Bakery Owner Back on His Feet After Spinal Epidural AVF Surgery
Juan Arellano was about to deplane after a two-hour flight when he realized he couldn’t feel his legs.
“That was the first time I could not move,” he said. “I was thinking: What’s wrong with me?”
He regained the feeling in his legs shortly after, but the incident led him to his orthopedist’s office. Maybe it was a complication from his knee replacements, he thought.
“The doctor said, ‘No, there’s nothing wrong,’” Juan recalled. “Everything was circulating properly.”
The Search for Answers
A few months later, Juan found himself in an emergency room instead of at a wedding he’d planned to attend. He was about to get ready when his wife, Maricela, heard him calling from the bedroom.
“I can’t feel my legs,” she remembered him yelling.
Maricela drove Juan to the nearest hospital, where he underwent a computed tomography (CT) scan of his spine and blood tests. The results of both came back normal. The emergency department staff recommended he cut back his hours at work and follow up with his primary care physician.
Around that time, Juan began experiencing weakness in his legs at the end of every work week. He and Maricela own a bakery called La Purisima, which they opened in 1983 after moving to the Phoenix area from Chicago. He does much of the baking himself, a trade the former machinist learned from his father.
“He’d be working Tuesday through Friday, but come Saturday, he just couldn’t handle it anymore,” Maricela said.
Juan found himself relying on a cane to move around the bakery on Saturdays. But after resting on his days off, he regained his strength each Tuesday.
The pattern continued week after week, until one Saturday when Juan couldn’t walk even with his cane. One of his sons and another employee had to carry Juan to his car and drive him home.
Juan rested and felt better by dinnertime. He and Maricela opted not to go to the emergency department since their previous visit hadn’t given them any answers. They did, however, consult with their family physician, who sent Juan to a neurologist.
The neurologist ordered an MRI, which didn’t clearly show the problem but did appear suspicious. That’s when Juan received a referral for Andrew Ducruet, MD, an endovascular neurosurgeon at Barrow Neurological Institute.
The Diagnosis: Spinal Epidural Arteriovenous Fistula
When Juan met Dr. Ducruet on April 7, 2021, he knew he’d found the right person to help.
“I even cried the first time I saw him,” Juan recalled.
Dr. Ducruet scheduled Juan for an angiography, which involves injecting a special dye into the blood vessels to provide more detail on imaging scans.
The neurosurgeon looked up and down Juan’s spine for several hours on April 21 last year before finally locating the culprit: a spinal epidural arteriovenous fistula. It was putting pressure on Juan’s spinal nerves.
An arteriovenous fistula (AVF) describes an abnormal blood vessel connection that causes blood to bypass capillaries and instead flow directly from an artery to a vein. It’s one of the few times in his career that Dr. Ducruet has seen an AVF in the epidural space—between the dura mater and the bony wall of the spinal canal. Such malformations are more likely to form within the dura itself, which is the tough layer protecting the spinal cord.
Because spinal epidural AVFs are so rare and challenging to spot on imaging tests, they are often misdiagnosed, Dr. Ducruet said. Symptoms of these lesions also tend to progress very gradually. However, left untreated, they can eventually cause permanent paralysis.
Dr. Ducruet had initially planned to treat the blood vessel abnormality once he found it. However, with the angiography taking longer than expected, he decided not to keep Juan under anesthesia any longer that day.
The Treatment: Endovascular Embolization
Juan returned for an embolization of the AVF on May 5. The procedure involved guiding a thin, flexible tube called a catheter to the site of the lesion and using it to inject a glue-like substance to seal the AVF off from blood flow.
Maricela thinks of it like carpentry work.
“The walls, after a while, they crack,” she explained. “As you age, something happens inside of you. Within time, it sort of started cracking. The glue was the plastering they did on his back.”
Juan stayed one night in the hospital as a precaution, adding that he received excellent care from his nurse.
“She was so sweet,” Maricela agreed. “She took care of him as if it was her papa.”
Juan’s recovery was smooth and steady. It wasn’t long before he was back to baking everything from empanadas to conchas.
“I know I don’t need to work,” said Juan, who is now 72 years old, “but I like to work. I like what I do.”
The Outcome: ‘Dr. Ducruet Saved My Life’
Juan has returned to his routine of waking up at 4 a.m. and heading to the bakery around 5:15 a.m. Sometimes he wraps up his day at noon—other times 3 or 4 p.m. Lately, he’s been balancing baking with business meetings, as he and Maricela are planning to expand one of their two locations.
I think Dr. Ducruet saved my life. My legs are part of my life.Juan Arellano, Barrow Patient
“Cases such as Juan’s are incredibly satisfying for us,” Dr. Ducruet said, “because we are able to take a person who has been suffering progressive symptoms over an extended period of time, and after the correct diagnosis is made, we are able to reverse much of the pathology and give the patient back their quality of life.”
Juan sees Dr. Ducruet every six months for follow-up MRIs of his spine. He and his wife of 51 years said they appreciate the surgeon’s ongoing commitment to Juan’s outcome and support throughout the process. They praised his kindness, patience, and comforting bedside manner in addition to his knowledge and expertise.
“I think Dr. Ducruet saved my life,” Juan said. “My legs are part of my life.”