I am a 73 year old male who suffered a mild heart attached 12 years ago. During a routine physical with my cardiologist he pressed my stomach with his fingers and without comment sent me to see a vascular surgeon. That was 1 1/2 years ago. The surgeon ordered a ultrasound and advised me that I had an abdominal aortic aneurysm measuring 4.8 centimeters. He advised monitoring it every six month for further growth evidence. My second ultrasound still showed 4.8. However a third one just this past July measured 5.2 centimeters.
Now he said you have three choices 1) surgery to fix it 2) continue to monitor it 3) do nothing (and run the risk of rupture and death).
I inquired about the new leg groin procedure with the stent and and he said that procedure wouldn't work in my case because the aneurysm was pushing up a little higher than he'd like to see against the renal arteries.
I opted to have another ultrasound in 3 mo instead of 6. I am moving to a new house and want to get settled in first. Am planing to call him about mid September though and tell him I'm ready to have him fix it.
I reviewed the web site -yoursurgery.com-. Very informative.
What do you think? Am I being prudent?
Update: 14 Sep 2002
Well, we got moved into the new house and are about 40% settled in. What an ordeal! I did managed to get in during all the confusion a visit with my family Dr. to dicuss the AAA and my secondary insurance carrier. He said I was much too young (73) and active not to have surgery but to check with my cardiologist to make sure the "ticker" was up to it.
I have been married for 45 years have 3 children and 8 fine grandchildren ages 2 to 17. I am college educated and served as a radioman in the US army signal corps during the Korea war. I retired after 37 years in 1991 as a representative for a major computer company.
My heart attack in 1991 was caused by a 99% blocked circumflex artery which was successfully reopened by balloon angioplasty. I have had no trouble since. I take daily an aspirin, and 20mg Zocor and walk 3 miles each day. I weigh 165lbs the same as I did at age 25 and am considered quite fit.
I visited my cardiologist on 9/11 (an easy date to remember)He prescribed Toprol, a beta blocker to reduce BP and the pressure on the AAA and set up a Cardiolite stress test for October 3rd. I also learned the AAA is above the renal (kidney) arteries and into the ciliac area which is why the endograft stent is out. This further complicates the surgery. I'm concerned now about kidney failure. I'm still set for a Nov 1st U/S with the surgeon's office.
Stay tuned!
Update: 1 Nov 2002
The 10/1 cardiolite test went well. I have had several of these over the years since my HA and knew what to expect. They used to call them thallium stress tests and identified possible coronary blockages. But everything was OK and he approved the OK for surgery. I now await my 11/1 ultrasound test with the surgeon.
11/1/2002
One of the major hospitals in our city also houses
the Indiana-Ohio heart center and is staffed by 1/2 doz surgeons
and is where I have the ultrasounds done. I was accompanied by my
wife and youngest daughter who is an emergency room RN and former
surgical nurse at the center. Is nice to have an inside tract on
the personnel there.
The u/s showed no change. But as mentioned before the AAA is high up beyond the renal arteries and involves the stomach and spleen arteries as well as the kidney arteries. This happens I'm told in 10% of the cases. I questioned the senior surgeon of choice in detail.
The repair would involve grafting these vital organ arteries to the graft and entry would be made thru the side under the rib cage as well down the front to repair the AAA. Quite a complex deal with a 90/10 success ratio. I was very depressed to hear the explanation and almost sorry I asked.
The AAA is 5.3cm and typically grows about .5cm per year.
There is no urgency since the AAA is stable. But it eventually would need repair. And the older one is the harder on the system. I haven't made the decision yet since this doesn't appear to be a simple operation like most I've read about. But am leaning on having it fixed. After much agonizing we decided with the Dr to have a CT scan done next week to see it's exact size and location. Then I may sign the consent forms.
I have 4 sisters who pray for me daily. Needless to say I do a lot of that myself without which I couldn't handle this thing.
Update: 15 Jan 2003
Sorry I haven't updated everyone sooner. But thanks for all the emails.
I had the C scan in early November and discussed the results with the surgeon, which were both good and bad. The good news is the AAA is not as high up as the U/S showed eliminating the need for a 2nd incision across the flank and below the rib cage. Boy I sure was glad to hear that! The bad news is it still protrudes above the renal arteries and presents a challenge to repair.
Now they have not encountered that too much locally and I requested a 2nd opinion.
I considered the Cleveland Clinic but alas my HMO denied my request. Not in our "network" A real good medical reason, eh?
These are difficult decisions to make and during my early morning walks in the cold winter air I turned the various options over in my mind many times.
I was referred to the Corvasc people a group of surgeons in Indianapolis which is about a 2 1/2 hour drive for me from home. I went there this past Monday and got a re-hash of what I already knew. The surgeon there wants an aortogram done to see precisely how high up it is. He seemed very confident and qualified.
I am now waiting to hear when the test is scheduled and most likely will have the surgery there. After all I've put this off for about as long as I dare!
I'll let you know as things progress.
Update: 15 Feb 2003
I had the arteriogram Jan 22 and a consult with a vascular surgeon. He plans the use the clamp and sew method, removing the left rib, and have a stent placed in the left leg from a blockage that was discovered in the arteriogram. A 10% risk of kidney failure and/or paralysis of of the lower extremities.
I didn't like that so arranged for a consult (the fourth 2nd opinion) with a thoracic surgeon. This occurred on Feb 12. His method would use the heart lung machine cooling the body to 55 degrees and involve no clamping. Only a 5% risk of stroke. I agreed and the surgery is set for March 3rd.
Because of the previous heart attack he's ordered a heart catheterization and evaluation by a cardiologist specialist first. This is scheduled for Feb 19th.
I believe there is a different approach between vascular and thoracic surgeons and since mine is above the renal arteries I chose the thoracic approach. The vascular doc is under a time constraint for sewing since the blood flow cannot be stopped for long. The thoracic doc has much longer time frame to sew. I did not want anyone doing a hurry up job.
I'll let you know how things proceed. Since I'm not sick, feel good it was a difficult decision to make.
Update: 25 Feb 2003
Was examined by two cardiologists and had a heart catheterization at St Vincent's Hospital Indianapolis as a prelude to surgery. This was ordered by the surgeon.
I passed with flying colors. Slight blockages, less than 50% but not an impediment to surgery.
I report at 5:30AM next Monday for surgery. And will update you when I am back home and able to sit at this keyboard again.
Update: 21 Apr 2003
It will be 7 weeks this monday since the surgery. I reported a 9:30 a.m. instead of 5:30, went to the OR at 10:15 and released to CCU at 8:10 p.m. that evening. It was a long surgery, performed by Dr John Fahrenbacher thoracic surgeon from the CORVASC group at Methodist Hospital, Indianapolis. I was pleased with his skill and knowledge He had to reach beyond the renal up into the splenic arteries. I am thankful I came thru safely.
I remember nothing for the first two days, spent 5 days in surgical recovery and sent home the following Sunday. After 3 weeks at home I went to the ER at the local hospital with dehydration and impacted bowel. Spent 4 days there. After that my recovery was unremarkable except I had absolutely no appetite. That didn't return till well after 5 weeks.
The incision extended from the middle of my back, down the flank, and in front about 3 in from the belly button. The back is still sore and I find it difficult to sit in a straight back chair for long periods. But he said it would be several months before I returned to normal. I didn't realize something could hurt this bad this long. But the dark days are only a distant memory.
I am feeling so much better than I did three weeks ago, can walk up to a mile and have been enjoying the spring sunshine. Even was able to get to Easter Mass.
If things go well the next 3 weeks and I regain this weight loss I should be in great shape.
Update: 05 Mar 2004
Wednesday, March 3 was my one year anniversary since my aortic repair. I can say I'm feeling fine. Up to 163 lbs so have gain all the weight I lost, and back walking 30-45 minutes a day. Sometimes I get a sore back doing yard work but don't we all.
My advise to anyone facing an AAA repair is get all the information you can, even talking to several different surgeons. Even asking how many of your particular type of surgery he performs a year. I cannot say enough good things about my surgeon Dr. John Fahrenbacher of the CORVASC group in Indianapolis.
Goodbye and good luck to all.
Update: 15 May 2004
Sometimes AAA's can result in good/bad things. Because of my followup Cat Scan with my AAA surgeon a suspect spot was discovered in my chest. My family doctor ordered a PET Scan which revealed a "mass" in the upper esophagus and he referred me to an gastroenterologist. He scoped my esophagus and took biopsies. He reported a cancerous tumor in the upper part. A second scope by a different doctor "staged" the tumor (sonar detecting size, width, and whether it spread to surrounding tissue).
I now have been referred to an oncologist for treatment. Since it was caught early we think five weeks of radiation/chemo will do the trick. Normally they find these things when you have difficulty swallowing and then it's too late. So Cat scans are not all bad.