A Second Opinion Gave One Patient a New Path for Complex Aortic Aneurysm Surgery
After being told his abdominal aortic aneurysm could not be treated, Miguel Castillo sought another opinion. A multidisciplinary UHealth team developed a surgical plan for his complex condition and repaired three aneurysms during one operation.
Key Takeaways
- An abdominal aortic aneurysm occurs when a weakened section of the body’s main artery enlarges beyond its normal size.
- After being told his aneurysm was not operable, Miguel Castillo sought a second opinion at UHealth.
- A multidisciplinary team reviewed imaging studies, medical conditions and treatment options before recommending surgery.
- Surgeons repaired Miguel’s primary aneurysm and two additional aneurysms discovered during the procedure.
When Miguel Castillo was diagnosed with an abdominal aortic aneurysm, his world changed overnight. What he heard then was devastating. The procedure he needed was complex and, apparently, he had no options.
“I felt very depressed,” Castillo recalled.
For a while, he lived with fear and anxiety. The uncertainty about his future left him with little hope.
Before arriving at UHealth, Castillo had visited other medical centers where he was told his aneurysm was not operable.
But everything changed when he met Jorge Rey, M.D., chief of vascular surgery at the UHealth—University of Miami Health System and associate professor in the DeWitt Daughtry Family Department of Surgery at the University of Miami Miller School of Medicine.
“Unfortunately, sometimes patients are told there are no options,” said Dr. Rey. “But it’s always important to seek another opinion.”
UHealth’s Comprehensive Aortic Center was created to provide coordinated, multidisciplinary care for patients with the full spectrum of aortic pathology, including thoracic and abdominal aortic aneurysms, aortic dissections, complex aortic valve disease, genetic aortopathies and connective tissue disorders such as Marfan and Loeys-Dietz syndromes. The center brings together specialists in vascular surgery, cardiothoracic surgery, cardiology, advanced cardiovascular imaging, genetics and endovascular therapies to develop individualized treatment plans for each patient.
Comprehensive Aortic Center
UHealth offers advanced, multidisciplinary care for patients with complex aortic disease.
What is an Abdominal Aortic Aneurysm?
Castillo’s story also reflects a broader advancement in the treatment of complex aortic disease, said Dr. Rey, noting that an aneurysm occurs when an artery weakens and expands beyond its normal size. In the case of the aorta, which is the main artery that carries blood from the heart to the rest of the body, this can become a life-threatening condition.
“The normal size of the aorta is usually between 2.2 and 2.8 centimeters,” explained Dr. Rey. “When that artery grows to more than one and a half times its normal size, we call it an aneurysm.”
The problem is that, in most cases, aneurysms do not cause symptoms.
“Many people don’t know they have one,” Dr. Rey said. “The risk is that the weak spot can keep growing and eventually rupture. When that happens, the probability of death can approach 75%.”
In Castillo’s case, the aneurysm was quite large and located near important arteries, including those that supply the kidneys, which made the case particularly complex. The first appointment with Dr. Rey lasted nearly an hour-and-a-half. For Miguel, that time was crucial.
“We talked for almost 90 minutes,” he remembered. “Every time it seemed like the consultation was over, the doctor would ask, ‘Do you have any other questions?’ When I left that appointment, I had no doubt this was the place where I needed to have the operation. I felt calm, like I was talking to a brother.”
How did the Team Choose the Surgical Approach?
Dr. Rey and his team carefully reviewed the case using a multidisciplinary approach.
“We analyze the imaging, the patient’s medical conditions, and discuss the case with other specialists,” he explained. “Sometimes the best option is a minimally invasive endovascular procedure and, other times, open surgery is the best alternative.”
The complexity of the Castillo’s aneurysm made an open procedure necessary to ensure the best long-term result.
During the operation, something unexpected happened. In addition to the main aneurysm, the surgical team discovered two additional aneurysms developing.
“When we saw them during surgery, we decided to repair them right then and there,” explains Dr. Rey. “We didn’t want the patient to have to go through another operation in the future.”
When Is a Second Opinion Worth Considering?
Complex conditions such as abdominal aortic aneurysms may require evaluation by specialists from multiple disciplines. Treatment recommendations can vary based on a patient’s anatomy, imaging findings and overall medical condition.
Miguel Castillo’s experience illustrates why additional evaluation can be valuable. After being told his aneurysm was not operable, he sought care at UHealth, where a multidisciplinary team reviewed his case and developed a treatment plan tailored to his condition.
The surgery lasted more than six hours, but it was a success.
“Dr. Rey was like a quarterback in American football, making a decision at the line of scrimmage,” Castillo said with a smile. “He knew exactly what he was doing.”
Thanks to that decision, all of the aneurysms were repaired in a single procedure. The recovery was better than expected. According to Dr. Rey, Castillo even set a kind of record.
“He was one of the patients who went home faster than we usually see for this type of surgery,” he said. “By the fourth day, he was already back home.”
Today, several years after the operation, Castillo looks back with gratitude.
“Every time I see Dr. Rey, I hug him,” he said. “What he did for me is beyond words. I feel like I’m living another life. I’ve been able to enjoy wonderful years that I might not have had if I hadn’t had surgery with Dr. Rey.”
After the surgery, Castillo also made important lifestyle changes. He quit smoking and now focuses on maintaining healthier habits.
“The doctor told me that quitting nicotine was one of the best decisions I could make,” Castillo said. “Now I try to enjoy the food I like, but in moderation.”
Multidisciplinary Aortic Care
Castillo’s story also reflects a broader advancement in vascular medicine. UHealth’s Comprehensive Aortic Program was designed to treat complex conditions of this vital artery through a multidisciplinary approach.
“The goal is to bring together specialists in cardiac surgery, vascular surgery and endovascular therapies to treat all diseases of the aorta,” explained Dr. Rey.
The center provides access to advanced surgical and endovascular technologies that are not widely available throughout South Florida. These include complex branched and fenestrated endograft technologies, advanced aortic reconstruction procedures, valve-sparing aortic root operations and specialized interventions for extensive thoracoabdominal aneurysms and chronic dissections. UHealth physicians also utilize advanced imaging and emerging artificial intelligence-enabled tools to improve diagnosis, procedural planning, surveillance and patient selection.
“In recent years, technology has transformed the treatment of aneurysms. Today there are advanced endovascular devices such as stents or grafts with special branches that allow us to treat complex aneurysms that previously could only be treated with open surgery,” Dr. Rey said. “We have access to technologies that many centers in South Florida still don’t have. This allows us to treat extremely complex cases with better outcomes and faster recoveries.”
But for Dr. Rey, technology is not the only important factor.
“The most important thing is not to see the patient as just an aneurysm,” he emphasizes. “It’s a person who is afraid, who will go through pain and a recovery process. Our job is to understand that and support them at every stage.”
For Castillo, the experience left a clear lesson. When someone receives a difficult diagnosis, it is always worth seeking a second opinion.
“If someone is told there is no solution,” he said, “they should look for another place, another doctor. For me, it meant starting a new life.”
More from the Comprehensive Aortic Center
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UHealth specialists use 3D fusion imaging, a hybrid operating room and minimally invasive procedures to treat complex aortic conditions.
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Tags: cardiothoracic surgery, Comprehensive Aortic Center, DeWitt Daughtry Family Department of Surgery, Division of Cardiovascular Medicine, Dr. Jorge Rey, vascular health, vascular surgery