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STORY OF HEART

Aortic Aneurysm – A Silent Fatal Disease

“Most illness has early warning signs before they strike. But unfortunately, some of them don’t give much of a clue. Aortic aneurysm is one such disease. It occurs when a segment of a blood vessel becomes weakened. The pressure of blood flowing through the vessel creates a bulge at the weak spot. The bulge usually starts small and grows as the pressure persists.”
 
            Aneurysms are dangerous because they can rupture, causing internal bleeding, other complications and death. They don’t usually cause any symptoms until they become very large or rupture. Not many people escape death when it comes to rupturing, but one exception is Dr. Likhit Wangsanutr, a rehabilitation medicine physician at Bangkok Hospital.
            Dr. Likhit, a now 72, was a one in a million case after his abdominal aorta erupted because he got to hospital just in time. He recently reflected on the day a messenger of death came to visit him.
            “I was 63 years old. I felt very thirsty and urinated very often for two-three days before my abdominal aorta exploded. In the evening of that day, I was dizzy and collapsed on the floor while singing my first karaoke song. After that, Bangkok Hospital mobile CCU came and picked me up”.
            Then I remembered that five years previously I had discovered that I had calcium deposits in my arteries coming from my heart. That led me to doubt that I would have an abdominal aorta eruption. I immediately asked for a CAT scan from which we discovered that it really was the aorta eruption and I was sent to the operating theatre straight away. I was very lucky that Bangkok Hospital is equipped with a full facility with an experienced team on standby 24/7. Three days after the operation, I was able to walk and started physical therapy. Over time, I fully recovered and regained my strength. It was a miracle”.
            Dr. Kosin Thupvong, Director of Cardio-Thoracic Surgery at Bangkok Heart Hospital described the symptoms of the disease and treatments required for aorta aneurysm patients.
            “Aneurysms don’t usually cause any symptoms until they become very large or rupture. Chest pain and back pain are the two most common symptoms of large aneurysms. Chest pain is usually the first sign of aortic dissection. Many people describe a tearing or ripping pain in the chest when the aorta enlarges to a critical size (over 7 centimeters) and ruptures. Pain, increased sweating, a fast heart rate, rapid breathing, dizziness and shock may also occur. Some people describe a strong pulse in the abdomen, a feeling of fullness after minimal food intake, nausea and vomiting”.
            “Treatment of this condition depends on the patient’s overall health, the size and location of the aneurysm and whether patients are showing symptoms. Abdominal aortic aneurysms occurring at the abdominal aorta – the last and largest section of the aorta that supplies blood to the lower regions of the body – are found most frequently. When aneurysm
 
is larger than about 5.5 centimeters or symptoms such as abdominal pain or an abnormally prominent abdominal pulsation occur, immediately repair procedure surgery is required to repair the section.
            Open abdominal aorta aneurysm repair surgery is implemented to prevent rupture of the bulging area of the aorta. Traditional open surgical repair is performed under general anesthetic for the duration of the procedure. The surgeon will begin by making an incision from the breast bone to below the navel. He or she will then locate the aneurysm and clamp the aorta just above and below it. The surgeon will then open the aneurysm and sew an artificial graft the same size and shape as a healthy aorta into place. Then the surgeon will stitch the wall of the aneurysm closed over the newly placed graft. The graft will reinforce the wall of the aorta. The surgeons will subsequently close the abdominal incision with stitches. The total duration of the procedure is usually 4-6 hours.
            Another aneurysmal repair technique is endovascular aneurysmal repair. Endovascular aneurysm repair is a newer minimal invasive procedure. It is rapidly gaining popularity and has proved a short term result to be as good as open repair technique. It has few other advantages, being a much less invasive techniques.  
            Before an endovascular procedure, the patient may be given a general anesthetic or sedative and an regional anesthetic to numb only the lower half of the body (for abdominal aortic aneurysm). The surgeon will begin the operation by making a small incision in the groin above the femoral artery, then insert a guide wire into the artery and gently push it up towards the side of aneurysm. 
            “A catheter or hollow tube is passed over the guide wire and pushed towards the aneurysm. Using live X-ray images as a guide, the surgeon passes an endovascular stent graft, a compressed fabric and metal tube, through the catheter to the aneurysm. After that, the graft is opened and held in place with metallic hooks and stents.
            “The surgeon may insert additional graft components to extend the graft into the blood vessel supplying the legs. Once the graft is in place, blood flows through it, not in the surrounding aneurysm sac, thereby removing the pressure at the point of the aneurysm.
            Finally, the surgeon will remove the catheter and close the incision in the groin. The procedure takes 2-3 hours, after which the patient is taken to an intensive care unit for recovery.
            The usual hospital stay for a traditional open procedure in uncomplicated case is 7-10 days while a stay for an endovascular procedure is usually shorter.
            Preventive measures can be taken to keep blood vessels healthy and strong. These includes stopping smoking, controlling blood pressure and diabetes. Patient should be on a low-fat, low cholesterol diet, and taking exercise at least 30 minutes a day,
            Some experts recommend screening individuals older than 55 years. Screening would detect aortic aneurysm that otherwise would go unrecognized because they don’t cause immediate symptoms. Ultrasound examination of the abdomen is more than 80% accurate in screening for the existence of abdominal aorta aneurysm”, concluded Dr. Kosin.