From Palm Beach Post, August 09, 2005, by Stephanie Horvath

BOYNTON BEACH — For Clyde Freint, it was all about the odds.

A weakened blood vessel leading to the 75-year-old man''s heart had a baseball-sized aneurysm, a swelling that could burst with deadly results. He had two options. Open-heart surgery would give him a one in 10 chance of dying. A new procedure, which his cardiologist had never performed, would improve those odds to one in 8,000.

"That''s pretty good odds compared to one in 10," Freint said, while sitting at his dining room table Monday. "It sounded like a good idea."

On Friday, Freint lay fully conscious on an operating table for three hours while doctors at JFK Medical Center in Atlantis threaded a catheter up from his groin to his heart and placed a stent inside the aneurysm, relieving pressure on the walls of the blood vessel. It was the first time the procedure had been done at JFK, and the doctors think it might be the first time in the United States that a stent intended for the leg or arm was used near the heart.

Dr. Jay Midwall, the JFK cardiologist performing the procedure, equated it to threading a needle through a basketball: Once the needle is in, it''s hard to find the tiny hole on the other side of the large open space.

The procedure was successful, and Freint went home for the weekend, the threat of a burst aneurysm behind him.

"I was elated because I was so concerned about having open-heart surgery. It was just a joyous thing to hear," Freint said.

Freint found out about the aneurysm in February after his ear, nose and throat specialist, in search of why one of his vocal cords had stopped working, determined that an aneurysm near his heart was pressing on the cord''s nerve.

Freint had triple bypass surgery in 1985 and one of the veins taken from his leg for the surgery had developed the aneurysm, which is uncommon but not unheard of. Freint''s other two bypasses were clogged, leaving him with blood flowing through just one good artery.

"I had never really seen anything like this. We didn''t know what to do at first," Midwall said.

Freint didn''t want to have surgery, and his aneurysm was 8 centimeters in diameter, too large to use stents made for the heart. Midwall discussed the case with Dr. John Lasala, a St. Louis interventional cardiologist who was in town giving a lecture.

Lasala, who is the director of interventional services at Barnes-Jewish Hospital at Washington University, said he''s seen about four cases like Freint''s in the past seven years. He has used stents made for the heart for some of them.

"The vein grafts used to be veins in your legs and are used to a very low-pressure environment," Lasala said, adding that veins are under much more pressure once they are used as heart bypasses, making it possible for aneurysms to develop.

Midwall came up with the idea of using a stent designed for aneurysms in the arm or leg and suggested it to Freint, who then got second opinions from eight doctors. All of them said the same thing: Have open-heart surgery.

"I struggled with the decision for a couple of months because everyone was saying have open-heart surgery. It''s hard to go against the world, and one doctor is saying he can do it," Freint said.

He decided to go for it, figuring he could always have surgery later. On Friday, Freint lay on the operating table while Midwall and Lasala struggled to thread the catheter through the aneurysm so they could insert the stent. After three hours, the stent was inserted. Freint went home the next day.

Midwall and Lasala plan to write about the procedure for a medical journal.

"We thought we had a very slight chance of being successful," Midwall said. "The patient is fine. It was a gorgeous result."