Doctors opt for minimally invasive procedure since patient had complicated medical history with many medical conditions
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A team of surgeons at a hospital in Dubai have successfully conducted a rare surgical procedure to save the life of an 80-year-old Emirati man who was in a critical condition.
The patient had been suffering from a symptomatic infrarenal (below the kidneys) abdominal aortic aneurysm (balloon-like bulge), and was brought to the Medcare Hospital at Al Safa after a sudden increase in abdominal pain. This condition is not rare among male patients above 65. If the aneurysm bursts it can be life-threatening for the patient.
The Emirati man had many pre-existing conditions. He suffered from numerous long-term health risks including chronic heart and renal (kidney) conditions, hypertension, type 2 diabetes, high cholesterol, iron deficiency anemia, and other challenges. He also had an umbilical hernia, which is an abnormal bulge at the belly button, and overgrown prostate blocking the flow of urine.
Dr Saher Arour, a vascular surgery consultant at Medcare Hospital in Al Safa, said that this made the case very complicated and it required immediate attention. “Given his extensive medical history, we opted for the EVAR procedure to prevent the aneurysm from bursting. Despite these precautions, this procedure was challenging with many associated risks considering the patient’s age and condition,” said Dr Arour.
He added they considered the EVAR to be the optimal course of treatment for this patient due to his multiple comorbidities and health risks. “We had to rule out the option of open surgical resection because of the high risk of death.”
Open surgical resection is a medical procedure that involves the replacement of the aneurysm with a graft. Unlike an open surgical resection, EVAR is a minimally invasive procedure that has revolutionised the management of abdominal aortic aneurysms in the past two decades. The procedure uses small punctures and sophisticated instruments to repair bulges in blood vessels in the abdominal area to prevent the swollen blood vessel from rupturing.
Dr Arour highlighted that EVAR can provide immense benefits for the patient compared to open surgical resection. “It is a gentler procedure that leads to less blood loss, discomfort during recovery, and shorter hospital stays. Additionally, patients can return to their daily activities faster and have a reduced risk of complications, such as heart attack and death,”
In spite of these precautions, the case presented various complications. “The patient had renal failure, making a standard EVAR procedure impossible due to not being able to use contrast angiography, which is very important for planning and implantation of the graft. Thus, we had to use CO2 angiography, an alternative to conventional iodinated contrast angiography, instead as the patient would have been at high risk with normal angiography,” said Dr Arour mentioning that the procedure has a high success rate but there is always a chance for complications arising, such as bleeding, infection, and kidney failure.
The patient got discharged in good general condition two days after the surgery.
“I have been suffering from multiple diseases for a long time. To be able to feel comfortable again is a daily reminder for me to cherish every moment and aspect of my life. The journey of recovery has been arduous but ultimately rewarding,” said the Emirati man.
Doctors say that aftermath can vary depending on the patient’s condition and the extent of the repair. In most cases, patients can expect to spend a day or two in the hospital for monitoring before being discharged to recover at home.
With proper care and follow-up, patients who undergo an EVAR can typically expect to return to their normal activities within a few weeks or months of the procedure. Regular check-ups with a healthcare provider will be necessary to monitor the patient’s progress and ensure that the aneurysm remains stable.
The future of EVAR in healthcare looks promising as it continues to advance with new technology and techniques. EVAR has the potential to become the standard of care for many patients with the ability to treat swellings in the blood vessels in a minimally invasive way.