Center overseas. It is only one of two medical facilities in the Department of Defense verified as Trauma Centers by the American College of Surgeons. LRMC provides medical care for more than 245,000 U.S. military personnel and their families within U.S. European Command. LRMC is also the evacuation and treatment center for all injured U.S. servicemembers and civilians injured in Afghanistan and Iraq, as well as servicemembers from 48 coalition forces.