The old woman had a 50 mm iliac artery aneurysm, 6 times larger than normal, and threatened to burst, which was successfully handled by a doctor at Tam Anh Hospital after 6 hours of surgery.
Ms. Ho Thi Hao (75 years old, Lam Dong) was hospitalized in mid-October in a state of abdominal pain. Through ultrasound and CT scan, the doctor found that the patient had an abdominal aortic aneurysm below the kidney, measuring 60 mm, and the right iliac artery was also enlarged up to 50 mm – more than 6 times Normal size, high risk of breakage.
The surgery was difficult because the tumor was enlarged, the patient was elderly
Doctor, Doctor Nguyen Anh Dung – Head of Cardiovascular – Thoracic Surgery Department, Cardiovascular Center, Tam Anh General Hospital in Ho Chi Minh City, said, this is a dangerous case on the background of an elderly patient with mass large aneurysm, with a very tight, thin artery wall. If not timely intervention, the aneurysm will burst, the entire amount of blood spills into the abdomen, threatening the patient’s life.
“Because the aneurysm is large and located behind the peritoneum, the injury site is just below the renal artery, extending down to the iliac artery. In which, the right iliac artery is very large, so the surgeon needs to determine the right dissection. very carefully, control the healing position before and after the lesion,” said Dr. Dung.
Dr. Dung explained, in Vietnamese people, the aorta is usually about 18 mm in size, women can be smaller; The iliac artery is 7-8 mm in size. If the aneurysm is small and asymptomatic, the patient may not need surgical intervention, only periodic follow-up examinations. Surgical treatment or endovascular stent grafting is indicated when the aneurysm is larger than 55 mm in diameter, rapidly growing, or has high blood pressure that is difficult to control.
Endovascular intervention to place a stent graft is a minimally invasive technique, the stent graft device is inserted into the artery from the femoral artery in the patient’s groin, up to the location of the aneurysm and fixed in the artery lumen. With this technique, because there is no large incision, the patient can recover quickly. However, according to Dr. Dung, not all lesions are suitable for stenting. In this case, the large aneurysm spreading to both iliac arteries belonged to the group with a lesion morphology that was not suitable for stent grafting.
After consulting for Mrs. Hao, the doctors of the Cardiovascular Center decided to choose the surgical option. The surgery is relatively complicated, with high risk for a 75-year-old patient because the aneurysm, although located below the renal artery, has spread to the iliac arteries on both sides. The right iliac artery is 50 mm in size and completely crosses the division between the external and internal iliac branches. The surgical team must control the abdominal aorta below the renal artery, then dissect the entire iliac artery, and finally cut the entire aneurysm instead of a Y-shaped artificial graft.
Patient recovered 2 days after surgery
The surgery lasted 6 hours, but thanks to the experience, careful preparation and close coordination of the team of internal medicine doctors, surgery, anesthesia resuscitation, intensive care, Tam Anh General Hospital, the bulge has been treated. On the second day, the patient can extubate, sit up, walk, eat, and exercise gently.
Ms. Vo Thi Ngan, the patient’s family member, shared that after the surgery, her mother’s health was quite stable, she only recuperated for a day and then returned to her room, the next day she could walk gently. During the hospital stay, the doctors were very attentive, visiting patients twice a day; continuing care nursing. Her condition is very good, blood pressure is regulated, eating and walking are normal. Her family did not expect her to recover so quickly.
Aortic aneurysms and iliac aneurysms are common vascular lesions. The disease usually progresses silently but can be life-threatening.
Doctor, doctor Nguyen Anh Dung said, 70-80% of cases are detected only when the disease has progressed to a severe stage, threatened to burst or has broken. Initially, the patient may appear atypical signs such as abdominal pain, slow digestion; In rare cases, a mass on the abdominal wall can be palpable, beating with the heartbeat. When there is a lot of abdominal pain, it is already in the threatened or broken stage. If the patient arrives at the hospital in time, the survival rate is 30-40%. However, with early screening, active treatment with stent grafting or surgery, the survival rate is up to 95-97%.
People over 60 years old, people with risk factors for cardiovascular disease such as high blood pressure, diabetes, lipid metabolism disorders… should be screened for abdominal aortic aneurysms periodically. If there are signs of suspected aortic aneurysm or dilation, the doctor will combine CT scan to determine the lesion morphology and decide if it needs immediate treatment. The 768-slice CT scan system applying artificial intelligence (AI) at Tam Anh General Hospital can detect early aortic and systemic vascular lesions for timely treatment.
The name of the character in the post has been changed.