Life-saving procedure now available in Monterey County
Marina resident Lorenzo Smith didn’t go to the doctor expecting a life-threatening diagnosis, but that’s what he got.
His stomach hurt. He felt tired. Something just felt off. A scan ordered by his Montage Medical Group primary care doctor Jean-Philippe Abraham, MD, revealed a large aneurysm in his aorta, the body’s main blood vessel, sitting in one of the most dangerous places possible, just above his kidneys.
If the aneurysm ruptured — which could happen at any time — it was guaranteed to be fatal.
The aneurysm wasn’t the cause of Smith’s stomach pain and fatigue, but catching it was serendipitous. Aneurysms typically have no symptoms until they rupture, making them silent killers.
“It’s a scary diagnosis,” Smith says. “One minute I’m talking about stomach pain, and the next minute they’re telling me an aneurysm could rupture and kill me. That’s a lot to take in.”
A local solution for aortic aneurysm repair
Until recently, Smith would have been sent out of town for treatment, likely to Stanford or another Bay Area academic medical center. Instead, he became the first patient in Monterey County to undergo a highly advanced, minimally invasive procedure called fenestrated endovascular aneurysm repair, or F-EVAR, right here at Montage Health’s Community Hospital of the Monterey Peninsula.
F-EVAR is now available locally thanks to vascular and endovascular surgeon Emaad Farooqui, MD, whose arrival at Montage Health expanded what’s possible for patients with complex vascular issues.
What’s an aortic aneurysm?
An aortic aneurysm is a weakened, ballooned section of the aorta. Think of a garden hose with a basketball-sized bulge. Blood fills the bulge and increases pressure on the vessel wall, increasing the risk of rupture. The goal of treatment is to relieve that pressure before it becomes life-threatening.
Aneurysm risk factors include:
- Smoking
- High blood pressure
- Family history of aneurysms or connective tissue disease
- Other vascular diseases
“It’s important to talk with your primary care doctor to determine if you require screening for aortic aneurysms,” Farooqui says.
Open vs. minimally invasive surgery
There are two primary ways to repair an aortic aneurysm: open surgery, which requires a large incision in the torso, and the minimally invasive F-EVAR procedure, which is performed through two small incisions in the groin.
Open surgery involves opening the chest or abdomen, providing direct access to the aneurysm. While it’s still sometimes the best option for some patients depending on their anatomy, health, and aneurysm location, it’s a major surgery that can take 6–8 hours.
Open surgery often means:
Open surgery risks and recovery can be significant, especially for older adults or patients with other medical conditions like heart disease, kidney problems, or obesity.
F-EVAR: A minimally invasive alternative to open surgery
Smith was a strong candidate for the F-EVAR procedure, which repairs the aneurysm from inside the blood vessel.
Guided by live X-ray imaging, Farooqui fed catheters and wires through the small incisions in Smith’s groin, through the blood vessel and up to the aneurysm, where Farooqui then placed a custom-built stent designed specifically for Smith's anatomy. The stent acts as a new inner lining for the artery, allowing blood to flow through the stent instead of into the aneurysm.
The procedure took about 3 hours. Smith was up walking the next morning and went home after one night at Community Hospital.
“I feel good and recovery has been easy,” Smith says. “Doctor Farooqui is an amazing doctor, and our community is lucky to have him. From start to finish, it was easy to trust that I was in great hands.”
Compared to open surgery, minimally invasive procedures like F-EVAR typically mean:
An investment in the health of our community
F-EVAR reflects Montage Health’s broader commitment to investing in advanced, high-quality care for Monterey County communities.
“We're building a comprehensive vascular program,” Farooqui says, “so patients can receive high-level, specialized care close to home.”
