Elderly Woman Bounces Right Back After Risky Vascular Surgery

An independent streak and a can-do attitude – a product of her Midwestern Iowa roots, no doubt – have served Myrna Nemzoff well over the years. Although the Tamarac resident has been around for more years than she cares to admit (hint: she was born before FDR was elected to his first term as president), she still lives independently and leads an active life, serving as committeewoman for the local Democratic Club.

“Sioux City was a nice place to grow up but I knew there was more to life. I wanted to meet people from different backgrounds and enlarge my vistas,” Mrs. Nemzoff says. At age 19, she moved to New York and ended up working as a secretary for a law firm on Wall Street. Living in New York was “a wonderful experience,” she says, and it was where she met her husband and they had their first child. The family eventually relocated to South Florida, settling in Boca Raton.

Flash forward to earlier this year. Mrs. Nemzoff was taken to a nearby hospital’s emergency department due to complications from high blood pressure. There, during her exam, the physician spotted something else: she had a large abdominal aortic aneurysm (AAA) that “could explode” at any time. “I didn’t even have any symptoms,” Mrs. Nemzoff recalls, adding that she has exercised every day for the past 25 years “and felt fine.”

Understanding abdominal aortic aneurysms

An aortic aneurysm is a balloon-like enlargement of an artery caused by weakness in the arterial wall. According to the Society for Vascular Surgery (SVS), this happens most often in the abdominal aorta, an essential blood vessel that supplies blood to the legs.

“Every year, 200,000 people in the U.S. are diagnosed with an abdominal aortic aneurysm (AAA),” the SVS says, and if not treated quickly, they can lead to life-threatening internal bleeding. “A ruptured AAA is the 15^th leading cause of death in the country, and the 10^th leading cause of death in men older than 55,” it says.

Aneurysms tend to run in families, the SVS adds, noting that of those patients in treatment to repair an AAA, 15 to 25 percent have a first-degree relative with the same type of aneurysm. “If you have a first-degree relative who has had an AAA, you are 12 times more likely to develop one yourself,” the SVS says.

Challenges treating Mrs. Nemzoff’s AAA

Unfortunately, the physician who diagnosed Mrs. Nemzoff told her he would be unable to perform the highly intricate vascular surgery required to repair her aneurysm. Instead, he referred her to vascular surgeon W. Anthony Lee, M.D., chief of vascular surgery at Lynn Heart & Vascular Institute at Boca Raton Regional Hospital, a part of Baptist Health. Dr. Lee treats the entire range of vascular diseases, with an emphasis on complex thoracic and thoracoabdominal aortic aneurysms and dissections.

W. Anthony Lee, M.D., chief of vascular surgery at Lynn Heart & Vascular Institute at Boca Raton Regional Hospital, part of Baptist Health

“Abdominal aortic aneurysms are typically treated with an endovascular stent which is put in place through a minimally invasive procedure but with Mrs. Nemzoff’s anatomy, this would have been technically hazardous and difficult,” Dr. Lee says. “An open repair would have been better for her in the short run and the long run.”

However, Dr. Lee points out, either procedure would require general anesthesia, which in turn requires the patient to be intubated so that their breathing can be maintained during surgery.

“Aside from Mrs. Nemzoff’s advanced age, there was another challenge we faced,” Dr. Lee recalls, noting that his patient years ago had throat surgery requiring the removal of one of her vocal cords. Preserving her remaining vocal cord would be critically important in her case.

On the day of Mrs. Nemzoff’s surgery, Leslie Renfro, M.D., the anesthesiologist who assists Dr. Lee with all of these cases, encountered “technical difficulty” while trying to intubate the elderly patient. It was not unexpected, says Dr. Lee.

“In 98 to 99 percent of cases such as hers, either the surgery would have been aborted at this point because of inability to intubate the patient or the patient might have ended up with a tracheostomy, or a hole in their throat, to maintain an airway for the procedure,” Dr. Lee says.

Close collaboration leads to successful outcome

In the end, however, both Dr. Lee and Dr. Renfro persevered, working together and trying different ways to safely pass the tube down Mrs. Nemzoff’s throat without damaging her vocal cord.

“It required extremely close collaboration and an unusual combination of techniques,” Dr. Lee says. “Ultimately, we were able to proceed with the high-risk surgery,” which he says was a success.

“Mrs. Nemzoff recovered very quickly and was able to be discharged just three days later, which is absolutely remarkable,” Dr. Lee says. “When I saw her for follow-up two weeks later, she looked amazing. She was initially hoarse from the breathing tube but that resolved quickly and her voice returned to normal.”

By the time he saw her again for her three-month follow-up, Dr. Lee says Mrs. Nemzoff was completely back to where she was before the surgery to repair her aneurysm. “She recovered as well as someone 10 to 20 years younger,” he says. “She’s doing so well, in fact, that I don’t need to see her again.”

Mrs. Nemzoff says she is “everlastingly grateful” to both Dr. Lee and Dr. Renfro. “Dr. Lee is an unbelievable surgeon – really excellent – and Dr. Renfro is just amazing. She’s a wonderful anesthesiologist. Together, they saved my life.”

Risks and rewards of vascular surgery

Dr. Lee says vascular surgeries such as the one Mrs. Nemzoff underwent are serious procedures that come with a high degree of both risk and reward.

“There were significant challenges in successfully treating her but the rewards of caring for someone like Mrs. Nemzoff are huge,” says Dr. Lee. “We were able to remove this life-threatening problem from her body and allow her to live her natural course worry-free. For me, that’s the definition of job satisfaction.”

If you or someone you know is diagnosed with an AAA, Dr. Lee says it’s important to see a board-certified vascular surgeon. “They are most qualified to discuss all of the different treatment options available to you and, most importantly, when and whether any type of intervention should take place.”

Where you get treated for an AAA can also make a real difference, Dr. Lee says, noting that volume correlates with outcome. “If you’re hoping for a good outcome, it behooves you to go to a high-volume center and see a high-volume surgeon who has lots of experience with such surgeries,” he says. Dr. Lee points out that Lynn Heart & Vascular Institute ranks among the state’s top three highest-volume centers for treating aortic aneurysms.

Dr. Lee also says that patients themselves can make a real difference in their outcomes, and he credits Mrs. Nemzoff’s positive attitude for her quick recovery.

“There is a clear mind-body connection to survival and recovery after surgery, and the will to survive has been shown to make a real difference,” Dr. Lee says. “Mrs. Nemzoff has so much spunk and energy, and so much to live for. She had a life-threatening problem and she faced it like a trouper.”