My Mother Is Having (Scary) Surgery Next Week
 

Hi, all,
My mother (71) is having a very delicate and scary surgery next week to repair an aortic aneurysm. It has grown over the last year and her doctors feel it's time to mesh it for containment. The caveat is that she was previously on kidney dialysis. She's been off dialysis for three years or so as some miracle kickstarted one kidney into working 50%. That has sustained her, and she has been able to maintain that level of kidney function with a good diet and exercise. The issue at hand is that the main lifeline of the 50%-functioning kidney involves the area they will be working on, and she'll be placed back on dialysis immediately after the operation, and chances are...from there...she'll be back on it for good, or until she gets a transplant. Luckily, after all these years on a waitlist, she's now on top. This is a very challenging time to say the least. She doesn't want to talk much about it all, but we are all so tense because we know it's a risky surgery. There's no way out of it--everyone knows how deadly a burst aneurysm can be. She lost her mom and brother to them. So, life changes permanently for me again. What a year it's been.

Re: My Mother Is Having (Scary) Surgery Next Week
 

I am sorry to hear about your Mom. I hope the surgery goes well.

Re: My Mother Is Having (Scary) Surgery Next Week
 

Is she a candidate for an endoprosthesis? Dr. Christopher Zarins of Stanford invented (in the mid 90s I believe) something that acts like pop-open wire/ mesh/composite lining which is inserted through the groin in a minimally invasive procedure. After insertion under fluoroscopic (video continuous xray) control, it pops open and forms a new inner lining of the part of the aorta that has the aneurysm so that it no longer matters that the wall of the artery is weak, because it has been reinforced from the inside and no blood can leak into the weakened wall because the entrance is blocked by the new lining.

It is like having a leaky pipe under your house that they sneak a new lining into via video control rather than digging it out and replacing it.

The problem with replacing the aorta seems to be that the arteries to the intestines and kidneys and legs (and even the spinal cord) branch out from it and there is a lot of repair to do to make sure all those organs have good blood supply which can take time (during which time the intestines, kidneys, legs and spinal cord can be denied of an adequate blood supply), the repaired juctions are under tremendous pressure with tremendous pressure on the repaired junction to leak and the whole procedure is tremendously traumatic temporarily depriving so much of the body of blood coming from the heart even in very (otherwise) healthy individuals.

Is the aneurysm more than 6cm? I believe that is the size above which they recommend repair. Of course, since it seems to be enlarging, it might be good to stay ahead of it (especially in view of the family history of ruptures), but if it is not that big yet, perhaps time is available to take the time to find out if the endoprosthetic option is reasonable in her.

There are a lot of scary aspects to this, so it would seem reasonable to get a second opinion and find out who has the best track record for treating these complicated aneurysms (those in the area near where the branches going to the kidneys take off)

I heard Dr. Zarins give a lecture about his invention 14 years ago --he was wonderfully humble and thoughtful. Patients were flown in from all over the world with very complicated problems. In the meantime, he and others must have trained many others in the technique.

Hope some of this was helpful--Best of luck!

Re: My Mother Is Having (Scary) Surgery Next Week
 

from a hospital in the Netherlands which is using his device:

The procedure can need to be repeated(successfully) in 20% of cases over time(about 7 years) , but only needs to be converted to an open repair in about 3% of cases over those 7 years. 30 day mortality was 1.1%. THese are GREAT stats.These is from the abstract below as I haven't read the whole article yet.


J Vasc Surg. 2010 Nov 3. [Epub ahead of print]
Long-term results of Talent endografts for endovascular abdominal aortic aneurysm repair.
Verhoeven BA, Waasdorp EJ, Gorrepati ML, van Herwaarden JA, Vos JA, Wille J, Moll FL, Zarins CK, de Vries JP.

Department of Vascular Surgery, St Antonius Hospital, Nieuwegein; The Netherlands.
Abstract
BACKGROUND: Since the introduction of endovascular aneurysm repair (EVAR), long-term follow-up studies reporting single-device results are scarce. In this study, we focus on EVAR repair with the Talent stent graft (Medtronic, Santa Rosa, Calif).

METHODS: Between July 2000 and December 2007, 365 patients underwent elective EVAR with a Talent device. Patient data were gathered prospectively and evaluated retrospectively. By American Society of Anesthesiologists category, 74% were categories III and IV. Postoperative computed tomography (CT) scanning was performed before discharge, at 3, 12 months, and yearly thereafter. Data are presented according to reporting standards for EVAR.

RESULTS: The mean proximal aortic neck diameter was 27 mm (range, 16-36 mm), with a neck length <15 mm in 31% (data available for 193 patients). Deployment of endografts was successful in 361 of 365 patients (99%). Initially, conversion to laparotomy was necessary in four patients. Primary technical success determined by results from computed tomography (CT) scans before discharge was achieved in 333 patients (91%). Proximal type I endoleaks were present in 28 patients (8%) during follow-up, and 14 of these patients needed additional treatment for type I endoleak. The 30-day mortality for the whole Talent group was 1.1% (4 of 365). Follow-up to 84 months is reported for 24 patients. During follow-up, 122 (33%) patients died; in nine, death was abdominal aortic aneurysm (AAA)-related (including 30-day mortality). Kaplan-Meier estimates revealed primary clinical success rates of 98% at 1 year, 93% at 2 years, 88% at 3 years, 79% at 4 years, 64% at 5 years, 51% at 6 years, and 48% at 7 years. Secondary interventions were performed in 73 of 365 patients (20%). Ten conversions for failed endografts were performed. Life-table yearly risk for AAA-related reintervention was 6%, yearly risk for conversion to open repair was 1.1%, yearly risk for total mortality was 8.9%, and yearly risk for AAA-related mortality was 0.8%.

CONCLUSION: Initially, technical success of endovascular aneurysm repair (EVAR) using the Talent endograft is high, with acceptable yearly risk for AAA-related mortality and conversion. However, a substantial amount of mainly endovascular reinterventions is necessary during long-term follow-up to achieve these results.

Copyright © 2010

Re: My Mother Is Having (Scary) Surgery Next Week
 

You have my heartfelt sympathy. Both our Moms are in a tough spot at this time. This site is also good for unburdening ourselves of these other problems that come into our lives.

You never know who will have some good insight as well as a sympathetic heart.

All good wishes for a successful surgery for your Mom!

Re: My Mother Is Having (Scary) Surgery Next Week
 

J Vasc Surg. 2006 Nov;44(5):920-29; discussion 929-31.
Endovascular aneurysm repair at 5 years: Does aneurysm diameter predict outcome?
Zarins CK, Crabtree T, Bloch DA, Arko FR, Ouriel K, White RA.

Division of Vascular Surgery, Stanford University, Stanford, CA 94305-5450, USA. zarins@stanford.edu
Abstract
OBJECTIVE: The appropriate size threshold for endovascular repair of small abdominal aortic aneurysms (AAA) is unclear. We studied the outcome of endovascular aneurysm repair (EVAR) as a function of preoperative aneurysm diameter to determine the relationship between aneurysm size and long-term outcome of endovascular repair.

METHODS: We reviewed the results of 923 patients treated in a prospective, multicenter clinical trial of EVAR. Small aneurysms were defined according to two size thresholds of 5.5 cm and 5.0 cm. Two-way analysis was used to compare patients with small aneurysms (<5.5 cm, n = 441) to patients with large aneurysms (> or =5.5 cm, n = 482). An ordered three-way analysis was used to compare patients with small AAA (<5.0 cm, n = 145), medium AAA (5.0 to 5.9 cm, n = 461), and large AAA (> or =6.0 cm, n = 317). The primary outcome measures of rupture, AAA-related death, surgical conversion, secondary intervention, and survival were compared using Kaplan-Meier estimates at 5 years.

RESULTS: Median aneurysm size was 5.5 cm. The two-way comparison showed that 5 years after EVAR, patients with small aneurysms (<5.5 cm) had a lower AAA-related death rate (1% vs 6%, P = .006), a higher survival rate (69% vs 57%, P = .0002), and a lower secondary intervention rate (25% vs 32%, P = .03) than patients with large aneurysms (> or =5.5 cm). Three-way analysis revealed that patients with small AAAs (<5.0 cm) were younger (P < .0001) and were more likely to have a family history of aneurysm (P < .05), prior coronary intervention (P = .003), and peripheral occlusive disease (P = .008) than patients with larger AAAs. Patients with smaller AAAs also had more favorable aortic neck anatomy (P < .004). Patients with large AAAs were older (P < .0001), had higher operative risk (P = .01), and were more likely to have chronic obstructive pulmonary disease (P = .005), obesity (P = .03), and congestive heart failure (P = .004). At 5 years, patients with small AAAs had better outcomes, with 100% freedom from rupture vs 97% for medium AAAs and 93% for large AAAs (P = .02), 99% freedom from AAA-related death vs 97% for medium AAAs and 92% for large AAAs (P = .02) and 98% freedom from conversion vs 92% for medium AAAs and 89% for large AAAs (P = .01). Survival was significantly improved in small (69%) and medium AAAs (68%) compared to large AAAs (51%, P < .0001). Multivariate Cox proportional hazards modeling revealed that aneurysm size was a significant independent predictor of rupture (P = .04; hazard ratio [HR], 2.195), AAA-related death (P = .03; HR, 2.007), surgical conversion (P = .007; HR, 1.827), and survival (P = .001; HR, 1.351). There were no significant differences in secondary intervention, endoleak, or migration rates between small, medium, and large AAAs.

CONCLUSIONS: Preoperative aneurysm size is an important determinant of long-term outcome following endovascular repair. Patients with small AAAs (<5.0 cm) are more favorable candidates for EVAR and have the best long-term outcomes, with 99% freedom from AAA death at 5 years. Patients with large AAAs (> or =6.0 cm) have shorter life expectancy and have a higher risk of rupture, surgical conversion, and aneurysm-related death following EVAR compared to patients with smaller aneurysms. Nonetheless, 92% of patients with large AAAs are protected from AAA-related death at 5 years. Patients with AAAs of intermediate size (5 to 6 cm) represent most of the patients treated with EVAR and have a 97% freedom from AAA-related death at 5 years.

PMID: 17098519

Re: My Mother Is Having (Scary) Surgery Next Week
 

Hi Karen. You have so much to deal with. I understand your are scared for your Mother but I hope everything will go fine and that she will recover fast from surgery. I'll be thinking of you until we have news next week. Sending Hugs. Michka

Re: My Mother Is Having (Scary) Surgery Next Week
 

Karen,

Are there others around who can help take care of your Mom after the surgery? From the description of the following link, she seems to fit the profile to be a candidate for the procedure. And it does mention something about 'low risk'...

http://www.healthline.com/adamconten...r-endovascular

We'll be praying for your Mom and your family.

Re: My Mother Is Having (Scary) Surgery Next Week
 

Karen
I hope your mother gets the best of care. Hope you get some care too at this difficult time.
Trish

Re: My Mother Is Having (Scary) Surgery Next Week
 

Karen
Will be keeping your Mom in my thoughts and prayers for successful surgery to repair the aneurysm...it must be frightening for all of you....our Mothers are such a precious commodity...we are lost without them....mine was the one person I could always turn to no matter what. Sending healing thoughts that this surgery will soon be behind your Mom and she will continue to regain her health.

Re: My Mother Is Having (Scary) Surgery Next Week
 

Karen, you have my sympathy. My Mom lives in Phoenix and I live in PA. She is 89 and is starting to fail but she refuses to move in with any of her 3 daughters. I love her so much and I call her at least 3 times a day. I will be praying for your Mom and for you. I hope the surgery goes well and she will heal quickly. Best wishes. Mary L

Re: My Mother Is Having (Scary) Surgery Next Week
 

Karen, I'm so sorry and will say a special prayer for your Mom tonight and hope she gets through this safely.

Re: My Mother Is Having (Scary) Surgery Next Week
 

OMG! You, my sisters, are amazing! I love you!

Re: My Mother Is Having (Scary) Surgery Next Week
 

So upsetting when our Mom's are ill. I hope that the surgery goes smoothly and your Mom heals quickly.
Sending you loving positive thoughts.

Jean

Re: My Mother Is Having (Scary) Surgery Next Week
 

Karen,

I'm praying that your mom's surgery is a success. It's a lot we have to deal with sometimes. Your own health problems and your concerns and fears about your mom's well-being, as well. Please let her know that she's in my prayers for a speedy recovery.

Joan

Re: My Mother Is Having (Scary) Surgery Next Week
 

Karen,

I'll be keeping your mom and your entire family in my thoughts and prayers.

Re: My Mother Is Having (Scary) Surgery Next Week
 

KDR,Wondering how things are w/your mother,hoping she is doing well....please fill us in,Joanna J

Re: My Mother Is Having (Scary) Surgery Next Week
 

Can you believe it!!???
My mother had the surgery yesterday and she will probably be released today! The surgery went really well and it looks like her kidney is still functioning and there will be NO return to dialysis! I spoke to her a little bit, she was in a lot of discomfort and had a sore throat from the intubation, but otherwise, the worst is behind her! Thank you, thank St. Theresa, Little Flower of Jesus--who sent me a rose, yes, she did!!!! Thank you so much for caring!

Re: My Mother Is Having (Scary) Surgery Next Week
 

KDR,So glad to hear the good news,this is wonderful,God is Good,Hugs from WV,Joanna J

Re: My Mother Is Having (Scary) Surgery Next Week
 

Karen -
So HAPPY to hear your Mom came through her surgery with flying colors. It seems this outcome is the best that could be hoped for.

Side note - my mom is also coming along and I had a good report from her physical/occupational therapists yesterday.