Longest aneurysm repair procedure in Delhi

Rare Aorta Rupture Averted Safely in Noida Metro Hospital

New Delhi, April 4:  Had weakened Aorta, swelling into balloons, ruptured, there would have been almost nil chance of 51 year old Vijay Kumar from Fijji being saved from fatal internal blood tsunami.

But he had a close shave. Dr. Purushottam Lal, a famed interventional cardiologist averted the impending catastrophe triggered by rupturing of aneurysm. Wall of aorta stretching like balloon due to its weakening is called aneurysm, which is a serious health risk because it can rupture and precipitate a tsunami of internal bleeding. His was one of the longest aneurysms seen the world over. The aorta is the largest artery in body and carries blood away from heart to all parts of the body.

Vijay Kumar from Fiji had complaints of chest and back pain and was diagnosed to have the aneurysm involving the thoracic and abdomen. CT angiography done at Metro Hospital revealed an aneurysm involving the thoracic aorta as well as abdominal aorta starting just below the origin of subclavian artery extending up to the celiac trunk. There was evidence of thrombosis as well dissection in the aorta. A non surgical repair was done through the right groin area like angiography procedure and 3 stent grafts have to be put of the length 117 mm long, 107 mm long and 212 mm long of Medtronic Company virtually reconstructing the whole of the descending aorta starting from the subclavian artery up to the renal artery.

The rare repair was done in Noida Metro Hospital on March 24. Dr Lal said, ‘It was one of the longest aneurysm coming across and to the best of our knowledge very few cases of such a long thoracic aneurysm requiring 3 stents have been done across the country. The patient did very well without any complications and discharged within a week in excellent condition.’

Talking to Meditoall, editor in Chief, Dhananjay Kumar, Dr. Lal further explained, ‘The aortic aneurysms are serious health risk because they can burst or rupture. A ruptured aneurysm can cause severe internal bleeding which can rapidly lead to shock or death. Only 20-30% of the patients who get to the hospital with a ruptured TAA survive. For this reason it is crucial to treat the aortic aneurysms early or to prevent their rupture and death.’

The part of the aorta that runs through the chest is called thoracic aorta and when the aorta reaches it is called abdominal aorta.  Sometimes as the people grow older the wall of the aorta in chest or abdomen can become weak and stretch to like a balloon called aneurysm. Most of the people don’t have many complaints. Some people of course complain pain in the chest or upper back and shortness of breath. There is no obvious reason for the development of the aneurysm. However, the people suffering from high BP, smoking and having family history of aneurysms can have more chances of developing the aneurysms.

Aneurysm is diagnosed by doing chest X-Ray, ultrasound, echocardiography, CT scan, MRI and angiography. In case the aneurysms are small and not causing the symptoms then every 6 months the size of the aneurysm is determined either by ultrasound or CT scan. As far as treatment of large aneurysms is concerned, it is done either by open surgical repair or non surgical endo vascular repair. Open surgical repair needs meticulous expertness and is extremely high risk surgery whereas non surgical endovascular repair is relatively simple and recovery is fast. The complications of these procedures are paraplagia (weakness of both lower limbs) and lack of blood supply to the intestine.

It may be mentioned here that Dr. Purshotam Lal performed the first case of endovascular repair of abdominal aortic aneurysm involving the aneurysms of the arteries of the legs with AAA graft of Boston Scientific on a 68 years old doctor from Chandigarh in 1997-1998 for the first time in the country.

The awareness about the aortic aneurysm is of utmost importance since majority of the aneurysm don’t cause any symptoms and their rupture means almost death. It is estimated that 4% of the people may have small or medium size aneurysm while 6 men out of one thousand will have large thoracic aneurysm requiring urgent treatment. A screening program is therefore very important. A simple ultrasound test can detect whether a thoracic aneurysm is present. It takes few minutes but it really could help save the life. The aortic aneurysms are six times more common in men than women and become increasingly common with age. Although it can happen to anyone, preventive steps can help to reduce the risk of developing an aortic aneurysm. These steps include giving up smoking, controlling of blood pressure, eating a healthy balanced diet, maintaining a healthy weight and taking regular exercise.