Rich McManus, 67, is a pretty lucky guy. In February of 2020, he had a fairly routine CT scan after a diagnosis of acute pancreatitis. That scan may have saved his life. The CT picked up something unexpected and much more concerning—a thoracoabdominal aortic aneurysm.
Most commonly found in men over the age of 65 with a history of smoking, an aortic aneurysm is a bulge or weak spot in the wall of the aorta, the largest artery carrying blood to the body. A thoracoabdominal aortic aneurysm is located in both the chest and abdomen.
An aortic aneurysm is like a ticking time bomb. If the aneurysm ruptures, it causes internalbleeding. Fifty percent of people die immediately. Of those who make it to the hospital, about half have significant complications, many of which can be deadly.
Shivani Kumar, MD, vascular surgeon, Tufts Medical Center
Rich’s aneurysm was still small since it was caught early, and didn’t require immediate attention at the time. But he had scans every 6 months to monitor it, and over the next few years, the aneurysm steadily grew until it reached 5.9 cm—meeting criteria for surgical intervention.
In the Fall of 2023, Rich was told his aneurysm was in a particularly difficult location, involving the blood supply to his small and large intestines, upper-GI organs (including the stomach, liver and pancreas) and both kidneys. This meant that the standard minimally invasive procedure would not be an option for him. Rich was told he would need open heart surgery with a partial cardiac bypass (and all the risks associated with it), a large incision on his chest, a week in the ICU, one-to-two months in rehab, the potential for temporary dialysis and up to 6 months for a full recovery. Unsurprisingly, this was not a particularly appealing approach for Rich.
“I was basically told that they’d need to open me up from my armpit to my navel,” he said. “I had recently started a new job as a Duck Boat narrator in Boston, and the lengthy recovery would mean I’d have to miss the entire 2024 tourist season.”
Rich asked if there were any other options for addressing his aneurysm, and if he could safely wait to have the procedure until the Fall of 2024. He was told that there was a new device and procedure in the pipeline that was much less invasive, but it was still being tested in clinical trials for safety and efficacy. Rich’s doctors felt it would be safe to wait until the following fall to see if this new option would be FDA approved, and if so, if Rich would be a good candidate for it.
Rich made it through the tourist season, and when he followed up with his medical team in the fall of 2024, he received doubly good news: the device and procedure had been FDA approved earlier that year and the size and location of the aneurysm and his individual anatomy made him a perfect candidate. He was referred to Dr. Kumar at Tufts Medical Center in January of 2025 to learn more about the approach, called Thoracoabdominal Branch Endoprosthesis (TAMBE).
TAMBE is a medical device and procedure used to prevent rupture of thoracoabdominal aortic aneurysms. The device is a specially-made stent graft that is implanted inside the aorta to cut off blood flow to the aneurysm, prevent rupture and cause the bulge to shrink. The device is inserted around the aneurysm in the aorta through a blood vessel. Only two small incisions, in the chest and the groin, are needed.
“TAMBE offers a much less invasive and durable option than open thoracoabdominal surgery for patients who meet the criteria,” said Dr. Kumar. “We use a minimally invasive, endovascular approach through the arteries and repair the problem from the inside, rather than the outside. There is no need for a partial bypass or reducing blood flow to vital organs. TAMBE requires less time in the OR and a shorter hospital stay, and it results in a faster recovery, fewer complications and overall better outcomes for the patient.”
Rich was impressed with Dr. Kumar and the benefits that TAMBE could offer him. The surgery was scheduled and Dr. Kumar performed the TAMBE procedure on March 13, 2025. She put a stent in Rich's aorta and placed stent-grafts in four critical arteries to maintain proper blood flow to his vital organs. Rich became just the second person in Massachusetts to benefit from TAMBE since it was FDA-approved; Dr. Kumar performed both of these TAMBE surgeries (the first of which was in January 2025), and is the first and only vascular surgeon to perform a TAMBE procedure in MA since its FDA approval.
The surgery went smoothly and was successful. After the procedure, Rich was extubated in the operating room and then moved to the ICU for blood pressure control and spinal drain removal. He left the ICU on the third day and was discharged the following day, March 17. He walked out of the hospital and went straight home with no rehab needed.
Now, several months out from his surgery, Rich is feeling good, looking forward to getting back to his Duck Boats job later this month and doing some traveling this summer, which he hasn’t been able to do in several years.
“Rich has recovered extremely well from the TAMBE procedure and both his short- and long-term prognoses are excellent,” said Dr. Kumar. “He is fully cleared to return to normal function with no restrictions on lifestyle or activities.”
“I am getting better every day and am grateful to have had TAMBE and the much shorter recovery and much faster bounce-back that goes along with it,” said Rich. “It reduces so much stress and gives me peace of mind to know I can go back to living and enjoying my life.”
