Doctors at the Georgetown Public Hospital recently saw success in performing an emergency aortic aneurysm repair, with the patient expected to make a smooth recovery.
The success of the procedure which was conducted on November 25, was revealed to members of the media yesterday during a press conference at the Georgetown Public Hospital. General and Vascular Surgeon, Dr Carlos Martin and Head of GPHC’s Transplant and Vascular Department, Dr Kishore Persaud, were the main physicians performing the operation. It was noted that the surgery was the first of its kind at the hospital
“What is significant about this case I think it’s the first of such cases to actually come off the operating table at this hospital, I’ve never heard of a ruptured abdominal aortic aneurysm that actually survived, so once he makes it through this critical period he will be history for our hospital,” Dr Persaud remarked.
The patient, 36-year-old Mahaicony farmer, Christopher James, who is currently recuperating at the hospital’s transplant and vascular unit, told members of the press that he had been diagnosed with kidney stones in his teens and as such he would usually have pain in his back and abdomen.
The pain, he recalled, became worse in early November and did not go away. “It started right where the kidney stone normally started but when it come to the lower tummy it never leave me and I start to drink pain meds and I find that pain meds is not helping,” James said.
He then decided to go to the Mahaicony Hospital as he assumed that this was something more serious than kidney stones. A subsequent ultrasound showed that he did not have kidney stones, but the pain however persisted.
James then came to Georgetown and had a CT scan done and it was suspected that it was more than that. “They suggest that I should do another one over at Mercy to see what it is really, when we did it, it turn out to be not kidney stone and it was a life or death situation, my main artery was swollen and could rupture any time.”
During further discussions with the physicians, he noted that they advised that it needed to be operated on immediately as it was a “ticking time bomb”. However, just a few hours after, the pain intensified and became unbearable. Whilst being rushed to the operating theatre, the aneurysm ruptured and according to James, his body started to shut down.
Dr Martin during yesterday’s press conference stated that the surgery which was performed was the repair of a ruptured abdominal aortic aneurysm. He explained that the aorta is the largest artery in the body and that an aneurysm is a focal dilation of an artery.
“In this patient the aneurysm ruptured, the patient was very sick in shock and we had to do an emergency repair of that aneurysmal segment of the aorta whereby we replaced that part of the artery with a synthetic graft.”
Martin noted that while an aortic aneurysm repair has been done before, it was never done in such a setting given that the previous patient was stable and the fact that the aneurysm had not ruptured. With the aneurysm being ruptured, the vascular surgeon explained that it escalated everything in that regard as the fatality rate in these cases are extremely high.
Giving a further breakdown, he informed that approximately 65 per cent of patients with a ruptured aortic aneurysm would die before reaching the hospital. This data, he said, relates to first-world countries. Further, even if patients arrive at the hospital alive, the mortality rate increases by one percent every minute.
“A ruptured triple A [Abdominal Aortic Aneurysm] is really a major event in anyone’s life so this young man is very blessed to be alive,” Dr Martin observed. When an aorta repair is being done, doctors can use a patient’s own material, like a vein, while in other cases synthetic material called a graft can be used which can be made out of Dacron, polyester, or other materials.
In this case, he said, the doctors used synthetic material – Dacron. The synthetic materials usually used for these procedures are made in such a way that the body does not usually reject them. The graft can last forever once placed in the patient.
Meanwhile, Dr Persaud said that the hospital currently has a dedicated vascular team that is working to improve their skills. One of the major things that made this surgery possible was the availability of a vascular graft and he mentioned that the team is working along with the administration to ensure that more of such grafts are available so in the event of another case like this, they will be able to offer the same type of surgery to that patient.
“What is important to note and we want to at this moment to highlight that we had a very competent anesthetic and nursing team that actually contributed significantly in saving this patient’s life,” Dr Persaud said. In addition the head of the vascular department stated that the survivability of these patients is only around 20 per cent in top centres around the world.
Speaking on some of the complications that occurred prior to the operation, Persaud disclosed that James went into hypovolemic shock (a sudden loss of a lot of blood or fluids in the body that makes the heart unable to pump enough blood to the body) just before he was intubated. However, the anesthesia team managed to resuscitate the patient and keep him stable in the operating room until doctors were able to operate.
The operation lasted for approximately three and a half hours and following the surgery, the patient spent about three days in the intensive care unit. He was subsequently transferred to the transplant and vascular unit where he is currently recovering in a stable condition.
James, who spoke to reporters from his hospital bed stated that he considers himself the luckiest person in Guyana and referred to the team of doctors that performed his surgery as his superheroes. “I’m feeling one hundred per cent better, I’m feeling good now. I have no doubt that I would have a normal life again,” he said. (Shamar Meusa)
