Ken Muscatel Experiences the Power of Team Medicine
By Jennifer Sorenson
One Sunday night, hospital patient Ken Muscatel listened as vascular surgeon Dan Neuzil, MD, described his treatment plan. Dr. Neuzil told Ken, who was facing permanent kidney failure, there was a way they might save his kidney function, but if the procedure failed he could die.
“Ken told me his whole life was about taking risks,” remembers Dr. Neuzil, who would later learn that one of his patient’s hobbies was driving H1 Unlimited Series Hydroplanes, the fastest boats in the world.
Two days before Ken met Dr. Neuzil, he had awakened at home feeling terrible, as if he had the worst flu of his life. After visiting the internal medicine clinic, Ken was admitted to Virginia Mason hospital facing a dire diagnosis: kidney failure. The blood work confirmed his kidneys were collapsing, but why?
Virginia Mason nephrologist Mike Sutters, MD, was about to head home late that Friday night when he took the first call in what became a medical sprint to save Ken’s kidneys. Dr. Sutters determined the sudden loss of kidney function and very unusual appearance of Ken’s initial scans could best be explained by a dissection of the descending aorta, a tear in the lining of the aorta’s muscular wall. Aortic dissection is a true medical emergency that must be diagnosed rapidly, as flaps of torn tissue can trap blood and restrict blood flow to vital organs. After discussion with Virginia Mason radiologist Justin Siegal, MD, CT angiography was performed to precisely outline the major arteries running from the heart to the kidneys. The test confirmed only one of Ken’s kidneys was receiving a trickle of blood. Both organs were at risk.
“I wasn’t terribly happy to think of a lifetime of dialysis for this patient,” says Dr. Sutters. “Emergency vascular surgery was considered too great a risk in the setting of widespread dissection, so I thought of the kidney transplant team. Could we save one kidney by moving it and rerouting the blood supply?”
Dr. Sutters contacted transplant surgeon Christian Kuhr, MD, FACS, who confirmed in follow-up scans that residual blood flow to the kidneys was diminishing, and irreversible loss of function was almost certain. It was Sunday night when he paged his colleague Dr. Neuzil to join him in the urgent operation. Dr. Neuzil happened to be in his office when his pager went off. He dropped everything to review Ken’s case.
“I looked at the images and thought of another possibility, that we could place a stent in Ken’s aorta,” says Dr. Neuzil. It was a minimally invasive approach, given stents can be collapsed and delivered by catheter, but stenting is not the standard of care for descending aortic dissection. Generally considered to be too extensive and risky to stent, most dissections of this type are left to heal on their own. But in Ken’s case no intervention would mean a total loss of kidney function.
Dr. Neuzil called a group he’d worked with for 15 years — a team from the company that produces medical stents. Dr. Neuzil’s contact tracked down Rodney White, MD, the group’s expert and teacher of stent graft procedures, who could review Ken’s images remotely. He told Dr. Neuzil he’d seen many aortic stent grafts succeed in similar circumstances and supported the attempt.
It was the confirmation Dr. Neuzil needed to present the option to his patient. Ken agreed to the approach and on Monday received his stent by way of a three-inch incision in his groin, where the device was guided up his femoral artery to the damaged aorta. Blood was immediately directed back to Ken’s kidneys, with a dramatic return of function. The two dialysis treatments he had needed to keep him alive before the procedure would be his first and last. Four days later, Ken went home.
“Having a relationship made the difference here,” says Dr. Neuzil. “I could make a call and get vital input quickly. The same goes for the team at Virginia Mason. Our culture is that we’re available to each other, to work together. Add technology to that and we can do extraordinary things.”
In the few days before Ken’s aorta was successfully stented, he had been planning for a life spending numerous hours a week on dialysis. But following the successful procedure, thankfully, there was a change of plans.
“My kidneys are functioning like they did before,” says Ken. “The path of least risk was to let my kidneys fail and put me on dialysis. But because many experts were able to communicate in real time they gave me a shot at recovery. It was quintessential team medicine.”
Jennifer Sorenson, communications program manager, wrote this story for the Virginia Mason 2012 Annual Report.