Tonight's Medical Mysterie

[George K]

Probably one of my least favorite operations. I am (still) in awe of the interventional radiologists who can fix this lethal problem.

[Klaus]

I always thought a ruptured AAA means death within seconds...

[bachophile]

that would be a free rupture, but often its a contained bleed, in other words there is a "leak" which is contained by the tissues around the aorta which sort of plug the leak until the systolic blood pressure overcomes the plug and then it explodes freely (that would be death within minutes) but the idea is in that golden hour(s) between the aneurysm starting to leak (called a sentinel bleed) and free rupture, the catastrophe can still be averted.

[taiwan_girl]

Interesting. You guys do great work!!!!

[Renauda]

Attended the funeral of a former colleague two weeks ago who died from an aortic dissection. He had been a heavy smoker and consequently suffered from severe COPD. There were other life threatening issues as well, but in the end it was the dissection that got him. He was 68 years old.

[George K]

Remember the surgeon who was part owner of the B-25 - The "Barbie III?"

Ray was a vascular surgeon - he assisted in heart surgery, did chest work, and a lot of carotids, aortas, and other stuff. He was trained in Canada, learned to fly in the RAF and then moved to the US.

Anyhow...

Back in the day (must be about 1995 or so), I got called to the ER because there was a guy with a rapidly-expanding abdomen, short of breath, in terrible pain, and turing blue. Ray was in the hospital and we met in the ER. Diagnosis was obvious, a ruptured AAA.

We rushed the guy upstairs to the OR. We put him on the table, I checked his BP - it was unobtainable. I hooked him up to the EKG and his heart rate was about 20. He had an agonal type of breathing.

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Ray and I looked at each other and said, "Nope," realizing this was going to be a 4-5 hour exercise in futility.

We let the guy pass on the OR table.

[bachophile]

Not everyone needs to die with a laparotomy scar. Not mandatory.

[Mik]

Still hard decisions.

[George K]

I should add that what used to be a really, REALLY, big operation for elective repair, has become a routine procedure done in radiology, with the patient going home the next day with only a 3-4" incision in the groin.

Have I mentioned, I hated this operation? I'd rather do a heart.