Kay Levan has several tales about adventurers hunting for emeralds in Hiddenite, the little North Carolina tourist town where she’s lived her whole life.
But these days the story that’s freshest on the 79-year-old’s mind is one about fate leading her to addressing a dangerous abdominal aortic aneurysm (AAA) that had been on her mind for years as it grew larger. An AAA is a weak, bulging area of the abdominal aorta, and if the aneurysm bursts it can be deadly.
Levan’s story begins recently at a hospital near her home. But when she was being transferred to a larger facility for an unrelated procedure she had to be rerouted to Novant Health Forsyth Medical Center in Winston-Salem.
“With all of the prayers from friends and family I felt like I got to where I needed to be,” Levan said.
Just one night in the hospital
Levan’s vascular surgeon at Forsyth Medical Center, Dr. Ashley Rickey with Novant Health Vascular Specialists, said she performs many aneurysm repairs and that minimally-invasive procedures with the current technology have been used regularly for over a decade and continue to evolve to give many patients a good alternative to open surgeries. Open surgeries can be difficult for some patients and require longer recovery times.
For endovascular aneurysm repair, or EVAR, the surgeon makes a small puncture site in the groin while the patient is under anesthesia. Then they insert instruments through a catheter in an artery and thread them up to the aneurysm.
A stent graft is then placed into the aorta to cover the aneurysm and prevent the risk of rupture. This fixes the aneurysm. (A stent graft is a tube-like structure covered in fabric and reinforced with metal stents that helps prevent the aneurysm from bursting.)
An estimated 1.5 million people in the United States have AAAs, and more than 200,000 new diagnoses are made each year, according to a 2003 report still widely cited in medicine. The minimally invasive EVAR exceeded open surgeries for elective AAA surgeries for the first time in 2006 and by 2016 made up 80 percent of elective AAA procedures.
“With EVAR, most people are just in the hospital overnight, then go home and come to the clinic in about a month for a CT scan to make sure that everything looks good and that the aneurysm itself is getting a little bit smaller,” Rickey said. “Then after that, if everything looks fine, we will follow up in six months to a year.”
Rickey said Levan’s recent EVAR surgery went very well and her successful follow-up scan meant Levan would only need to come back once a year for imaging.
Risk factors for this type of aneurysm include smoking or genetic predisposition, Rickey said.
When to get it done
Levan said she’d long wanted to get the aneurysm taken care of for years but had been putting it off since the problem was spotted in 2004, which was around the time her husband Robert Lee Levan passed away.
More recently, she said her doctors had been asking her to strongly consider taking action because the aneurysm was getting bigger.
Rickey said she was glad Levan felt ready to have the procedure done. “We have the conversation with patients a lot,” Rickey said. “It’s been well-studied and outlined that when the aneurysm gets greater than a diameter of about 5.5 centimeters there’s a significant chance that the aneurysm can rupture, which is a life-threatening event and a lot of people don’t make it to the hospital when that happens.” (Levan’s had exceeded 7 centimeters.)
For that reason, aneurysms are often called “the silent killer.”
Why she came to Forsyth
Levan actually was brought to Forsyth Medical Center for an unrelated medical problem -- an incarcerated hernia. An incarcerated hernia, which can cut off blood flow to part of the intestine, can have serious consequences if untreated. But surgery for the hernia, at that point, also posed a risk for Levan’s aneurysm.
At first, she’d planned to just take care of the hernia that was giving her intense pain before eventually deciding to get the important aortic procedure done, too.
It turns out that a general surgeon on duty at Forsyth Medical Center was able to get Levan’s intestine back in position to reduce the hernia without requiring surgery. Of course, that was great news to her.
Levan said she then immediately felt relief from the hernia. Then she said she thought: “This is a wonderful place, why not get the aneurysm fixed too?”
Back to Hiddenite
Levan said her next plan is to get a surgery for her hernia, although she said it’s hurting far less than before, and joked that she might one day put skydiving back on her bucket list.
In the meantime, she’s back with her dog, Precious, and spending time with her three grandkids.
She said she’ll miss the hospital units where she stayed at Forsyth Medical Center and all of the people there that helped her feel comfortable and confident enough to follow through with EVAR. “It was just a lot of fun for me because I’m used to being by myself,” Levan said. “Everyone was just so good down there. When they would move me to a different unit, I would say I don’t want to go.”
But now Levan said she’s happy to be back in Hiddenite with her family and all her friends amid the famous precious stones of her hometown.
The skilled surgeons and clinical specialists of Novant Health’s heart and vascular surgery programs provide the very latest treatments for heart and vascular diseases.
