5.3 mm abdominal aortic aneurism, prognosis?
Patrick Coghlan
which was < 4.7 mm when first detected. In the past 6 months it grew to
5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
until 5.6-5.7 mm.
What does 5.3 mm actually represent (increased diameter of aorta at
femoral branch)?
Because of her age, she may not be able to survive the surgery. If the
aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
etc. years? Are there stats available?
Thanks in advance.
Jeff
disease. Any of the ones that she could modify (improving diet, exercise,
etc.) should help.
The problem with a AAA is that Aorta has a tendency to rupture. Not good. In
most people, it is a fatal event. Unfortunately, the surgery is very
extensive and risky. One has the weigh the risk of the surgery vs. the risk
of the AAA.
You can read more about this condition here:
http://www.aafp.org/afp/970915ap/santilli.html
http://www.clevelandclinic.org/health/health-info/docs/0300/0391.asp?index=3930
An alternative to open repair (if I needed this surgery, I would definitely
ask my doctor about this - but I don't know your mother's history or
circumstances, so I don't know if this applies):
http://www.dcmsonline.org/jax-medicine/2000journals/dec2000/endovascular.htm
http://www.riversidecardiology.com/archive/01192000.htm
And the importance of choosing the right surgeon and hospital here:
http://www.healthandage.com/Home/gm=1!gid1=4956;!-768323858!174479238!7537!7038
http://www.eurekalert.org/pub_releases/2003-10/uomh-aad101303.php
http://www.healthcentral.com/news/NewsFullText.cfm?id=515571
Jeff
"Patrick Coghlan" <cog...@sympatico.ca> wrote in message
news:g%Dnb.1519$9j3.2...@news20.bellglobal.com...
Orac
Patrick Coghlan <cog...@sympatico.ca> wrote:
Note: I think you mean cm, not mm.
In the U.S. the usual recommendation is to operate on most AAA's when
they reach around 5 cm. The usually quoted figure for yearly rate of
rupture for a 5-6 cm AAA is around 7%--very high. Think about it; this
translates to a 35% chance of rupture in 5 years and roughly a 50%
chance of rupture within 7 years. And this is the cumulative risk; it
doesn't mean the aneurysm couldn't rupture tomorrow. Mortality from a
ruptured AAA is between 70-90%.
The 5 cm rule is not a hard and fast rule, but with the decreased
morbidity and mortality of AAA repair and new endovascular techniques
for fixing them without major abdominal surgery, the threshold for
recommending repair is lower than it used to be, and even octogenarians
can do pretty well, especially if they are good candidates for
endovascular repairs. This is particularly true if the patient is
relatively healthy and therefore a good operative risk. (Of course, as
my vascular surgery faculty told me when I was a resident, if you have
atherosclerotic disease bad enough to cause a AAA big enough to consider
repair, you probably have atherosclerotic heart disease or
cerebrovascular disease; vascular patients almost by definition are not
truly healthy.)
What is more worrisome than the AAA's size is that the aneurysm has
grown from 4.7 to 5.3 cm in a pretty short period of time. Rapid
increase in size of an aneurysm (more than 0.5 cm in 6 months) is a
pretty strong indication for operation in a patient with more than 2-3
years of life expectancy, unless the operative risk is very high. From
the surgeon's reluctance to operate, I can only infer that your mother
has comorbid conditions that render her to be a very high operative risk.
--
Orac |"A statement of fact cannot be insolent."
|
|"If you cannot listen to the answers, why do you
| inconvenience me with questions?"
Martha H Adams
Where is "abdominal"? If the aneurism is where I think it's
"abdominal," then it wouldn't be hard to reach. Is there a
comorbidity factor between the surgeon and the aneurism, like a
morbidly obese person? (Which seems unlikely at age 80.)
If this were my mother, or any friend, I'd be keeping an eye out for
a surgeon with a good track record dealing with such aneurisms; in
a hospital of good reputation. You can find out a *lot* if you can
find opinions from *nurses* about who and where is good.
Cheers -- Martha Adams
Patrick Blanchard, M.D.
wrote:
Frankly, I would take you mother to another vascular surgeon for a second
opinion, and then seek out an interventional radiologist trained to place
abdominal aneurysm stents.
http://www.wfubmc.edu/neuro/departments/neuroradiology.shtml
--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
Jeff
"Martha H Adams" <m...@TheWorld.com> wrote in message
news:bnnhk7$ehb$1...@pcls4.std.com...
> I wonder if relying upon one single opinion might be a bad idea.
Usually is.
> Where is "abdominal"? If the aneurism is where I think it's
> "abdominal," then it wouldn't be hard to reach.
Actually, it is really hard to reach. The aorta lies near the back You have
intestines and stuff in the way. In addition, there are major branches of
the aorta that branch off to supply vital organs, like the instestines and
spinal cord with blood. You have to take care that these are not blocked off
after the surgery.
> Is there a
> comorbidity factor between the surgeon and the aneurism, like a
> morbidly obese person? (Which seems unlikely at age 80.)
No, but people who have AAAs often have coronary heart disease or similar
vascular disease elsewhere.
> If this were my mother, or any friend, I'd be keeping an eye out for
> a surgeon with a good track record dealing with such aneurisms; in
> a hospital of good reputation. You can find out a *lot* if you can
> find opinions from *nurses* about who and where is good.
You can find a lot of opinions about which cars are good and who the best
dealers are from nurses too. It does not mean that they are best opinions
out there. What really counts is the experience and record of the hospital
and surgeon, not what the nurses think. Don't get me wrong, nurses have a
lot of information. Unfortuantely, they usually don't have the actual
statistics, which is what you need.
I would definitely try and find the best hospital for the surgery and the
best surgeon, even if it means going out of state. The doctors should be a
good source of information.
Jeff
> Cheers -- Martha Adams
>
Orac
m...@TheWorld.com (Martha H Adams) wrote:
> I wonder if relying upon one single opinion might be a bad idea.
> Where is "abdominal"? If the aneurism is where I think it's
> "abdominal," then it wouldn't be hard to reach.
It sounds to me like a standard abdominal aortic aneurysm. What wasn't
said was whether or not it involved the iliac vessels and whether it was
completely below the renal arteries. If it involves the area where the
renal arteries branch from the aorta, then the surgery will require
clamping the aorta above the renal arteries, cutting off the blood flow
to the kidneys for the time it takes to sew the vascular graft in. This
increases the risk of postoperative renal failure and is technically
more challenging, particularly if the renal arteries have to be
reimplanted.
>Is there a
> comorbidity factor between the surgeon and the aneurism, like a
> morbidly obese person? (Which seems unlikely at age 80.)
Well, most patients with AAA's have vascular disease elsewhere (such as
the coronary arteries or the carotids). As one of the vascular surgeons
at my residency program used to say when we rotated on his service: If
the patient has bad enough atherosclerotic disease to get a AAA, chances
are good that he has it in his heart or carotid arteries as well.
[Snip]
Dr. Andrew B. Chung, MD/PhD
> My mother (81) has been living with an aneurism for the past 18 months
> which was < 4.7 mm when first detected. In the past 6 months it grew to
> 5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
> until 5.6-5.7 mm.
>
May not be mandatory but should be considered.
>
> What does 5.3 mm actually represent (increased diameter of aorta at
> femoral branch)?
>
The diameter of the aneurysm.
>
> Because of her age, she may not be able to survive the surgery.
Risk would be higher.
> If the
> aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
> etc. years?
Depends on when the rupture occurs. Rupture has very high mortality rates
(in 81 year olds, probably greater than 95%).
> Are there stats available?
>
Yes. Try the Pubmed link on my web site.
>
> Thanks in advance.
You are welcome.
--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
Emma Chase VanCott
: My mother (81) has been living with an aneurism for the past 18 months
: 5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
: until 5.6-5.7 mm.
My uncle had an AAA (abdominal aortic aneurysm). Apparently the surgeon
told some family members that they can run in families.
He suggested all the siblings get imaging done.
-Emma
Patrick Coghlan
> In article <bnnhk7$ehb$1...@pcls4.std.com>,
> m...@TheWorld.com (Martha H Adams) wrote:
>
>
> It sounds to me like a standard abdominal aortic aneurysm. What wasn't
> said was whether or not it involved the iliac vessels and whether it was
> completely below the renal arteries. If it involves the area where the
The surgeon showed her a sketch which showed the "ballooning" just above
the femoral branch. What's confusing is that she is adamant that the
techs told her that the units were mm, yet most aneurisms of this type
seem to be measured in cm (except for, perhaps, saccular?).
Patrick Coghlan
> In article <g%Dnb.1519$9j3.2...@news20.bellglobal.com>,
> Patrick Coghlan <cog...@sympatico.ca> wrote:
>
>
>>My mother (81) has been living with an aneurism for the past 18 months
>>which was < 4.7 mm when first detected. In the past 6 months it grew to
>>5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
>>until 5.6-5.7 mm.
>>
>>What does 5.3 mm actually represent (increased diameter of aorta at
>>femoral branch)?
>>
>>Because of her age, she may not be able to survive the surgery. If the
>>aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
>>etc. years? Are there stats available?
>
>
> Note: I think you mean cm, not mm.
I thought it was cm, too. However, there are different types, one of
which being saccular (sp?), which perhaps is measured in mm, no?
Patrick Coghlan
All *10* of her siblings have passed away. The 2nd last to go was her
brother, who died in his 70s of a ruptured AAA. None of the other 9
died of this, but might have had they not died accidentally (drowning,
run over by a felled tree, run over by a grader, suicide...).
Patrick Coghlan
> It sounds to me like a standard abdominal aortic aneurysm. What wasn't
> said was whether or not it involved the iliac vessels and whether it was
> completely below the renal arteries. If it involves the area where the
> renal arteries branch from the aorta, then the surgery will require
> clamping the aorta above the renal arteries, cutting off the blood flow
> to the kidneys for the time it takes to sew the vascular graft in. This
> increases the risk of postoperative renal failure and is technically
> more challenging, particularly if the renal arteries have to be
> reimplanted.
Ah, I wondered what they did while repairing the artery (clamping).
This must be why they don't want to operate if the patient's heart is
not in good condition.
Jeff
It is one reason. But the other reason is that this surgery is extremely
stressful. TO get at the AAA, the abdominal contents are moved out of the
way (mostly the intestines). This perturbs their function for a few days.
There are also major fluid and electrolyte changes, with lots of fluids and
blood and plasma administered by IV (the last time I saw this operation,
there was something like 10 units of blood and 20 liters total fluid
administered to a patient -- that is about 5 gallons of fluid, which is
about 1/3 of the entire fluid volume of the patient (you know that those 5
gallon buckets around -- it is that big.) I usually make around 3 liters of
urine a day. That is the volume of urine I make in an entire week. And 10
units of blood is a lot, too That is a lot of fluid. That is very stressful,
especially if the kidneys' function is compromised for a few hours, because
of temporary loss of blood flow. Remember, the kidneys play a major role in
the regulation of the body's electrolytes and fluids.
This is very stressful surgery.
And the heart and kidneys are not the only organs that are at risk If the
blood pressure drops too much because of the blood loss, the brain might not
get enough blood. Let us just say this is not desirable.
Jeff
Orac
Patrick Coghlan <cog...@sympatico.ca> wrote:
No. They're all in cm. The normal diameter of the aorta in an adult is
around 2-3 cm, as I recall.
Patrick Coghlan
> In article <gAapb.610$mB5....@news20.bellglobal.com>,
> Patrick Coghlan <cog...@sympatico.ca> wrote:
>
>
>>>Note: I think you mean cm, not mm.
>>
>>I thought it was cm, too. However, there are different types, one of
>>which being saccular (sp?), which perhaps is measured in mm, no?
>
>
> No. They're all in cm. The normal diameter of the aorta in an adult is
> around 2-3 cm, as I recall.
I assume that's OD (outside diameter, as in plumbing). Either way,
that's a whopping big blood vessel.
Orac
Patrick Coghlan <cog...@sympatico.ca> wrote:
Yes, which is why a ruptured abdominal aortic aneurysm is so fatal. Only
around 70-90% of patients with a ruptured AAA who actually make it to
the hospital alive survive. To me, having seen the aorta and how much
blood passes through this hose of a vessel, it's amazing that anyone
survives a ruptured AAA. And almost no one does survive a large rupture;
it is the smaller ones that are temporarily contained by the surrounding
tissues that are survivable.
Howard McCollister
"Jeff" <kidsd...@hotmail.com> wrote in message
news:bo3oo4$m...@library2.airnews.net...
There are many risks to AAA repair, but the one that causes death most often
is related to the cross-clamping of the aorta with resultant lack of blood
flow to the lower extremities for the amount of time it takes the surgeon to
sew in the graft. This lack of blood flow forces anaerobic metabolism to the
unperfused parts of the body with resultant buildup of lactic acid. When the
aorta is finally unclamped, a large load of lactic acid is dumped into the
circulation with resultant deleterious effects on the cardiovascular system
nor for the kidneys. The longer the clamp time, the more the ischemia, the
more lactic acid. Throw in a huge dose of the body's post-op reparative
hormones such as ADH, MDF, bradykinins and other such stuff and the body has
a lot of work to do in the post-op period.
It's a dangerous operation by comparison to most others, but AAA is a
dangerous condition with a *cumulative* mortality of 5-8 percent each year
once the aneurysm reaches 5 centimeters. Such an operation is done when is
represents a lesser risk than the disease it's going to fix.
HMc
Patrick Coghlan
> It's a dangerous operation by comparison to most others, but AAA is a
> dangerous condition with a *cumulative* mortality of 5-8 percent each year
> once the aneurysm reaches 5 centimeters. Such an operation is done when is
> represents a lesser risk than the disease it's going to fix.
By "cumulative", I assume this means that up to 48% of any sample group
of patients would not be alive after 6 years.
In my mother's case (age 81), she has often said that she doesn't want
to live much beyond age 85, so she runs up to a 24% (ballpark) risk of
not surviving the AAA for another 4 years.
I'm not a doctor, but my guess is that these are better odds than having
the surgery (history of high cholesterol, one of her heart valves has
"narrowed" - I assume due to a buildup of plaque).
Orac
Patrick Coghlan <cog...@sympatico.ca> wrote:
Not necessarily. An 81 year old woman these days has an expected
additional life expectancy of approximately 8.5 years (source: Office of
the Actuary of the Social Security Administration), which means a 50%
chance of living 8.5 more years or longer. Although I don't know enough
about the case to make a determination, even if your mother is not that
healthy, as long as she has a good performance status, the risk-benefit
equation still probably favors operation. I also suspect that your
mother's risk of dying of AAA rupture is likely to be higher than the
usually quoted figure of 7% per year, simply because, according to your
earlier post, the AAA enlarged rapidly (0.6 cm) over the last six months.
These decisions are rarely easy, because patients with AAA's are rarely
perfectly healthy, and they are usually old. It takes an examination of
the patient's overall medical condition versus the cumulative annual
risk of dying from rupture of the AAA, coupled with the patient's
wishes, to come to a decision.
Jeff
> Howard McCollister wrote:
>
> > It's a dangerous operation by comparison to most others, but AAA is a
> > dangerous condition with a *cumulative* mortality of 5-8 percent each
year
> > once the aneurysm reaches 5 centimeters. Such an operation is done when
is
> > represents a lesser risk than the disease it's going to fix.
>
> By "cumulative", I assume this means that up to 48% of any sample group
> of patients would not be alive after 6 years.
>
> In my mother's case (age 81), she has often said that she doesn't want
> to live much beyond age 85, so she runs up to a 24% (ballpark) risk of
> not surviving the AAA for another 4 years.
This is something that you should discuss with the doctor. Why doesn't she
want to live "much beyound 85?" Or is it that she is afraid of not being
able to do things for herself or living in a nursing home? Again, regardless
of the AAA, considering that she is closing in on 85, this is something that
you probably want to talk with the family doctor and her about.
> I'm not a doctor, but my guess is that these are better odds than having
> the surgery (history of high cholesterol, one of her heart valves has
> "narrowed" - I assume due to a buildup of plaque).
And we haven't examined your mother and we don't know her entire history.
The risk of the surgery is clearly an issue that you, your mother and her
doctors have to consider and discuss. And don't forget that there are less
invasive sugery that might be done. In any case, you want the surgery done
by a surgeon who does the surgery regularly in a hospital where many such
surgeries are done regularly.
I would think that the odds with your mother having the surgery are better.
But, this is something you need to talk with the docs who know your mom
about.
Jeff
Patrick Coghlan
> "Patrick Coghlan" <cog...@sympatico.ca> wrote in message
> news:Mejpb.993$Pg1....@news20.bellglobal.com...
>
>>In my mother's case (age 81), she has often said that she doesn't want
>>to live much beyond age 85, so she runs up to a 24% (ballpark) risk of
>>not surviving the AAA for another 4 years.
>
> This is something that you should discuss with the doctor. Why doesn't she
> want to live "much beyound 85?" Or is it that she is afraid of not being
> able to do things for herself or living in a nursing home? Again, regardless
> of the AAA, considering that she is closing in on 85, this is something that
> you probably want to talk with the family doctor and her about.
For her it's a quality of life decision. Apart from a bit of arthritis,
she's been in relatively good health, and if she can make it to 85 or so
without becoming an invalid, she's happy.
> And we haven't examined your mother and we don't know her entire history.
> The risk of the surgery is clearly an issue that you, your mother and her
> doctors have to consider and discuss. And don't forget that there are less
> invasive sugery that might be done. In any case, you want the surgery done
> by a surgeon who does the surgery regularly in a hospital where many such
> surgeries are done regularly.
>
> I would think that the odds with your mother having the surgery are better.
> But, this is something you need to talk with the docs who know your mom
> about.
I'm not sure why the surgeon didn't propose a less invasive procedure
(stent). This is something she'll have to explore when she is
re-examined 6 months from now. I don't think she realizes how serious
the more invasive procedure is, according to what I've read in this thread.
Bill Schowengerdt
Coghlan <cog...@sympatico.ca> posted:
.
Are cerebral aneurisms measured in mm? For example.... As I recall,
several years ago they said I had one that was 5.5mm.
(Since it is inoperable, I have just sort of blocked the details from my
mind.)
--
I am a member of the rabble in good standing. -- Westbrook Pegler --
Jeff
> Jeff wrote:
>
> > "Patrick Coghlan" <cog...@sympatico.ca> wrote in message
> > news:Mejpb.993$Pg1....@news20.bellglobal.com...
> >
> >>In my mother's case (age 81), she has often said that she doesn't want
> >>to live much beyond age 85, so she runs up to a 24% (ballpark) risk of
> >>not surviving the AAA for another 4 years.
> >
> > This is something that you should discuss with the doctor. Why doesn't
she
> > want to live "much beyound 85?" Or is it that she is afraid of not being
> > able to do things for herself or living in a nursing home? Again,
regardless
> > of the AAA, considering that she is closing in on 85, this is something
that
> > you probably want to talk with the family doctor and her about.
>
> For her it's a quality of life decision. Apart from a bit of arthritis,
> she's been in relatively good health, and if she can make it to 85 or so
> without becoming an invalid, she's happy.
I have to agree with Orac on this one. Potentially she has many happy years
of life left. I suspect that this bit about making it to 85 has a lot more
to do with her fears about being an invalid and/or your fears about having
to take care of her and see her not doing so well. So this is something your
going have to deal with, one way or another.
Anyway, this is about making the best decision about her quantity and
quality of life, not whether she would be happy with 85 years. My dad is 76.
He has said that he never thought he would live this long. He does not mean
that he wants to die at 77. But rather, that he is pleased at how well he is
doing and how he is enjoying his life. I would look at any remaining years
your mother has as a gift to enjoy with her, as well for her to enjoy with
her kids and grandkids.
> > And we haven't examined your mother and we don't know her entire
history.
> > The risk of the surgery is clearly an issue that you, your mother and
her
> > doctors have to consider and discuss. And don't forget that there are
less
> > invasive sugery that might be done. In any case, you want the surgery
done
> > by a surgeon who does the surgery regularly in a hospital where many
such
> > surgeries are done regularly.
> >
> > I would think that the odds with your mother having the surgery are
better.
> > But, this is something you need to talk with the docs who know your mom
> > about.
>
> I'm not sure why the surgeon didn't propose a less invasive procedure
> (stent). This is something she'll have to explore when she is
> re-examined 6 months from now. I don't think she realizes how serious
> the more invasive procedure is, according to what I've read in this
thread.
I would agree. I would also argue that I don't know if she realizes how
serious the AAA really is.
The other thing I would do is talk with your family doctor about doing
things that would increase her chances of surviving the surgery and
recovering from the surgery faster. The things that particularly come to
mind are increasing exercise (maybe just walking around the block or the
mall more) and increasing muscle strength (studies have shown that older
people who do some mild weight lifting and other exercises life longer and
are more mobile for longer). If you mom is overweight, losing weight would
help too. So anything you do along these lines would help improve your
mom's quality of life long-term, regardless of whether she has surgery. You
definitely want to work with your mom's family doctor on this one.
And you would probably want to discuss the quality of life issues that I
think are bothering you and your mom. I get the impression that dealing with
these now will really help you and your mom in the future, both with dealing
with the surgery and the other life decisions that will await her at some
point in the future.
All the best,
Jeff
Howard McCollister
>
> For her it's a quality of life decision. Apart from a bit of arthritis,
> she's been in relatively good health, and if she can make it to 85 or so
> without becoming an invalid, she's happy.
I agree with Orac that rapidity of enlargement is a significant risk factor
that probably increases your mother's risk of AAA rupture beyond what would
be considered typical.
No one will be able to predict your mother's future. Doctors can only look
retrospectively at large populations of people in similar situations and
draw some rather general conclusions about your mother's case. That's not as
good as having a crystal ball, but it's all there is. Your mother's actual
operative risk might be substantially higher or lower based on undiscovered
facts about her medical condition, or a less-than-accurate assessment of the
clinical significance of the medical problems they DO know about.
Bottom line is that she gets to decide which risk to take. Her doctors will
try to give her the best information they can so she can weigh the pros and
cons as accurately as possible, but no one can predict the future. To a
lesser degree, that's what the other posters here are trying to do for you,
only we all have less information than her doctors, so the information
imparted here is necessarily more general.
HMc
Orac
"Jeff" <kidsd...@hotmail.com> wrote:
> "Patrick Coghlan" <cog...@sympatico.ca> wrote in message
> news:Mejpb.993$Pg1....@news20.bellglobal.com...
> > I'm not a doctor, but my guess is that these are better odds than having
> > the surgery (history of high cholesterol, one of her heart valves has
> > "narrowed" - I assume due to a buildup of plaque).
>
> And we haven't examined your mother and we don't know her entire history.
> The risk of the surgery is clearly an issue that you, your mother and her
> doctors have to consider and discuss. And don't forget that there are less
> invasive sugery that might be done.
Quite true. There are now endovascular techniques for repairing
aneurysms. They work best with simple AAA's that don't involve the Iliac
arteries, but they can be done for many that do. If his mother's
aneurysm is suitable for endovascular repair, it's a much less invasive
and dangerous procedure than operative AAA repair. The tradeoff is that
we still don't know the long-term results of these new techniques.
Patrick Blanchard, M.D.
> In article <bo4ha4$7...@library2.airnews.net>,
> "Jeff" <kidsd...@hotmail.com> wrote:
>
>> "Patrick Coghlan" <cog...@sympatico.ca> wrote in message
>> news:Mejpb.993$Pg1....@news20.bellglobal.com...
>
>> > I'm not a doctor, but my guess is that these are better odds than
>> having
>> > the surgery (history of high cholesterol, one of her heart valves has
>> > "narrowed" - I assume due to a buildup of plaque).
>>
>> And we haven't examined your mother and we don't know her entire
>> history.
>> The risk of the surgery is clearly an issue that you, your mother and
>> her
>> doctors have to consider and discuss. And don't forget that there are
>> less
>> invasive sugery that might be done.
>
> Quite true. There are now endovascular techniques for repairing
> aneurysms. They work best with simple AAA's that don't involve the Iliac
> arteries, but they can be done for many that do. If his mother's aneurysm
> is suitable for endovascular repair, it's a much less invasive and
> dangerous procedure than operative AAA repair. The tradeoff is that we
> still don't know the long-term results of these new techniques.
>
> [Snip]
>
I think a good interventional radiologist can help you sort this out too.
Dr. Andrew B. Chung, MD/PhD
More likely you would seek the consultation of a vascular surgeon who is
trained to do endovascular aortic stenting.
Patrick Blanchard, M.D.
any suggestions?
Dr. Andrew B. Chung, MD/PhD
Howard McCollister
"Dr. Andrew B. Chung, MD/PhD" <and...@heartmdphd.com> wrote in message
news:3FA7CCB7...@heartmdphd.com...
> > >
> > I think a good interventional radiologist can help you sort this out
too.
> >
>
> More likely you would seek the consultation of a vascular surgeon who is
> trained to do endovascular aortic stenting.
I agree. While most vascular surgeons that do endovascular stenting do them
in conjunction, to some degree, with an interventional radiologist, I
believe that it would be very unusual (and probably unwise) for a
radiologist to do them without the involvement of a vascular surgeon. I
suspect that if the OP did take his mother to an interventional radiologist,
the radiologist would send them right on to a vascular surgeon. At least
that's how it works in the programs that I'm familiar with.
HMc
Orac
Personally, I'd tend to recommend a good vascular surgeon who is also
skilled in endovascular techniques over an interventional radiologist.
Endovascular AAA repair is still more risky than most things that
interventional radiologists do, and if something goes wrong he can
operate immediately. Not so for interventional radiologists, who have to
call in the vascular surgeon. Most vascular surgery training programs
these days are training vascular fellows in endovascular techniques.
Jeff
"Patrick Blanchard, M.D." <nospa...@wamego.net> wrote in message
news:oprx4iue...@news-60.giganews.com...
> any suggestions?
The people who are on this page have lots of experience:
http://www.riversidecardiology.com/archive/01192000.htm.
I didn't see any other links for people who do the less invasive surgery.
But you can search the net with google or whatever.
Jeff
Patrick Blanchard, M.D.
<and...@heartmdphd.com> wrote:
I could not find a vascular surgeon on your list who is trained to do
endovascular aortic stenting.
Cardiologists sometimes venture outside the coronary arteries and deploy
stents in the peripheral circulation, but I would not recommend this
specialist for an aortic stent.
However, interventional radiologists undergo fellowship training for
peripheral circulation (and brain circulation) endovascular therapy, which
includes stent placement in the aorta.
Call this guy and ask his opinion. He is a neurointerventionalist, and does
a great job for stroke victims, and will know the best in nation for the
aorta. Tell him I sent you.
https://www.saintlukeshealthsystem.org/app/findadoctor.asp?doc=D01D0NBKRX
Patrick Blanchard, M.D.
Any good interventional radiologist will make certain a vascular surgeon is
available for standby.
Orac
"Patrick Blanchard, M.D." <nospa...@wamego.net> wrote:
> On 4 Nov 2003 13:58:36 -0600, Howard McCollister <hma...@nospam.net> wrote:
>
> >
> > "Dr. Andrew B. Chung, MD/PhD" <and...@heartmdphd.com> wrote in message
> > news:3FA7CCB7...@heartmdphd.com...
> >
> >> > >
> >> > I think a good interventional radiologist can help you sort this out
> > too.
> >> >
> >>
> >> More likely you would seek the consultation of a vascular surgeon who is
> >> trained to do endovascular aortic stenting.
> >
> >
> > I agree. While most vascular surgeons that do endovascular stenting do
> > them
> > in conjunction, to some degree, with an interventional radiologist, I
> > believe that it would be very unusual (and probably unwise) for a
> > radiologist to do them without the involvement of a vascular surgeon. I
> > suspect that if the OP did take his mother to an interventional
> > radiologist,
> > the radiologist would send them right on to a vascular surgeon. At least
> > that's how it works in the programs that I'm familiar with.
>
> Any good interventional radiologist will make certain a vascular surgeon is
> available for standby.
Personally, I believe that a vascular surgeon, not an interventional
radiologist, should be doing these procedures. The stents (and thus the
holes in the arteries) involved are larger than anything else
interventional radiologists use, and it is not infrequently necessary to
repair the femoral artery after the stent is placed.
Patrick Blanchard, M.D.
I do not know of any vascular surgeon who also performs stent placement.
There always seems to be a tug-o-war between the vascular surgeon group and
the interventionalist group on who is right.
--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
Orac
"Patrick Blanchard, M.D." <nospa...@wamego.net> wrote:
> On Thu, 06 Nov 2003 19:05:31 -0500, Orac <or...@mac.com> wrote:
> > Personally, I believe that a vascular surgeon, not an interventional
> > radiologist, should be doing these procedures. The stents (and thus the
> > holes in the arteries) involved are larger than anything else
> > interventional radiologists use, and it is not infrequently necessary to
> > repair the femoral artery after the stent is placed.
> >
>
> I do not know of any vascular surgeon who also performs stent placement.
I know a few. In fact, nearly every vascular surgeon at our hospital
does them. There are vascular surgeons at most major academic medical
centers who do them.
> There always seems to be a tug-o-war between the vascular surgeon group and
> the interventionalist group on who is right.
Indeed, but in my mind for *this particular procedure* the deciding
difference is that (1) surgeons do these in the O.R. and (2) the surgeon
can intervene to fix his own complications far more rapidly than an
interventionalist can get a vascular surgeon (even a vascular surgeon on
"backup") to bail him out if the stent placement results in a big hole
in major arteries like the aorta or iliacs. Given how fast an iatrogenic
hole in the aorta (or any other kind of decent-sized hole, for that
matter) can kill a patient, I think that makes all the difference in the
world for this particular procedure.