A general contractor based in Boca Raton who was formerly a paramedic, Richard Edwards, 58, realized the critical nature of his condition — which caused extreme pain and swelling down his left leg — only after he was taken to the ER at Bethesda Hospital East  and underwent specialized surgery.
Later in the operating room, the surgical team led by vascular surgeon Reagan Ross, M.D. , found the cause: A large abdominal aortic aneurysm (AAA) that had left Mr. Edwards with what is known as “critical limb ischemia”– when tissues of the legs and feet are robbed of oxygen-rich blood. It is not uncommon to face an amputation in such cases. His ordeal began one year ago this month.
Mr. Edwards recalls he was trying to lose some weight after having quit smoking eight months previously. Although an active person who enjoys free diving, spear fishing and swimming, Mr. Edwards dealt with some health issues, including rheumatoid arthritis and high blood pressure — and he had smoked for much of his adult life.
(Watch video: Hear from patient Richard Edwards and Reagan Ross, M.D., vascular surgeon at Bethesda Hospital East. Video by George Carvalho and Dylan Kyle.)
“I was walking and trying to lose weight, and then I felt a lot of pain radiating down my leg, extremely acute — I actually collapsed, got back up, and walked a bit longer,” recalls Mr. Edwards. “It happened again, and I sat down and tried to stretch it out. I used to be a long-distance runner when I was younger … I finally got home, collapsed again, took a shower, tried to get hot water on it, and fell in the shower.”
He would end up at the ER the next day because paramedics initially thought it was just cramps from walking and he was urged to go to an urgent care center. But the next day, the urgent care doctor sent him to the Bethesda East ER .
“I was a firefighter/paramedic so I know that AAAs are often fatal,” said Mr. Edwards. “I went to the emergency room, and they told me that the AAA was sending blood clots down to my lower legs, especially my left lower leg. So, I was in the operating room pretty quickly.”
Mr. Edwards also had compartment syndrome of his left lower leg, and extreme swelling and bulging of the muscle that can affect the neurological function of his leg. The breakdown of this muscle was causing his kidneys to fail as well, said Dr. Ross.
“Once we resuscitated him, improved his kidney function, removed all the clot from his left leg and performed fasciotomies to release the pressure on the muscle, the cause of this happening was then fixed by taking him back to the operating room two days later to repair his infrarenal abdominal aortic aneurysm (AAA) that was 8 centimeters large at the time.”
Dr. Ross performed a minimally-invasive procedure called endovascular aneurysm repair (EVAR) to treat Mr. Edwards’ 8-centimeter (cm) aneurysm (surgery is usually required when an aneurysm becomes greater than 5.5 cm). In the EVAR procedure, a stent graft, essentially a fabric tube with metal wire stents that reinforces the weak spot in the aorta, is inserted into the aneurysm through small incisions in the groin.
“An 8-cm aneurysm is fairly large,” she said. “The guidelines recommend that for abdominal aortic aneurysms in the infrarenal position (below the kidneys) is to start discussing repair at about 5.5 centimeters in men. And that’s when the risk of rupture outweighs the risk of doing any type of repair. So, he was well above that.”
‘Dr. Ross was Really There for Me’
Mr. Edwards: “Dr. Ross was really there for me, and did an outstanding job. I’ve just been so grateful … and hopeful about my care.”
Recalls Mr. Edwards: “I didn’t have any pulse in my foot. I remember them monitoring me while I was in intensive care, and they told me that there’s a possibility that, if I don’t get a pulse to my foot that day, I have to prepare myself for possible amputation of my foot, or amputating my lower leg, which was quite an eye opener, and quite upsetting. But I felt like I was under good care even then.”
A Challenging — But Successful — Recovery
It has been a long but successful recovery for Mr. Edwards that included a vacuum-assisted closure (VAC), a method of decreasing air pressure around a wound to assist the healing, on his left leg and many months of follow-up appointments and physical therapy.
“I’ve actually stopped physiotherapy, and I’ve started strength training,” he says “I’m pushing and pulling a sled, I’m working out in a gym with all sorts of bands and free weights. I’ve been riding my bike, and walking, and swimming laps for about a month and a half. And now I can walk almost without a limp for a period of time.”
Dr. Ross adds that her patient is doing very well.
“We see him in the office for surveillance ultrasounds and CAT scans, and he’s fairly back to normal as far as walking and working,” said Dr. Ross. “His fasciotomy sites have all healed. His leg looks tremendously better. His motor function and most of his neurological function has all returned. We’re very happy for him.”
Risk Factors for Vascular Disease
Smoking is a huge risk factor for vascular disease and abdominal aortic aneurysms, explains Dr. Ross. “That’s probably the No. 1 thing that people can change for themselves in trying to prevent not only peripheral vascular disease, but also aneurysmal disease.”
Top risk factors for AAAs also include high blood pressure, high cholesterol, genetic factors and age (great than 60). Being male is also a risk factor. Men have a four times greater risk of developing AAAs than women. However, women who develop AAAs tend to fare worse than men.
Mr. Edwards, who said he smoked for about 25 years of his adult life, has a message to those in his age group who may have put off vital lifestyle choices to improve their health — with not smoking being at the top of his list.
“This happened to me, and I almost died, and I had to spend the better part of a year rehabilitating,” said Mr. Edwards. “So, if you are smoking — stop. If you don’t smoke, don’t start, and that’s my takeaway. Your health is your most valuable asset. You can get through anything as long as you’re healthy.”