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Aorta Problems

The TVClubHouse: General Discussions ARCHIVES: 2006 Jun. ~ 2006 Dec.: Health Center (ARCHIVES): Aorta Problems users admin

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Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 12:59 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
I will be posting information here shortly. (Having connection problems with Ivanhoe.com right now, Nic.) If anyone else has info about enlarged aortas, please contribute!

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 1:21 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Ok, fixed now, Nic.
Source: Ivanhoe.com
Pub Date: 6/24/99

Abdominal Aortic Aneurysm Q&A


First explain to me what an abdominal aorta aneurysm is.

Dr. Money: An aneurysm is an abnormal dilatation or ballooning of the wall of the blood vessel. The aorta is the largest blood vessel in your body. It runs from your chest down into your belly where it divides in two, one going to each leg. What happens with an aneurysm is the wall becomes weakened, sort of similar to a car tire that develops a balloon. This is a point where it starts dilating and getting bigger With time, it can get bigger and bigger and eventually can pop and rupture. If it ruptures, a vast majority of these patients do not even make it to the hospital to survive surgery.


What happens, they just pass out and start bleeding?

Dr. Money: They get internal bleeding, sometimes they get severe back pain, sometimes they get severe belly pain. Sometimes they get flank pain, the pain gets worse and they lose most of their blood volume into the area around the aorta not running in the body's blood vessels.


What's been the traditional treatment for these people?

Dr. Money: The traditional treatment over the past thirty years has involved surgery. Surgery is done through a full abdominal incision and a portion of the aorta, the aneurysm, the weakness is replaced by a graft that's synthetic material.


So that's the traditional but what is this new form of treatment?

Dr. Money: The new modality that we're testing involves a small incision in the groin and a miniaturized graft is delivered up to the aorta, through the groin and positioned in place with balloons. Therefore you sort of stint over or fix the aneurysm from inside rather than replacing the aorta.


Let's do that one more time, but don't say modality, keep it real simple. Tell me about this new treatment.

Dr. Money: The new treatment that we are testing involves fixing the aortic aneurysm through a small incision in the groin rather than the large abdominal incision.


Tell me about this new treatment for an aneurysm.

Dr. Money: The new technique for aneurysm repair involves fixing the aneurysm through a small incision in the groin rather than a large abdominal incision. What we do is we basically snake a graft up from the arteries in the groin and we put a tube within your aorta that stops blood from flowing into the aneurysm. So basically we fix the aneurysm from inside rather than going from outside through your belly.


What are the advantages to this kind of treatment?

Dr. Money: The advantages involve less recovery time in the hospital and less recovery time at home. And there's a lesser chance of associated problems occurring such as lung problems or heart problems along the way.


What kind of results are you having? I know this is kind of new technology, you've tested twelve patients.

Dr. Money: Results are not perfect and it's not for everybody, only certain patients qualify. And the results are variable, a lot depends on the anatomy of the patient's aneurysm before we fix it. In other words, whether it goes to the right, the left or straight. Because it's never a straight path to fix an aneurysm.


This is something, it sounds like emergency surgery almost, can you plan for this?

Dr. Money: You actually can plan for it. Most of the patients we take care of have aneurysms that are discovered either by accident or the doctor actually feels something and sends the patient for testing. And they're sent to us electively to fix this before it ruptures, before they get in trouble.


Tell me about Mr. Foret, what's his situation?

Dr. Money: Mr. Foret was the first patient who we used this technique for. And he is a barber from a small town outside of New Orleans, and he was referred to us with an abdominal aneurysm. And it had slowly been getting bigger over time.


How's he doing now?

Dr. Money: He is doing very, very well. He actually had his procedure and left the hospital after a few days. And I think the biggest problem we had post operatively was trying to convince his wife that he was o.k., and he could do whatever he wanted.


That's amazing isn't it?

Dr. Money: Well for aneurysm surgery it is. Recovery from a routine aneurysm repair usually takes about four to six weeks till the patient feels good.


Where are we going with this, is it in the testing phase right now, what's going to happen?

Dr. Money: This is clearly a testing technique now. It is not approved by the Food and Drug Administration as of yet. This is sort of the first technique that we have. There are newer techniques that hopefully will improve things, make it more easily usable in a lot more of the population and make it a lot more-- a lot more beneficial and less side affects.


Where is this headed, is it still in the testing phase?

Dr. Money: Yeah, I believe this is sort of the first testing phase we're going to see. This modality is not yet approved, the Food and Drug Administration has not approved this for general use. It's being used in only select centers across the US. I think that technology will improve as time goes on and it will be able to be used in a lot more patients and also a lot easier for the surgeon to place it. Rather than now where sometimes it's easy and sometimes it can be difficult depending on the shape and diameter of the patient's aneurysm.


What about the cost of this surgery, are there savings any where?

Dr. Money: I think the biggest saving we're going to see is in the patient's being able to return to work earlier and basically getting back to a normal lifestyle. Instead of spending a week in the hospital you spend two or three days. But just as important as that is that patients can go back to work earlier, get back to their normal routines of life.


Is there anything else that we need to add about this that we left out?

Dr. Money: Just that it's not for everybody. And only certain aneurysms are admitable to this treatment.


How can you find that out if you're the person for this?

Dr. Money: Send us a copy of your CAT scan and we'll be sure to evaluate it


Are they doing this anywhere else around the country?

Dr. Money: Yes, there are about nineteen or twenty centers through out the US who are presently involved. And I'm certain more centers will start testing as different companies try to get their device evaluated.

END OF INTERVIEW

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 1:28 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Pub Date: 9/16/05

Shrinking Aneurysms

SAN DIEGO (Ivanhoe Broadcast News) -- Each year, 15,000 people in the United States will have a thoracic aneurysm -- a bulge in the aorta that can lead to sudden death if it ruptures. Less than 30 percent of people who get to a hospital when their aneurysm ruptures survive. Now there is an easier and safer way to repair those aneurysms before they ever do any harm.

Vascular surgeon Nikhil Kansal, M.D., says if a thoracic aneurysm ruptures, you're in trouble. "Most patients who rupture their thoracic aneurysms won't survive," he says.

Treating aneurysms before they rupture is key, says Dr. Kansal, of the University of California, San Diego. The standard fix is risky surgery, and recovery isn't easy. Good health is essential to be a candidate. He says, "The real question is, 'what about the patients who aren't in good health, who aren't in great shape'?"

Now, Dr. Kansal and colleague Kai Ihnken, M.D., who is a cardiothoracic surgeon, have an answer for those patients. They use a catheter to deploy a graft in the aorta through a small incision in the groin.

"The graft is going to direct flow ... so there will be no more blood flow into that aneurysm itself," Dr. Kansal says. Without blood, the aneurysm shrinks.

Dr. Ihnken says, "These patients who probably wouldn't have been candidates for an open repair now can be treated with this minimally invasive approach." Using the new approach, there is much lower mortally, lower morbidity, and fewer blood transfusions.

Pat Kittredge was 8 years old when her mother died of an aneurysm. Last year, doctors showed pat she had one, too. "There on the monitor, it made it very plain. I knew I was looking at the face of death," she says. She had surgery to remove it and is doing fine. Doctors say the new procedure would have been easier for her and hope future patients will feel the benefit.

The procedure received FDA approval earlier this year. Dr. Ihnken says the procedure may be useful for more than just aneurysms. In the future, it could prove beneficial for trauma patients or for those who have a tear in their aorta.

If you would like more information, please contact:

Brenda Dixon
University of California San Diego Medical Center
Vascular Surgery
200 West Arbor Drive - MC 8403
San Diego, CA 92103
(619) 543-6980
bdixon@ucsd.edu

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 1:36 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Pub Date: 9/8/03

Marfan Syndrome

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NEW ORLEANS (Ivanhoe Broadcast News) -- Marfan syndrome is a genetic disorder that, until recently, was thought to affect one in 10,000 people. Brand new data now suggests the condition is much more common. With diagnosis and treatment, patients often live long lives, but if they don’t know they have it, they’re at high-risk for sudden death. Here's what you need to know about the condition.

At 18, Kevin Mahony was told he had Marfan syndrome -- a potentially deadly disorder of connective tissue, affecting the skeleton, eyes, heart and blood vessels. He says: “You feel like you’re never going to die when you’re 18 years old. It really didn’t scare me.”

But two months after he and Alesia married, he almost did die -- from a dissected aorta, a consequence that pediatric cardiologist Douglas Moodie, M.D., says is often fatal. “They either dissect their aorta or tear it, or they rupture it, and if that happens, you will be dead within seconds,” says Dr. Moodie, of Ochsner Clinic in New Orleans.

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That was the case with volleyball Olympian Flo Hyman in 1986. Marfan patients are usually very tall, have long fingers and toes, have loose joints, and flat feet. Their tall stature is what pushes many into sports.

Dr. Moodie says, “What causes that sudden death is, during the stress of that athletic activity, a rupture or tear of the aorta.”

Once diagnosed, patients are put on beta-blockers to protect their aorta. Diagnosis is made with heart tests, physical appearance, and a slit-lamp eye exam. The biggest hallmark of Marfan’s is lens dislocation. It’s also hereditary.

Once diagnosed, patients are put on beta-blockers to protect their aorta. Diagnosis is made with heart tests, physical appearance, and a slit-lamp eye exam. The biggest hallmark of Marfan’s is lens dislocation. It’s also hereditary.

All three of Kevin’s kids have it and are on beta-blockers. Alesia says, “They lead a basically normal life. With their medications, they probably go to the doctor’s a little more than most kids.” “I don’t look any different, except that I’m a little skinnier and a little taller than most kids,” says Daniel Mahony. But he does have one talent his friends don’t have -- he's a contortionist!

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Men and women are affected equally. Dr. Moodie emphasizes that lens dislocation is the strongest clinical marker to detect the condition. When Kevin was diagnosed, the average age of death for a patient was 28. Today, the life expectancy for a person diagnosed has increased to over 70.

Vacanick
Member

07-12-2004

Saturday, February 25, 2006 - 1:40 pm   Edit Post Move Post Delete Post View Post Send Vacanick a private message Print Post    
HP ... I know it's not Marfan but the Abdominal Aorta Aneurysm could be it. Thank you for all your research!

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 1:43 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Pub Date: 4/7/03

New Predictor for Stroke Death

PARIS (Ivanhoe Newswire) -- For the first time, researchers say they have found a risk factor linked to fatal strokes. Their study shows the stiffness of the aorta can indicate the risk of a fatal stroke regardless of other risk factors.

The aorta is the major artery that carries blood from the heart to the rest of the body. An increased stiffness in the aorta can lead to elevated blood pressure. Researchers from Paris conducted a study to determine if arterial stiffness is a risk factor for fatal strokes.

The study included 1,715 patients with mild high blood pressure but no apparent signs of cardiovascular disease. The patients were followed for nearly eight years. All of the patients had some arterial stiffness, which was measured by determining how long it took a pulse wave to move from the heart to other parts of the body. Those with stiffer arteries had higher numbers.

Over the study period, researchers say 157 participants died including 25 from strokes and 35 from a coronary event. Researchers looked at the risk for fatal stroke as it compared to the arterial stiffness measurement. They report a 72-percent increase in the risk for a fatal stroke for each four meters per second in the measurement of arterial stiffness. This risk remained even after adjusting for other risk factors including age, elevated cholesterol, diabetes, smoking and high blood pressure.

Researchers say there are several explanations for this association between arterial stiffness and a fatal stroke. First, the stiffness could increase the difference between the upper and lower numbers of a blood pressure reading in turn increasing the risk of a stroke. They say another possibility is that the stiffness measurement may indicate damage to the artery wall. Authors of the study say large clinical trials are needed to see if relieving arterial stiffness could prevent stroke deaths.

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 1:46 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Pub Date: 8/26/04


New Heart Surgery Still Evolving


(Ivanhoe Newswire) -- Early results of a British study suggest a new surgery to repair aortic aneurysms could reduce death within a month of the procedure by about two-thirds.

An abdominal aortic aneurysm is a swelling of the abdominal aorta, which has an increased chance of rupture if it is larger than 5.5 centimeters. A majority of the patients die from these ruptures. The complex cause of the condition includes atherosclerosis (fat build-up in the arteries), smoking and a genetic predisposition.

Surgeons have perfected this new method for treating abdominal aortic aneurysms called endovascular repair over the past decade. In the procedure, two small incisions are made in the groin. A graft is passed through the arteries under X-ray control and fixed with a stent, which holds the graft in place.

Investigators say their results warrant further scientific studies but not a change in clinical practice just yet.

Though the procedure is much less invasive than standard surgery, which requires a deep abdominal incision, 75 percent more secondary procedures were done in the trial among patients initially given the new surgery instead of standard surgery.

More than 1,000 patients with the condition at 41 hospitals in England randomly received either EVAR or standard open surgery.

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 1:51 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Hey, Nic. You're very welcome. Sounds kinda scary, hon. Hope this doesn't cause you MORE anxiety rather than less.

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 1:53 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Pub Date: 2/23/06


New Tool Discovers New Link
in Heart Disease



(Ivanhoe Newswire) -- A new study reveals a link between stiffness in arteries and the presence and amount of coronary artery calcium. Researchers used an arterial tonometer tool -- a simple, noninvasive tool -- to find the association. They say this discovery could lead to the possibility of more accurate assessment of heart disease risk in adults with no symptoms.

Iftikhar Kullo, M.D., of the Mayo Clinic in Rochester, Minn. says, "About 40 percent of the American public is considered to be at moderate risk for heart disease. Nearly half the heart attacks come without warning, which means we need to do a better job of screening people. This test has that potential."

The aortic pulse wave velocity (aPWV) test measures the speed at which the pulse wave travels down the aorta. Researchers say it is better than other methods because it is quick, painless, noninvasive and less expensive. During the test, patients lie on a bed and the tonometer, a pencil-like device, is placed on the skin over the neck and upper thigh. The tonometer measures the pressure wave inside the artery, and sends the information to a computer for calculation of aPWV. Slower pulses mean the artery is more elastic and healthier, whereas a faster pulse means the artery is stiffer and less healthy.

Dr. Kullo says study participants with stiffer arteries also had a greater presence and amount of calcium in the coronary arteries -- an indicator of coronary atherosclerosis. Previous studies show aPWV predicts cardiovascular disease in older adults, but until now, the association of aPWV and the amount of coronary artery calcium (CAC) in the general population has not been known.

Researchers say the association between artery stiffness and CAC strengthens the case for using aPWV as a screening tool, especially for those with moderate risk, history of heart disease, high blood pressure or kidney disease.

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 2:01 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Pub Date: 11/22/04


Aneurysm Sensor


SALEM, Ohio (Ivanhoe Broadcast News) -- What if a sensor could warn you about life-threatening aneurysms? Now, it can. Physicians at the Cleveland Clinic have implanted the first ever wireless sensor.

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Gene Zeppernick has a passion for fixing cars, old and new. He diagnoses the problem, and then gets to work. So, when he was faced with a life-threatening aneurysm -- like all good mechanics, he wanted it fixed. "I had no fear," Zeppernick says. "I knew what I had. I know what happens if you don't get it taken care of, and I'm not ready to go yet."

An abdominal aortic aneurysm is an abnormal ballooning of the abdominal portion of the aorta -- the major artery of the heart. If too much pressure builds, aneurysms can burst.

"If the pressure in the aneurysm sac is not diminished, then, functionally, we have not corrected the patient's problem, and we've allowed them to remain with a significant pressure in the aneurysm sac, which is the driving force behind the expansion of the aneurysm," vascular surgeon Daniel Clair, M.D., of The Cleveland Clinic, tells Ivanhoe.

A dime-sized sensor is implanted in the aneurysm sac to pick up even the slightest change. Doctors activate the sensor by holding a tennis racket-shaped device over the abdomen. The device displays pressure readings.

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"Ideally, what we would like to see is that the pressure sensor gives us the signal that the pressure has decreased dramatically in the aneurysm sac outside of the stent graft," Dr. Clair says.

Zeppernick cannot feel the sensor, but he can feel the benefit. "My aneurysm had already started deflating. The pressure has dropped," he says. For this self-proclaimed "Jack of all trades," it means more time to spend with his cars and dog, Charlie.

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The incidence of these aneurysms has increased three-fold over the past 40 years. It's the 13-leading cause of death in the United States. The FDA gave the green light for the investigational study of the sensor, which is expected to be approved by 2005.

If you would like more information, please contact:

The Cleveland Clinic
9500 Euclid Ave. W14
Cleveland, OH 44195
Resource Nurseline
(866) 289-6911

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 2:11 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Souce: Ivanhoe.com
Pub Date: 7/15/05


Easier Detection of Aneurysms

ATLANTA (Ivanhoe Broadcast News) -- Aneurysms are often referred to as ticking time bombs. Most occur when an area of an artery balloons out. Now, a new device is changing the way patients live after the problem is repaired.

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Pope Watson loves the predictability of everyday life. It was a shock to him when a routine doctor’s visit uncovered a deadly problem. He says, “They located an aneurysm, and it really needed attention right away.”

Ninety percent of aneurysms occur in the abdominal aorta -- when an artery wall starts to balloon. If the aneurysm ruptures, it can be fatal. Vascular surgeon Ross Milner, M.D., says, “That’s a horrible situation. Almost half of the patients, if they suffer a ruptured aneurysm, won’t even make it to the hospital.”

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Dr. Milner, from Emory University in Atlanta, used a stent to redirect Watson’s blood flow, much like a detour. Most patients have frequent computed tomography scans to look for leaks, but Watson was part of a study that used a tiny implant and antenna to work as an internal watchdog.

Dr. Milner sys, “The pressure sensors let us know what the pressure is in the aneurysm sac and will hopefully allow us to detect problems sooner.” He says 110 people have had the implant put in with no complications. So far, the results look good.

“Right now, our main goal is it'll eliminate the possible bad side effects of a CT scan," Dr. Milner says. Those effects include radiation exposure as well as danger to the kidneys from the contrast dyes used with CT scans.

Now, Watson looks forward to playing that game even longer.

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Dr. Milner says in the future, patients may be able to be monitored from home by placing a unit next to them and then sending the information via phone line to the doctor's office. However, he says that is still several years away.


If you would like more information, please contact:

Julie Bumgardner
Vascular Surgery
Emory University
1365 Clifton Road
Clinic Bldg. A 3rd Floor
Atlanta, GA 30322
(404) 778-3022

Herckleperckle
Member

11-20-2003

Saturday, February 25, 2006 - 2:21 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Pub Date: 12/3/00

Controlling Aneurysms

Ivanhoe Newswire) -- Each year, 15,000 people die of a ruptured aortic aneurysm, a condition where an artery wall bulges and weakens. The problem can start small but if it grows and is not treated, the result can be fatal. Now, doctors say a common drug may keep the problem from getting any worse.

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Bill Bair was enjoying the fun and sun of Hawaii when a pain bothered him behind his knee. "I said, 'Britt I'm going to get out of the water, that pulled muscle is starting to bother me again,'" remembers Bill.

Before he even reached the shore, Bill collapsed in agony. An aneurysm in his leg had burst.

Bill explains, "I don't do pain good anyway, I'm a baby. I was down and screaming."

Like a balloon, a blood vessel can slowly expand un-noticed until it pops.

Bill ended up losing his right leg. Even more serious, he found out he had a small aortic aneurysm; the blood vessel to his heart was at risk of rupturing, too.

Vascular surgeon Robert Thompson, M.D., of Washington University School of Medicine in St. Louis, Missouri, says, "When a blood vessel the size of the aorta ruptures and bleeds internally, you can essentially bleed to death."

An enzyme called MMP slowly eats away proteins that provide strength for blood vessel walls. A bulge grows, weakening the wall.

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Dr. Thompson says, "After about four or five years, [aneurysms] reach a size where the risk of rupture becomes concerning. At that time repair is usually recommended."

An antibiotic called doxycycline may stop the growth. In a small study, Dr. Thompson found it reduces the destructive enzyme by 80 percent. "That may mean not needing an aneurysm operation at all or maybe postponing the need for it for many, many years," he says.

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After four years the aneurysm in Bill's heart has not grown -- giving him more time to focus on his art.

Bill says, "That keeps us busy. We kick out about 300 ornaments a year."

It also gives him more time to spend with his wife, Britt.

Another phase of the study is scheduled to begin in July 2001 and will involve about 350 study participants at 9 centers. They will be given a placebo, the doxycycline or half a dose of doxycycline for four years and will be closely monitored for changes.

If you would like more information, please contact:

Nicole Vines/Media Relations
Washington University School of Medicine
Campus Box 8508
4444 Forest Park Ave.
St. Louis, MO 63108-2259
(314) 286-0100

Robert Thompson, M.D.
Washington University School of Medicine
(314) 362-7410

Sage
Member

07-20-2000

Monday, February 27, 2006 - 9:29 pm   Edit Post Move Post Delete Post View Post Send Sage a private message Print Post    
Hi Herc, my Mom had the Triple A - Abdominal Aortic Aneurysm. It was surgically removed on Nov. 21. That's when she got the blood clot in her right foot and lost it to gangrene. She is doing quite well after the Triple A. She had her bladder removed a few weeks ago, and is doing really well from that also. She will need to learn how to walk again with a prosthesis, but in the meantime she is getting around pretty good in her wheelchair, and learning to use a walker.

Vacanick
Member

07-12-2004

Sunday, March 12, 2006 - 9:02 am   Edit Post Move Post Delete Post View Post Send Vacanick a private message Print Post    
Hi Sage & HP ... yep, that's what my dad has AAA. He's scheduled for surgery at the end of this month. My dad & I are both going to donate blood, just in case. If it's not needed, then we'll donate it to the hospital.

Sage, I'd love to hear how your mom did during recovery.

a

Vacanick
Member

07-12-2004

Tuesday, April 04, 2006 - 7:12 pm   Edit Post Move Post Delete Post View Post Send Vacanick a private message Print Post    
My dad is going to have some type of spinal block during and after his surgery for pain control. I'm think it's like during pregnancy but I'm not sure. Does anyone have information on this??

BTW his surgery is next Monday April 10.

Herckleperckle
Member

11-20-2003

Tuesday, April 04, 2006 - 7:31 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
I have no personal knowledge, Nic, but it makes sense it would be the same as for women in labor. (I am searching thru my Ivahoe.com emails now for any updates on your topic now, btw!)

Herckleperckle
Member

11-20-2003

Tuesday, April 04, 2006 - 7:47 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Eureka!

Herckleperckle
Member

11-20-2003

Tuesday, April 04, 2006 - 8:00 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported April 3, 2006

Protect Your Vessels

Full-Length Doctor's Interview


Michel Makaroun, M.D., explains what an abdominal aortic aneurysm is and what the future holds for its treatment.

Ivanhoe Broadcast News Transcript with Michel Makaroun, M.D., Vascular Surgeon, University of Pittsburgh, Pittsburgh, TOPIC: Protect Your Vessels



What is an abdominal aortic aneurysm?

Dr. Makaroun: An abdominal aortic aneurysm is a dilatation of the wall of the artery and a growth of the artery to a size that is much more than is normal for the patient. It's the same type of concept as when you're blowing into a balloon, and it starts growing in size as more pressure is applied on the inside. At the same time, the balloon's wall starts thinning and becomes more liable to rupture under increased pressure.



What causes abdominal aortic aneurysms?

Dr. Makaroun: There are families that have a much higher tendency to develop abdominal aortic aneurysms than the general population. It is not exactly known what is the defect that actually leads the wall to weaken and start enlarging in size. However, smoking and high blood pressure are the two most common factors that have been linked to the actual expression of the disease. So, you are born with the tendency to develop it, but then you have to smoke it into existence or you have to actually do things during your life to make that aneurysm grow in size.



Are there any symptoms of having an abdominal aortic aneurysm?

Dr. Makaroun: There are rarely any symptoms of an aneurysm. It's a very silent dilatation. It doesn't cause pain, it does not cause any other problems with the abdomen or the back.

Unfortunately, the first symptoms are the symptoms of rupture when the aneurysm starts leaking blood to the outside, and that's associated with severe pain in the back, the belly, or on the side. On occasion, an aneurysm can be inflamed and cause some pain, and that's what you call a symptomatic aneurysm, but it's rare. By and large, most aneurysms have no symptoms until they rupture.



When the aneurysm ruptures is it something that will kill you? Or is it just a condition that causes pain?

Dr. Makaroun: It's actually a very lethal situation. It is estimated that patients who rupture have about 70-percent to 80-percent chance of dying. Several of them will never reach the hospital. Of those who reach the hospital, about 50 percent of them can still be saved. So, it is actually a very deadly disease.



How is the aneurysm usually diagnosed?

Dr. Makaroun: Sometimes we can feel it by physical examination during an annual check-up. Sometimes it is picked up on general X-rays like a computed tomography scan obtained for something else. Usually a patient has another issue, and he or she is in the hospital when we note the aneurysm. We have been asking for a routine screening of abdominal aortic aneurysms that unfortunately has not been covered yet by insurance, but now there's a lot of documentation that screening for abdominal aortic aneurysms is cost efficient in the subset of elderly, male population with the high risk. It will pick up a lot of these aneurysms early enough for us to treat them before they rupture.



How would you screen this subset of men?

Dr. Makaroun: With ultrasound -- It's actually a very cheap test. It's done in about 10 minutes. It's very quick, its non-invasive, and it doesn't really involve a whole lot of pain. There are a lot of companies that actually do it for profit. They go and set up an ultrasound in a church or a schoolyard and unfortunately, the elderly people go and pay about $100 for screening of arterial disease. That's how some of these patients are being picked up. I understand that Medicare and Centers for Medicare & Medicaid Services are now considering covering screening for most of the elderly population so we will pick up these aneurysms early enough to be treated.



After you find the abdominal aortic aneurysm, what do you do about it?

Dr. Makaroun: When we find it, it obviously produces a lot of anxiety for the patients. They're nervous that they have a so-called time bomb in their abdomen and that it's going to rupture at any time. The truth of the matter is they don't rupture as often and as frequently as people think. The rupture rate is related to the size of the aneurysm. The larger the aneurysm, the higher the chance that it will rupture in the foreseeable future. So, we try to evaluate the size, the shape and the location of the aneurysm. Obviously, some aneurysms are easier to treat than others, depending on what they involve. We try to always balance the risks of the interventions that we have to do to treat the aneurysms vs. the risks of leaving the aneurysm alone. The risk/benefit ratio seems to be in favor of treating aneurysms around five centimeters, so when the aneurysm is about five centimeters, or two inches, is when we typically recommend that we treat those aneurysms. It seems that the size probably should be a little bit smaller for women than for men because women tend to rupture at a smaller size than men do.



How risky is the procedure of stenting as a treatment for the aneurysms?

Dr. Makaroun: Actually, it is not as risky as it sounds. Of course, you only hear about the problems that are widely reported. It's a safer procedure than the traditional procedure that we've been doing in terms of mortality and the complication rates during the operation. However, the long-term results remain somewhat shrouded with doubt, and the reason is those devices have not been 100-percent stable and free of deterioration over time. They rely on metal and on suturing and fabric that can break over time. Long-term they require a much closer follow-up and occasionally require some kind of maintenance. You have to bring the patients back, add a stent, and do something to make sure that the device is still functioning the way it is supposed to. But, by themselves, the stenting procedures in general are actually less risky than the open procedures.



What is the reason that you wouldn't want to just take care of the aneurysm right then and there rather than tracking it?

Dr. Makaroun: Because we are talking about a disease that afflicts typically an elderly population that has a lot of other problems. The average age of the patients that come to see me with aneurysms are in their 70s and already have cancers, heart disease, they've had strokes, and a lot of times. When the aneurysm is still small, the chances are quite significant that the patient will not live long enough for the aneurysm to rupture, so there is no sense in actually putting them through a procedure that still has some complication. There's absolutely nothing that we do to patients that does not have a complication rate, so we try to avoid interventions unless there is a significant risk that this aneurysm might rupture in the next year or two.



From your standpoint as a vascular surgeon, why is computer modeling so important to treat aneurysms?

Dr. Makaroun: This is a project that we started about 10 years ago where we tried to figure out if there is an easier way for us, or a more accurate way for us, to predict the risk of rupture. We have a lot of patients who have a nine- or 10-centimeter aneurysm and they've not ruptured yet, and then there are some patients that ruptured at five centimeters. So, obviously there are other issues involved in the risk of rupture of these aneurysms. This project of computer modeling is really an attempt at finding additional factors that are linked to the ruptures, so we will be able to tell the patient more accurately the risk of rupture. We can then more accurately determine what is the appropriate time that we should intervene and treat the patient.



What is the computer modeling that you're doing?

Dr. Makaroun: Actually, it's a simple idea. It derives from the ability of most engineers to actually produce models knowing the characteristics of the tissues and of the products that they're dealing with when considering the amount of stress and strain that is applied to a particular material. For example, Boeing or any other airline company can really model a new airplane on the computer, build it, and it will fly because science is good enough with computer modeling to know exactly what to expect from certain physical characteristics of a particular material. So, if we knew exactly how strong the aneurysm tissue is, how much pressure is applied to it under different situations, depending on the blood pressure and the size and shape of the aneurysm, we could probably predict where and how much stress is being placed on a particular part of the aneurysm. So, it's simply taking information that can be obtained non-invasively and applying it to a computer model to try to obtain an analysis of how high the risk is of rupture. Now, this is not entirely pulling it out of our hat. We have taken a lot of specimens from the operating room when we do open surgery and tested the strength of this wall. We have produced in this model a lot of other factors that lead to the increased stress or strength of the tissue. Obviously, tissue is only going to fail when the stress applied to it is more than the strength of the tissue, and that's the basis of the model.



What kind of information do you gather to create the model?

Dr. Makaroun: Well, you have to understand it's not a clinical model that can be applied to patients yet. We're still in the research and study phase, but you can take the CT scan images and reconstruct the exact shape of the aneurysm, the exact amount of thrombus, which is a clot that forms on the inside of the aneurysm, how thick it is, and where its located. We can take the blood pressure of the patient where it's applied, and we apply this all in a complex formula and come up with the picture of where the stress is located and how much stress is being applied.



What are the hopes for the future of computer modeling?

Dr. Makaroun: The hope for the model is that when we see a patient, no matter what the size of the aneurysm is, we will be able to apply this model to tell the patient what their risk for rupture is. We can watch you for a much longer period of time. So, the hope from a public health issue is that we will be only treating the patients that need to be treated, and yet making a good impact on the rate of rupture and the death from this disease. We hope we will be able to treat less patients, but actually have better outcomes.



If a patient falls into this subset of being older, male, a smoker and having high blood pressure, is there anything they should be doing to protect themselves?

Dr. Makaroun: To reduce the chance for the aneurysm to grow they should quit smoking. That's probably the most important thing that patients can do. Number two is to control blood pressure. High blood pressure is linked to increasing the size of the aneurysm and its rupture. Three is that there is some evidence now that beta blockers, which is a medication given to a lot of patients in this age group for blood pressure and for the heart, seem to also reduce the chance that the aneurysm will grow and rupture. These are the only three factors that we know can affect the natural history of the disease. Otherwise, there's really very little that the patient or their physicians can do to change the natural history of the disease. So, we just follow these patients with serial ultrasounds every six months to see the growth rate. When they get to the point where we think it's too large, or it's growing very fast, that's when we recommend intervention.



Do aneurysms ever just go away?

Dr. Makaroun: Practically never. That is something that just does not happen. They do not heal themselves and shrink back to normal. They just stay there and keep growing. Sometimes they grow fast, sometimes they grow slow, so some people with a small aneurysm occasionally can go two or three years before they grow to a size that needs treatment, but it's also very hard to predict the rate of growth.



How do you respond to the recent bad press about the stenting device and that a lot of patients were dying from interventions?

Dr. Makaroun: That actually has shed this stenting or minimally invasive treatment of aneurysm in a bad light, and I think that's completely unwarranted. It took things completely out of context, and unfortunately, now the public is in the phase where they're mistrusting the treatments, especially the endovascular treatment, which is actually quite beneficial to most patients. I don't know if I can add any word of reassurance to them that actually most of these devices are relatively safe and are in their best interest.



If somebody doesn't know they have an aneurysm yet, but yet they're a 60-plus male and smoke is there anything they should do?

Dr. Makaroun: They can go to the doctor and say, "I'm concerned that I have an aneurysm and I'd like to be checked." It's a simple ultrasound test, and it is not very expensive if they have to pay for it themselves. We strongly recommend that all family members of patients be tested.


END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc., or any medical professional interviewed. Ivanhoe Broadcast News, Inc., assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors in different ways; always consult your physician on medical matters.

If you would like more information, please contact:

Frank Raczkiewicz
University of Pittsburgh Medical Center
Office of Public Affairs
(412) 647-3555
raczkiewiczfa@upmc.edu

Herckleperckle
Member

11-20-2003

Tuesday, April 04, 2006 - 8:21 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Hey, Sage. Sorry that I missed your note til now. After reading the above article, I suggest you and Nic each mention your parent's history to your own docs, watch your blood pressure, avoid smoking and ask for an abdominal CAT scan when you start getting up there in age.

Sage
Member

07-20-2000

Wednesday, April 05, 2006 - 6:42 pm   Edit Post Move Post Delete Post View Post Send Sage a private message Print Post    
Nic, mom's recovery from the Triple A surgery itself was good, but it was the blood clot in her foot that clouded how well she recovered. I didn't realize that blood clots and gangrene can be so severely painful. That is all she can remember in the hospital afterwards, is how much pain she was in. She was so heavily drugged during that time that she doesn't remember the first 6 days following the surgery.

I sure hope your dad does well and there are no complications following his surgery.

I've never smoked and don't plan on starting. My blood pressure is always low, but it would be a good idea to keep in mind in my later years to have a CAT scan just in case.

Vacanick
Member

07-12-2004

Wednesday, April 05, 2006 - 6:45 pm   Edit Post Move Post Delete Post View Post Send Vacanick a private message Print Post    
Sage, my dad is going to be opened up for his AAA surgery ... instead of going through the groin. How did your mom have her AAA repaired and how long was her recovery?? My dad is 72, is your mom close to that age??

Thanks for responding! And continued healing for your mom!

Sage
Member

07-20-2000

Thursday, April 06, 2006 - 11:40 am   Edit Post Move Post Delete Post View Post Send Sage a private message Print Post    
Mom was opened up. Her recovery from the AAA surgery was very quick. She went to a nursing home afer a week in the hospital because of her foot. She is 69.

Vacanick
Member

07-12-2004

Thursday, April 06, 2006 - 11:56 am   Edit Post Move Post Delete Post View Post Send Vacanick a private message Print Post    
We have been told a 5 - 10 day hospital stay after the surgery ... is that about right?

Sage
Member

07-20-2000

Thursday, April 06, 2006 - 5:54 pm   Edit Post Move Post Delete Post View Post Send Sage a private message Print Post    
Nic, 5 to 10 days sounds right. I hope things go well for your dad - a lot better than how it went with my mom. I wouldn't wish on anyone what she has been through. If it wasn't for her bladder cancer and the CT scan for that, they wouldn't have found the AAA, so I guess we can look at it as some sort of twisted blessing.

Vacanick
Member

07-12-2004

Tuesday, May 23, 2006 - 5:22 pm   Edit Post Move Post Delete Post View Post Send Vacanick a private message Print Post    
My dad had his first post-op appointment today since his AAA surgery and was given a clean bill of health! Yay!!!

Herckleperckle
Member

11-20-2003

Tuesday, May 23, 2006 - 5:27 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Oh, thank goodness, Nic! Yay!!! He is one lucky man! I am thrilled for you and him.