More news about my mom's abdominal aneurym

On Wednesday the 28th my mom and I went to a consultation with a vascular surgeon to discuss the results of the abdominal CT scan she had for her aortic abdominal aneurysm (AAA) on Monday the 26th. An aortic aneurysm is a weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. As blood flows through the weak aorta, the weak area bulges like a balloon and can burst if the balloon gets too big. This results in massive internal bleeding that can be fatal unless it’s treated rapidly. The burst typically happens VERY quickly and without much warning. Once an abdominal aortic aneurysm has ruptured, the chances of survival are low, with 80 to 90% of all ruptured aneurysms resulting in death. These deaths can be avoided if an aneurysm is detected and treated before it ruptures. Below is a picture of an aneurysm, as well as a comparison between a normal-sized aorta and an aortic aneurism. KEEP IN MIND THAT A NORMAL DIAMETER OF AN AORTA IS TWO CENTIMETERS.

The news was not what we’d hoped. As I wrote in my previous entry, her bi-annual sonogram showed that the aneurysm had grown from 4.5cm to 5cm. That’s why she had to get the CT scan, to get a closer look. That 5cm mark is cause for concern. Once an aneurysm reaches 5 cm in diameter, it is usually considered necessary to treat to prevent rupture. The surgeon suggested that getting an operation was very necessary and important because of how rapidly it was suddenly growing. 

Thy idea of her having this operation is very scary and was the LAST thing I wanted to hear. Operations for abdominal aneurysms are VERY risky. The main surgery would be to just do an open repair in which a large cut is made in the abdomen, the aneurysm is taken out, and is replaced with a synthetic material . However, the surgeon said that this surgery is one of the riskiest and most difficult surgeries EVER…not only to do but from which to recover, and what makes it riskier is my mom’s past health issues. There is a second option though. It is much less risky, but of course there ARE always risks, especially with this type of condition.

The second option is a procedure that involves placing what called Abdominal Aortic Aneurysm Stenting, in which a stent is placed into the artery around the aneurysm. This takes no open cutting at all...just small incisions around the groin. I’ll try to put this in English as best as I can. As an aneurysm grows, the artery around it becomes weakened. A stent is designed to reinforce and seal tightly a weak spot in that to help prevent it from bursting. The stent allows blood to pass through it without pushing on the bulge, therefore making it less likely to rupture. However, the stent has to be placed JUST IN THE RIGHT SPOT or complications could occur, so the surgeon has to be very precise. This surgery allows the patient to leave the hospital sooner and recover more quickly, with less pain and a lower risk of complications, and sometimes a lower risk of death than the open surgery because of the smaller incisions. The word SOMETIMES scares me quite a bit.

Here is a placed stent:

The picture on the left is the aneurysm, the picture in the middle is a wire and catheter that is used to guide the stent into place, and the picture on the right is the stent being put in (top picture) and the stent in place (bottom picture)

So what are the risks?

1.    Blood can leak back into the aneurysm sac through small arteries feeding the aneurysm sac. That is called an "endoleak.” I know it sounds weird because it has the word "leak" in it, but it does not mean that the aneurysm has ruptured or is leaking. Some of the leaks stop by themselves and are not dangerous, but others need to be treated immediately or infection can occur.
 
2.    Infection
 
3.    The stent could move
 
4.    The stent itself could get fractured.
 
5.    Blockage of the blood could end up still flowing through the stent. This is what we don't want to happen, because the main reason for the stent is to keep the blood flowing so that it doesn’t burst.
 
6.    Conditions such as heart disease and kidney disease can increase these risks. My mom has heart disease and only one kidney. The operation involves using iodine contrast dye, which can cause damage to the kidneys. She’s already had several scans using that dye, and is allergic to it. She broke out from the CT scan she had on Monday, turning red and itching all over.

So my mom is going to have the second choice. I’m still scared that something could go wrong, but it is far less risky than an open surgery. Even so, it is in a sensitive area which is more prone to risks. After the procedure is (hopefully) complete and successful, my mom will have to have frequent checks and x-rays to make sure that everything is where it should be, but otherwise she won’t have to do anything that would interfere with her daily life. She is going to have the surgery on November 19, 2009.  I am so afraid that something might go wrong that I worry I’ll only have about two weeks left with her. She has gotten though so many surgeries just fine, but I know that one day something could go wrong, and maybe this will be that time. I've always called the aneurysm a ticking time bomb, just waiting to go off. I guess the time has come to diffuse the bomb.

I have to ask myself though…are the risks worth the benefits?