Pain in the legs turns out to be a blessing for Bridgeville man

By Lynn R. Parks

Although he didn't think so at the time, Kyle Lucas was lucky that his legs started to hurt. Without that leg pain, which was caused by blockages in his blood vessels, he would not have been referred to vascular surgeon Farouk Marzouk. And without Dr. Marzouk, the aortic aneurysm that was growing in his belly and that was unrelated to his leg pain could have gone undetected until it ruptured. Only 10 percent of the people who have such ruptures survive them.

"I sure am glad," said Lucas, a 72-year-old retired welder who lives near Bridgeville. "If that aneurysm would have burst, I'd have been a goner. I'd say that Dr. Marzouk saved my life."

Marzouk is the new director of vascular surgery at Nanticoke Memorial Hospital in Seaford. (The body's vascular system is its arteries and veins.) He came to the hospital in September and brought with him the training necessary to do endovascular surgery, or minimally-invasive vascular surgery.

Instead of involving an incision from his breastbone to his pubic bone, Lucas' surgery meant just a small cut in his groin. "That traditional surgery is a huge surgery," Marzouk said. "You have a huge incision and you can get a lot of complications from that. It's painful to breathe, so you run the risk of pneumonia. You usually have a long stay in intensive care, part of a week to 10 days in the hospital."

The minimally-invasive surgery, on the other hand, means only a two- to three-day stay in the hospital, usually after one day in intensive care. "You get the same good results as with the traditional surgery, and the complications are way less," Marzouk said.

Since his arrival at Nanticoke, Marzouk has done three endovascular procedures to remove aortic aneurysms. While none has been an emergency situation, he said, all, including Lucas', were urgent.

Lucas first saw Marzouk in October. He had been under treatment for leg pain for about a year and the medicine he was taking wasn't working.

Marzouk prescribed an x-ray of Lucas' vascular system to look for blockages in the arteries that lead to the legs. When he looked at the pictures of Lucas' veins and arteries, he saw a few blockages. He also saw the aneurysm.

"An aneurysm is like a balloon in the aorta," Marzouk said. "It expands over the years. When we find one, we usually watch it until it gets to be 5 centimeters, then take it out because of the danger of rupture."

When Marzouk found Lucas' aneurysm, it was already 8.5 centimeters (3.3 inches). Surgery was scheduled for the next day. The aneurysm was located in Lucas' abdominal aorta. It was beneath his kidney and just above the point at which the abdominal aorta splits into two branches to supply blood to the legs.

During the surgery, Marzouk used a catheter and wires to push a stent, shaped like an upside-down Y, through an incision in Lucas' groin to the spot of the aneurysm. The catheter was about the width of the point on a pen; the stent, made of specialized fabric and springy steel, was compressed to also be that size.

When it was in place, the stent expanded to match the width of the abdominal aorta and the two branches. The leg of the Y matched up with the main aorta; each of its branches matched up with a leg aorta.

Marzouk positioned the leg of Lucas' new stent so that it passed right through the aneurysm. Now, blood flows through the stent instead of through the aneurysm, taking pressure off the walls of the aneurysm and eliminating the risk of a rupture. The remains of the aneurysm will be slowly absorbed by the body with no side effects, Marzouk said.

During the surgery, Marzouk also removed the blockages that were causing Lucas' leg pain. The surgery lasted about four hours, he said; surgery just to remove an aneurysm would last about two and a half hours.

Lucas spent two days in intensive care. He left the hospital four days after his surgery.

"I feel real good, excellent," Lucas said. "Especially considering how I felt before. My legs were getting worse and worse." Marzouk said that endovascular technology was developed in the late 1990s. He studied it as a resident at the New York Medical College in Westchester, N.Y., and during a fellowship in vascular surgery at Staten Island University Hospital in New York City.

"It's truly an amazing technology," he said. "You really can do a lot with catheters. I predict that 10 years from now, we will do everything with a little hole, a catheter and some wire."

For your information The office of Dr. Farouk Marzouk is in the vascular center at Nanticoke Memorial Hospital. For details, call 629-0452.

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