Patient Hits High Notes after Receiving Advanced Endovascular Repair
According to Richard Noll, a patient in the
(CVI) at Beth Israel Deaconess Medical Center (BIDMC), music performed by a
great band can be “divine intervention.” Today, Noll continues to fulfill
his lifelong passion to make music, thanks to advanced medical
The 78-year-old resident of Lakeville, Mass., is a retired school music
director who still plays the trumpet in the choir of his church, where he
is Eucharistic minister at the daily mass. Noll also considers himself
blessed to be with four children and 14 grandchildren.
Most importantly, he feels lucky to be alive, thanks to an advanced medical
procedure at BIDMC that repaired his abdominal aortic aneurysm (AAA) — a
bulge that occurs where the aorta, the main blood-carrying artery, develops
weakened arterial walls where it passes through the abdomen. This
procedure, which preserves the flow of blood and prevents potentially
lethal rupture, is known as fenestrated endovascular aneurysm repair
Marc Schermerhorn, MD
, Chief of
at CVI, was the principal investigator who recently helped develop the
sophisticated software used in FEVAR. He is one of the region’s few
vascular surgeons who specialize in this technique.
A Journey Toward Heart Health
Noll (right) survives his father and four brothers, all of whom died of
In 1988, Noll underwent successful open heart surgery. Striving to adopt a
healthy cardiovascular lifestyle, he started walking five miles a day and
He credits these changes, along with his faith and outstanding physicians,
for helping him persevere to the point where he now goes to the gym every
day and feels “stronger than ever.”
As a band leader, Noll maintained an active routine and was often on the
road with bands in Long Island, NY. After moving to Lakeville, he became
the musical director of the Apponequet Band of 100 musicians. Mindful of
his family’s medical history, however, Noll went for regular check-ups with
his local cardiologist and his primary care physician.
In the fall of 2014, Noll told his primary care doctor that he “felt
something funny” in his stomach. While there weren’t other obvious AAA
symptoms (which is typical), the doctor thought Noll may have been at risk
and in need of further consultation. He referred Noll to Schermerhorn.
At BIDMC, Schermerhorn performed a high-resolution CT scan. These
computerized X-rays that form a picture of the aneurysm verified that Noll
had an AAA. Schermerhorn explained to Noll the options for patients with
Open surgical repair:
This proven medical procedure involves a large incision made in the
abdomen. It is more invasive and has a longer recovery time than
minimally invasive endovascular aortic repair (EVAR).
Standard EVAR, recommended for most AAA patients, typically involves a
small cut near each hip to get to the femoral arteries, although
Schermerhorn and his team perform this procedure through a simple skin
puncture (an advanced technique). Through these punctures, a graft in
the shape of a fabric tube is inserted to seal off the aneurysm and
creates a new path for blood flow.
Fenestrated endovascular aortic repair:
FEVAR is a special kind of EVAR for patients like Noll whose normal
aorta below the kidneys is too short to form a seal with the standard
endovascular (“inside a blood vessel”) stent, which holds the graft in
place. Fenestrations are precisely-placed holes in the graft that allow
blood to continue to flow into the kidneys and intestines.
Schermerhorn consulted with Noll's doctor, and they determined that FEVAR
was the preferred treatment.
FEVAR was approved by the FDA in 2011 but recently, the technique used in
the procedure has become more refined, thanks to advanced proprietary
software known as VesselNavigator. Schermerhorn helped to develop this
software for the manufacturer. This innovative tool uses CT scanning to
produce three-dimensional “road-mapping,” which improves accuracy by
helping the surgeon to visualize the exact positioning of the graft inside
the blood vessels during the procedure.
The benefits of using the Vessel Navigator for aortic procedures such as
FEVAR include reductions in radiation dose, fluoroscopy (X-ray) time,
contrast agent dose, and length of procedure.
Noll’s two-and-a-half-hour procedure in October 2014 was followed by a
two-day hospital stay, after which he was discharged with a one-month
prescription for Plavix to help prevent blood clots.
Noll had no complications. Recovery is usually a week or two. He was back
to playing his trumpet and serving communion within a month.
Trumpeting a New Approach
Says Schermerhorn (right), “This new approach gives patients a decided
advantage they didn’t have in the past. Being a bit of an ‘IT geek’ has
helped me further my role as a cardiovascular specialist.”
“I was happy to go to BIDMC, where many in my family received excellent
care,” says Noll. “I wouldn’t go anywhere else. Dr. Schermerhorn and his
team are great communicators and great clinicians.”
Schermerhorn, who has published articles about FEVAR, says that
VesselNavigator is now being used for standard EVAR as well. He is hopeful
that many more patients with AAA, like Noll, will benefit from this new
technology in the future. He has a special feeling about the impact FEVAR
had on restoring Noll to his normal activities — Schermerhorn studied music
in college and still plays guitar.
Noll continues to see Schermerhorn for checkups, the last of which revealed
that “He is doing perfectly well with no limitations.”
“My quality of life isn’t good, it is excellent!” says Noll. “Younger guys
at my gym ask me how I do it.”
He adds, “In my field, musical excellence requires a certain amount of
precision. With medicine, the stakes are much higher. I’m here today, still
playing the trumpet, because I have my faith, my will-power, and my
Above content provided by the CardioVascular Institute at Beth Israel
Deaconess Medical Center. For advice about your medical care, consult