Fate brings accident victim to BAMC for groundbreaking procedure

By Lori NewmanJune 26, 2023

Fate brings accident victim to BAMC for groundbreaking procedure
1 / 4 Show Caption + Hide Caption – Madisyn Cardenas, center, is pictured with her family after a graduation ceremony for her sister Larissa Sanchez at Texas A&M University in Kingsville, Texas, May 12, 2023. From left, dad Stephen Cardenas, brother Stevie Cardenas, sister Larissa Sanchez, Madisyn Cardenas, mother Jennifer Cardenas, sister Natalie Villarreal, not pictured is brother Trystan Edison. Cardenas was severely injured in a roadside accident on Oct. 5, 2022 and brought to Brooke Army Medical Center for care. (DoD courtesy photo) (Photo Credit: Courtesy) VIEW ORIGINAL
Fate brings accident victim to BAMC for groundbreaking procedure
2 / 4 Show Caption + Hide Caption – Madisyn Cardenas on extracorporeal membrane oxygenation, or ECMO, after being severely injured in a roadside accident in Southeast Texas on Oct. 5, 2022. Cardenas was treated for multiple injures at Brooke Army Medical Center, one of two Level I trauma centers that serves San Antonio and 22 surrounding counties. (DoD courtesy photo) (Photo Credit: Courtesy) VIEW ORIGINAL
Fate brings accident victim to BAMC for groundbreaking procedure
3 / 4 Show Caption + Hide Caption – A medical team from Brooke Army Medical Center preformed a groundbreaking procedure using a thoracic branched endoprosthesis, a first-of-its kind, FDA-approved device designed for repairing problems with the arch of the aorta at Joint Base San Antonio-Fort Sam Houston, Texas, Oct. 6, 2022. From right, Army Lt. Col. Wayne Causey, vascular surgeon; Army Capt. Olivia Pearry, general surgery resident; Air Force Maj. Jeremy Bolin, vascular surgeon; Army Capt. Ethan Maulsby, anesthesia resident; Beth Maddox, surgical technologist; Army Maj. Alex Paladino, cardiovascular anesthesiologist; and Diana Allen, surgical technologist. (DoD courtesy photo) (Photo Credit: Courtesy) VIEW ORIGINAL
Fate brings accident victim to BAMC for groundbreaking procedure
4 / 4 Show Caption + Hide Caption – Left: Intraoperative picture demonstrating placement of the graft over the torn aorta (blue arrow). Pictures to the right demonstrate the postoperative imaging at one month showing perfect alignment and coverage of the Thoracic Branch Endoprosthesis (blue arrow). (DoD courtesy graphic) (Photo Credit: Courtesy) VIEW ORIGINAL

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas, June 26, 2023 – Fate forever changed the life of an 18-year-old girl who was severely injured in a roadside accident.

Madisyn Cardenas was driving back to San Antonio from her parents’ home in southeast Texas excited to embark on her “life journey” with her best friend.

“We were moving to New Braunfels to be roommates and live our best lives,” she said.

But that night something happened on the road along the way.

“I approached a wrecked vehicle in the middle of Highway 37 just South of Pleasanton and saw a woman needing help,” Cardenas explained. “I didn’t know at the time, but she had been in a hit and run accident prior to my arrival.”

Cardenas pulled over and ran across the highway to help.

“As I got closer to her and asked her if she was okay, she replied ‘no’ and at that moment I looked up and saw headlights coming,” Cardenas said. “I remember thinking, help is here. But as I watched them get closer, it was too late when I realized they were not stopping.”

The vehicle, traveling about 65 mph, struck them. The woman who she was trying so desperately to help died at the scene and Cardenas was thrown over 30 yards down the highway median.

“My memory is sporadic from the moment of impact to about 10 days into my stay at BAMC,” she said. “I knew I was injured but between the medications EMS gave me, and the shock and adrenaline, I didn’t know the extent of them. I ended up having multiple and severe injuries.”

Cardenas had a torn aorta, broken hip, pinky finger, pelvis, and clavicle; lacerated tongue; separated abdomen; kidney lacerations; colon tear; brain hematoma; and multiple cuts, bruises, and puncture wounds.

“The scariest of all was a tear in my aorta that went undetected until my arrival at BAMC,” she explained.

At BAMC, Cardenas met vascular surgeon Army Lt. Col. (Dr.) Wayne Causey, who had just completed training on a new technology to repair a torn aorta. The aorta is the main artery that exits the heart and carries blood to all the organs and the rest of the body. After leaving the heart, the aorta branches to the arms and the brain before running down the back of the chest (thorax) into the abdomen, splitting to each leg.

Typically, repairing the aorta would require a minimally invasive procedure called a Thoracic Endovascular Aortic Repair, or TEVAR. However, because Cardenas’ anatomy was a little different than the average person, the procedure was more complex. Causey, assisted by Air Force Maj. Jeremy Bolin used a thoracic branched endoprosthesis, a first-of-its kind, FDA-approved device designed for repairing problems with the arch of the aorta, the first portion of the aorta as it exits the heart.

“Normally the artery that goes to your right arm and right brain is the first branch off of the aorta, but hers is the last branch,” Causey said. “In her case it wrapped backwards, so the options to fix this injury were to have bypasses done from the neck arteries to the arm arteries on both sides or use this new technology that had only been available for a few months.”

Thankfully, a few weeks earlier Causey had attended a two-day course to learn how to use this new type of graft. At the time, only two surgeons in the San Antonio area were trained to use the technology, he said.

“We were the first in the DOD and the first in San Antonio to use this device,” Causey said.

The company that produces the novel graft, confirmed that this was the first thoracic branch endoprosthesis procedure performed in the Department of Defense and in San Antonio.

“We determined that this procedure would be the best option for her, because she was also bleeding significantly from her kidney and was in the ICU getting blood transfusions,” he said. “With the extent of her injuries, she wouldn’t have done well with invasive vascular surgeries. Her hospital course later proved that to be very true when her lungs failed to oxygenate her blood during her orthopedic finger repair.”

The vascular surgeon spoke very openly preoperatively with Cardenas and her mother to explain the novelty and details of the procedure, as well as the significant risks involved.

“When Dr. Causey explained her complicated surgery would be more complicated due to her unique anatomy, and this new custom graft was being flown in, I definitely had an internal shock factor come over me that left me numb in the moment,” said Jennifer Cardenas. “He assured me he had the best colleagues at his disposal and together they would figure out the best plan of action for her. He explained the very high risks involved and that he had high hopes for a successful intervention.

“I had no choice but to agree, and thank him over and over again,” she added. “When I hung up, I was swallowed by emotion of fear and hope all at the same time.”

Causey needed to get approval from the manufacturer and hospital leaders to get the special graft.

“Leaders at all levels were extraordinarily supportive when it came to bringing this new technology to the hospital,” he said, noting that many factors aligning together would quickly lead to a positive outcome for the aortic repair.

Unfortunately, Cardenas wasn’t out of the woods yet. The following night she underwent emergency surgery to stop the bleeding in her right kidney and three days later she ended up on Extracorporeal Membrane Oxygenation (ECMO) because she wasn’t able to oxygenate her blood properly.

“She was only on ECMO for about 24 hours, and thankfully her respiratory failure quickly resolved,” Causey said.

“I will never forget, after I was weaned from ECMO and the ventilator, getting a visit from Dr. Causey,” Cardenas said. “Not only did he save my life, but he changed my life. He spoke to my spirit without even knowing it. I’ll always hold him dear to my heart; no pun intended.”

Cardenas said she was struggling with her faith, but Causey told her what a miracle it was that she had survived and how very precious life is.

“I will never doubt that again,” she said. “I never want to forget what God did for me through my amazing doctors. I will forever consider them my angels on earth. I would not be here if it weren’t for the team at BAMC. They truly are world class professionals who genuinely love what they do. They saved my life!”

Cardenas’ mother agrees, “Madisyn's care while at BAMC is why she is with us today. Every nurse, doctor and surgeon that crossed our paths treated her as if she was their own. Her life was saved multiple times and I truly believe it was only because of the attention and dedication these people gave her.

“I will never in my lifetime be able to express the gratitude we have to each and every one of them for giving us back our baby girl,” she added. “Any time I recall this event or think about the staff there or look into her eyes, I am overcome with thankfulness. There is not a doubt in my mind that each person involved in Madisyn's case was handpicked by God himself to save her life.”

More than six months later, Cardenas is still recovering physically and emotionally.

“The hardest part of my recovery is unseen,” she said. “I am not doing well with the emotional and mental damage this has caused me. I wanted to save her, and I couldn’t – I’m not sure I’ll ever be over that, honestly. I just keep praying that I can overcome.”

That being said, Cardenas is hopeful about her future.

“I was given a second chance and I have reached out for help so that I can fully recover and find my light and my way,” she said. “God has big plans for me, or he wouldn’t have intervened multiple times to save me.

“I will be ok; I will have the family I always dreamed of, and I will live a healthy and happy life,” she affirmed. “Recovering from something like this takes time and that has been my biggest hurdle, but I plan to fight through my dark days and use this experience to help me be a light in this world.”