Gary Pratt is a man whose garage in Parker reflects his passions. A 21-foot Yamaha speedboat and accessories, including an Air Chair hydrofoil (basically, a fat waterski with a chair going up and a stainless-steel wing going down), occupy about two-thirds of it. The rest is crammed with a wood shop cluttered with lumber, a band saw, a disk sander, a drill press, Jorgenson hand screws, corner clamps, and various other tools.

Whether he’s artfully shaping it or zipping around Lake Powell or the Cherry Creek reservoir in it, Pratt is into stuff that floats. Had it not been for an incidental finding on an MRI a little over five years ago, it all might have sunk with their owner’s premature demise.

The scan confirmed that Pratt, now 78, had spinal stenosis that was causing him back pain. It also depicted something else that the radiation technologist happened to note. His abdominal aorta – which pipes blood from the heart to supply much of the torso and the entire lower body – as well as his neighboring iliac arteries were stretching out. That distending, when it grows to one-and-a-half times the artery’s typical diameter, gets classified as an aneurysm. In this case, Pratt was headed toward more than one of them – an abdominal aortic aneurysm (AAA) as well as iliac aneurysms.

The retired U.S. Air Force officer and grandfather of four was exceptionally healthy, biking, hiking, and skiing in addition to his boating exploits. He has never been a smoker, so the most common AAA risk factor did not apply (smokers have a lifetime AAA risk of about 10.5%). But he is male (men are vastly more susceptible) and while young at heart, Pratt was no longer young. About 3% to 5% of men over 60 have AAAs, and some studies have estimated that number to be as high as 9%.

But there was one major concern. Pratt’s father had died of a brain aneurysm at age 64, and his mother had been left a paraplegic after open surgery to repair an abdominal aortic aneurysm when she was in her 80s. If Pratt at some point were to have had an aneurysm rupture while shaping wood, riding his Air Chair, or about anywhere else, his survival chances would have been less than one in five. Even those who make it to the hospital have a 30% to 50% mortality rate.

The U.S. Preventative Task Force recommends a one-time ultrasound screening for abdominal aortic aneurysm for men over 65 who have ever smoked and selectively for the general male population over 65 who have never smoked. Such screening has been shown to reduce risk of rupture among men ages 64 to 83 by about half. Pratt had not been screened. He had, quite simply, been lucky.

Surveillance program first before surgery

In October 2018, Pratt and wife, Kelly, saw Dr. Max Wohlauer, a University of Colorado School of Medicine vascular surgeon, at UCHealth University of Colorado Hospital on the Anschutz Medical Campus. Wohlauer performed an in-clinic ultrasound scan that confirmed what the MRI had spotted.

Surgery is the only way to reduce the risk of an abdominal aortic aneurysm rupturing. The larger the aneurysm, the greater the risk of rupture. When detected early, though, larger aneurysms can be scheduled for repair. Wohlauer suggested surveillance.

Wohlauer established a surveillance program with Pratt, monitoring him for aneurysm growth. Every six months, Wohlauer would do an ultrasound, and there would be an annual CT scan.

While Kelly Pratt worried at first that the delay would put her husband of 48 years at risk, one checkup after another over the next two-and-a-half years came back showing minimal arterial expansion. By June 2021, though, one of Pratt’s iliac arteries had swollen to the point that Wohlauer said it was time to intervene.

As he did with all his patients, the surgeon walked through the two repair options: open surgery and an endovascular procedure. Open surgery involves more immediate risk and a longer recovery time, but enables the more reliable suturing of the grafts and sleeves designed to take pressure off the artery.

Patients undergoing an endovascular repair are often back home the day after having endografts inserted through a small incision near the groin and placed via the femoral artery. They typically recover completely within a couple of weeks. These self-expanding stents have been proven highly reliable, too, but being held in place primarily by radial pressure against artery walls augmented by small anchoring barbs, they must be monitored going forward.

His mother’s experience with the open procedure made the endovascular approach an easy decision for Pratt. The real complication for him was that it was boating season. He asked Wohlauer if the repair could wait until the weather cooled off again.

“Just some time in the next six months would be best,” Wohlauer advised.

Those with risk factors should consider abdominal aortic aneurysm screening

In October 2021, with Pratt’s boat back in the garage for the winter, Wohlauer inserted seven stents to fortify its owner’s abdominal aorta and iliac arteries, likening the effort to assembling the interlocking components of a modular home. Pratt viewed it as overhauling an auto engine via the tailpipe. After the procedure, Wohlauer visited Kelly in a hospital waiting room and sketched out on paper where he had placed the stents.

Pratt was home the next day, and the day after that, he walked up and down the stairs 13 times to get some exercise. A CT scan a month after the surgery showed the grafts to be doing their jobs, and annual checkups ever since have confirmed their staying power.

The Pratts are thankful for Wohlauer’s and his team’s work.

“He was calm, he didn’t make you feel more nervous than we needed to be, and he would explain things as many times as I asked questions,” Kelly said.

Wohlauer says Pratt’s case illustrated the importance of men over 65 who have risk factors ranging from smoking to family history to get screened for possible abdominal aortic aneurysms.

“He’s not a guy that had obvious risk factors,” Wohlauer said. “That’s why his family history was important.”

Pratt stepped from the garage housing his buoyant hobbies into the January sun. He had been lucky, true. But he had also followed up.

“If you think you may have an issue, do something about it,” he said.