Excellence & Compassion

From left: Drs. Arash Bornak, Stefan C. Kenel-Pierre and Jorge Rey of the Division of Vascular and Endovascular Surgery

It’s a trope that we can all recognize from movies and television — the ornery surgeon, excellent at his or her craft but devoid of bedside manner. At the University of Miami DeWitt Daughtry Family Department of Surgery, we don’t fit the stereotype. We are trailblazers in the operating room, but never lose sight of why we do what we do. Our ability to help patients begins with understanding the life they hope to resume once surgery is over.

MAKING THE IMPOSSIBLE, POSSIBLE

When I walked into the hospital room, I saw his three-year-old daughter crying.” Dr. Jorge Rey remembers meeting Alexander Mejia’s family in “ 2016. They had just been told there were no options for saving his life after a motor vehicle accident. Alexander, then 39, had arrived at Jackson Memorial Hospital’s Ryder Trauma Center with multiple intracranial hemorrhages and a large aortic pseudoaneurysm of the distal ascending aorta.

“Usually in these cases the only way to repair the aorta is to open the chest and the major vessels,” said Dr. Rey, chief of the division of vascular and endovascular surgery. To do that, cardiac surgeons would have had to use blood thinners, an impossibility with the existing bleeds in his brain. “When we arrived, the option they had was to give the patient morphine and allow him to say his goodbyes to his family. That was it.”

For the multidisciplinary vascular surgery team, that was not an acceptable solution. “The case with many patients with multiple injuries is that we think we can’t help because of the need for blood thinners. We needed to get creative,” said Dr. Rey. Since a stent to cover all the major vessels would have similarly caused a stroke and death, the team did something that had never been done before.

“We decided to create temporary blood flow to the brain from the patient’s femoral artery in the leg,” explained Dr. Rey. “With this in place, we deployed a stent to cover all the great vessels and created a bypass to the other organs.” To then restore blood flow directly from the carotid to the brain, the team had to be even more creative. “We used a laser that we usually employ to clear blockages in the legs to punch holes in the graft, then connected the blood vessels through the holes we made.”

Three years later, we called Alexander Mejia to see how he was doing. “He said, ‘Let me give you a call back, I’m driving my truck.’” A patient once near death was back to living a normal life. “Blunt traumatic aortic injury is a leading cause of death in trauma patients,” said Dr. Rey. “Developing this technique means we can reduce mortality for patients with this kind of injury, even when blood thinners are not an option.”

From left: Patient Alexander Mejia and surgeon Dr. Jorge Rey

BEING RELENTLESS FOR OUR PATIENTS

Dr. Marwan Tabbara recalls meeting a patient whose chronic illness was threatening his life. “I met him for the first time around two years ago, when he presented to my clinic with a left groin dialysis catheter and no permanent access for hemodialysis.”

He had exhausted all his options for a permanent hemodialysis access point in the upper extremities, after many failed attempts by local surgeons in West Palm Beach county. “I remember meeting this very intelligent, cordial, funny person, with a great sense of humor despite his near terminal situation,” said Dr. Tabbara.

The patient was not a candidate for a kidney transplant something that had never been done before. and had exhausted his options for peritoneal dialysis. The team pushed for another option, however unlikely. “After many procedures,” said Dr. Tabbara, “I was able to secure a very unusual access in the left upper extremity using a frozen femoral vein from a cadaver routed around his left shoulder.” Unbound by the typical set of solutions, the team found a way.

HELPING A DREAM COME TRUE

Dr. Stefan Kenel-Pierre’s patient had a rare chronic vascular condition that was keeping him from the thing he loved most. “Initially, he came to us as a teenager after a period in which he put on a significant amount of muscle mass in preparation for his athletic career.” One day after a heavy practice, he noted swelling and pain of his right arm. Doctors at another hospital discovered a blood clot in the major vein draining his right arm and put him on blood thinners.

After his symptoms did not improve, he presented to the University of Miami, where he was diagnosed with thoracic outlet syndrome. “Given his desire to play baseball, we offered him decompression surgery, including removal of the first rib, to relieve the pinching of the blood vessels and nerves in the neck and shoulder area,” said Dr. KenelPierre. “He returned to competitive play in less than three months.” Now more than a year after his surgery, he is throwing even harder than before. “We are thankful for his faith in us, and for helping make his dreams a reality.”

LIMB SALVAGE AND VEIN CENTER

(Left to right) Dr. Arash Bornak, Dr. Alberto Lopez, Advanced Practice Registered Nurse Rebekah Kramer, Dr. Omaida C. Velazquez, Dr. Jorge Rey, Dr. Marwan Tabbara, Dr. Naixin Kang and Dr. Stefan Kenel-Pierre celebrate the official opening of the Limb Salvage and Vein Center.

Few things strike more fear in patients than the possibility of losing a limb. For many, it means the loss of independence and the inability to perform many activities that we take for granted. Department of Surgery Chair and vascular surgeon Dr. Omaida C. Velazquez and the Vascular and Endovascular Division are on a mission to save limbs.

The founding of the Limb Salvage and Vein Center at UHealth Tower in 2017 has meant a resource unlike any other in the region for patients who receive news that their limbs are in danger. “We do anything necessary to save a limb,” said Dr. Jorge Rey, chief of the division. “Minimally invasive procedures—such as angioplasty and stents—open reconstructions, medical treatments, stem cells, gene therapy. Whatever it takes.”

Our team also works on the next generation treatment for vascular patients involving mesenchymal stem cells through the Pluristem trial, led by Principal Investigator Dr. Arash Bornak.

An all-hands-on-deck approach was what Panamanian diplomat David McGrath needed when he arrived in Miami from the Bahamas. What started as mild pain while walking the golf course had become severe peripheral artery disease with gangrene. “Mr. McGrath was weeks away from losing his feet,” said Dr. Rey.

During an eight-hour procedure, a multidisciplinary four-surgeon team lead by Drs. Arash Bornak and Jorge Rey removed plaques in the femoral artery to restore flow and circulation, placed stents in both iliac arteries and the left leg, and performed a bypass on the right leg, creatingan alternative conduit for blood flow to circumvent thearea of blockage and restore direct blood flow. He wasback on the golf course months after surgery, his limbsand lifestyle back to normal.