My first encounter with a patient at a new hospital ends up being while they are unconscious; in theatre. I have been in the operating room multiple times to watch the skilled surgeons and accompanying staff at work. However, this time was more memorable due to the complexity of the patient at hand.
Our patient was a man in his 60’s, who unfortunately happened to have all the necessary complications to put him in this current position. He had what is called an abdominal aortic aneurysm (AAA), which was being closely monitored so it doesn’t burst and potentially send him into a life threatening situation. Just a bit of background to assist with understanding of the condition and how this man’s complications got him tot his point.
The aorta is the major blood vessel in the body. The abdominal aorta is just the part of this artery that supplies the organs of the abdomen. An AAA is where a laxity in the artery wall is exploited by different types of cells in the body such as elastic, fibrous, fatty and inflammatory cells that go to work on forming a home. This home continues to build in size until it starts encroaching on the area where blood flows through the artery, resulting in impaired blood flow and no surprises as to why that’s a bad thing.
Moreover, with this aneurysm continuing to grow, it can start to put pressure on other structures that are next to or around it. Therefore, not only making it harder for blood to flow to different parts of the abdomen, but also impacting the function of other structures in the abdomen. Below is a picture to help put it all together
Back to the man about to go under the knife. His abdominal aorta diameter was measured at 5.8 cm, which is higher than the 5.5cm standard for surgery. Typically, this procedure is no longer done in an open surgical fashion. However, I walked in to witness a rare procedure nowadays and that is an AAA open surgical repair. The reason the doctors felt this would be the best for the patient was due to the risk factors this man had, which included: being a chain smoker, having high blood pressure, having peripheral vascular disease, being overweight just to mention a few.
These days, most AAA repairs are done under the guidance of some sort of imaging to put in a stent. They clean out what ever is clogging the area of blood flow, also known as lumen, and place a stent that reinforces the wall of the artery and stops it from rupturing. The procedure is called an endovascular aneurysm repair and a clearer visual of the final product is shown in the image below:
This procedure is much more comfortable for the patient, no need for all the potential harms that come from surgery. It also doesn’t have the same recovery period that one needs post-surgery because it’s normally done when you’re awake! This type of procedure, use of a stent has been developed to help minimise the typical harms associated with surgery and to help people get back to normal life as soon as possible.
Despite all of this, the surgery seemed to have gone well for the man so hopefully he can appreciate the importance of taking care of his health. Making the adjustment to be health focused can often be difficult, particularly in the situation of smoking and adapting healthy lifestyles. The problem often lies in trying to help people through the process of changing old habits, which is no mean feat.
Sometimes people see the impact of their lifestyle on their health, yet can’t seem to quite get around to making it a priority. The barriers to making these changes are both mental and physical, hence being of assistance in this process is always much better than being of an opinion. One day just maybe, the individual sees for themselves that prioritising their health has nothing to do with taking away from their other commitments, but rather it will enhance their ability to fulfill their other commitments.
Just to fulfill the curiousity of those among you who may want to see what the surgical repair may have looked like, I’ve embedded a video of an AAA surgical repair below. Actual AAA repair occurs from time 1.30-6.00 minutes