From the Kinked Wire


From crisis to care How interventional radiology saved Sebastian Junger’s life


Sebastian Junger, the New York Times best- selling author of In My Time of Dying, The Perfect Storm and more, wrote about his near-


death experience due to a ruptured aneurysm. Junger was treated by interventional radiologist Philip J. Dombrowski, MD, who features in his book.


Junger will be a special guest at SIR 2025, joining Daniel Y. Sze, MD, PhD, FSIR, and Merve Ozen, MD, on a panel regarding patient- focused care.


Dr. Dombrowski and Junger reunited to discuss Junger’s book, treatment and patient experience on a recent episode of the Kinked Wire. To learn more about Junger’s experience, listen to the full episode or read a brief excerpt below.


The following transcript has been edited and condensed for flow.


Philip J. Dombrowski, MD: I got a call late on a Sunday night that somebody was coming in with a presumed hemorrhage. Initially, they assumed that he had some acute process going on in his belly, but wasn’t quite sure what, and that led, of course, to a CT scan, which demonstrated that he had a huge hematoma in his retroperitoneum. Once the CTA was done and interpreted, it was apparent that he had a gastrointestinal artery aneurysm that had ruptured.


[At our facility,] not only do we have a good team of people in the ER, but we have a multidisciplined approach in terms of working collaboratively with vascular surgery, interventional cardiology and IR to really provide the best possible care for our patients. [The vascular surgeon] on call that night knew that taking Sebastian to the OR was going to be devastating, and the morbidity and mortality associated with trying to operate on a situation like this is just dismal. So, he called me, and I activated the staff and we got prepared to take him to the angio suite.


Warren Krackov, MD, FSIR: Sebastian, you write so eloquently about your perspective while you were in the ER, and it sounded like they were trying to maybe put a central line or something in your neck. What was that like for you?


Sebastian Junger: I had just hit the ER, and I was feeling okay on the ride down. I think I was in compensatory shock. My mind cleared, my cognition improved, [but] I had a lot of pain in my belly. And I lost control of my bowels, which was alarming. I just didn’t understand it and it was quite painful. But I hit the ER and I just went off a cliff and it was very disorienting and the next thing I knew there were 12 people around me.


It never occurred to me that I was in there for something serious. I was like, “What is this party for?” And that gave me a sense that something was a lot worse than I realized. When they asked my permission to put a line into my jugular, I didn’t understand why. I said, “You mean in case there’s an emergency?” And he said, “No, this is the emergency.” I mean, I had no clue.


One takeaway from this is that I think we can assume many people who are dying have no idea they’re dying. Their cognition is compromised. And while [the seriousness] might seem obvious to you, they just think they’re in for belly pain and have no understanding that this is serious business.


Warren Krackov, MD, FSIR: Phil, from your perspective, what was going on?


Philip Dombrowski, MD: I was pretty much focused on trying to get the job done and get to where we needed to be. When we first got to the angio suite, most of us would typically go from the femoral approach. Based on the CT scan that showed he had the typical arcuate ligament syndrome, where the celiac axis was pretty much obliterated, we knew he had huge collaterals arising from the inferior pancreatic duodenal arcade. So, our initial approach was to get up through those collaterals and embolize and hopefully take care of it. But when we started trying catheters and microcatheters, we saw that the problem was kind of up toward the origin of the celiac.


After a couple hours of trying different approaches, it just wasn’t working. As you know, we can’t just empirically shut down vessels, considering the degree of hemorrhage he had. And we couldn’t just put a couple coils in and hope for


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