After a 30-plus year career as an employee benefit plan consultant, Ray retired at age 56. That was two years prior to the time he underwent AAA surgery. He and his childhood sweetheart reside in Connecticut where they've raised two fine sons. They now have an equal number of equally fine grandchildren to dote on.
I've recently learned that I have a 4.5 cm infrarenal AAA. The question now is should I have surgery immediately or wait a bit (with periodic scans) to see what the outcome is of experimental work currently in progress using an endovascular grafting system, specifically one produced by EndoVascular Technologies (EVT). I've sought out and received two contrary medical opinions:
"Have the surgery done immediately" (both my primary physician and a highly regarded general surgeon at the local community hospital). They argue "get it out of the way while your overall health is reasonably good" and "there is a danger of rupture while you wait."
"Wait (at least until it gets to be 5 cm) and see" (vascular surgeon at a major teaching hospital). "EVT (or a similar minimally invasive procedure) is the way these will be done (at some point) in the future" and "all aspects of surgery (and, for that matter, medicine) are improving at a rapid clip, so don't undergo any major surgical procedure until it is necessary."
I wonder if other are in a similar predicament or what individuals who have gone through conventional surgery would suggest.
(Use of EVT is currently experimental and limited to patients who would otherwise be at high risk in case of abdominal surgery. There has been a problem in some patients - which may now be corrected - with the hooks that attach the graft to the wall of the artery. I have no idea (but a great deal of concern!) what data exists on the durability of the graft in comparison to the usual Dacron or Gortex fabric).
Update 11 May 96
Thanks for posting my question on your aneurysm support forum for the last few months. It's now been answered by nature taking its course. As the result of expansion in the size of the AAA to approx 5 cm, I'll be going in for conventional surgery later this month.
Update 30 May 96
Just want to let you -- and the many well-wishers that I received support from -- know that my AAA surgery was preformed a week ago today (in fact, at this time last week I was just about to leave the operating room) and that I was discharged from the hospital the day before yesterday. The total confinement ended up being for five of the originally anticipated seven days
AAA resection is a very invasive procedure -- but it is not the end of the world. (The incision runs from just below my left breast down to the pubic area) Frankly, it hurts . However, most of the pain subsides within a few days and -if you understand what is going on -- is manageable. Drugs were administered at a constant level -- and, under my direct control, at a higher level when pain threatened to become intense -- directly into the nerve block in the spinal column that controls sensations in the abdominal area. This is a big help during the first few days. I observed at least one patient (in the recovery room and ICU during the day or two that follow the operation) who didn't seem to fully understand that he was, to a large extent, in control of how much pain he endured. He suffered needlessly.
I'm now a strong believer that this is a complex area where practice makes perfect. A general surgeon who does just a few of these a year would not be my first choice. My doctor (the hospital I went to is a major New York City teaching facility) felt is was important that I undergo a stress test (that records any existing damage to the heart) prior to surgery to make sure the pump is up to the strain it will be subjected to during the procedure. I met one patient, who as the result of this precaution, underwent another corrective procedure (bypass surgery) prior to having the vascular surgery. It is reassuring to know about the potential for this kind of problem in advance.
Anyway, the bottom line is in the hands of an experienced surgeon everything should be OK. I met several patients in their late 70's who went through the procedure. While there recovery was not as swift as my own (I'm 58 and a 5-day confinement is about as short as they come), they were coming along just fine. The degree of pain (more discomfort at this point) that I feel decreases with each passing day. In another 2 or 3 weeks I hope to be pretty much back to normal.
P. S. While I know from personal experience there is a real fear of a rupture occurring prior to surgery, reality is the chance of that occurring in an aneurysm that is less than 5 cm is apparently pretty small (in fact, it's my understanding they don't do surgery in the UK until 6 cm or a certain rate of expansion is exceeded). So, my advise to anyone who is facing surgery is "get it over with as soon as you can but don't rush into things". You should have ample time to carefully consider whatever choices are available to you. As it turned out in my own case, an option I had considered in lieu of conventional surgery (a currently experimental Endovascular stent), was not a practical choice due to extensive hardening of the arterial wall. Interestingly, even though I had dismissed that alternative prior to the time surgery began, we didn't learn that that condition was so severe until the operation was underway.
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