Aortic Aneurysms and Vascular Screening
Dr. Rajabrata Sarkar, professor of surgery and chief of vascular surgery at the University of Maryland Medical Center, first met patient Allen Weller in the operating room. Weller had been diagnosed with a ruptured aortic aneurysm at Washington County Hospital, and had an undetectable blood pressure upon his arrival at UMMC. Dr. Sarkar and his team immediately began working to revive Weller, and upon discovering a low blood pressure reading, began surgery to repair his aneurysm. Weller is now expected to make a full recovery following his ordeal. Dr. Sarkar discusses his experience below.
How common are aortic aneurysms?
Aneurysms of the aorta, or swellings in the aorta are actually very common. If you look at men over 65, at least five percent are walking around with aneurysms.
Is it possible to prevent an aneurysm from rupturing?
Vascular surgeons try to diagnose aneurysms using painless ultrasound technology before they rupture. The small aneurysms we find usually do not need to be repaired, but at least we know they are there and we can keep an eye on them. For those that do need to be repaired, the outcomes of repairing an aneurysm under controlled conditions are a lot better than trying to repair it after it has ruptured.
What happened when you met Allen Weller in the operating room?
Because Mr. Weller arrived in the operating room with no detectable blood pressure, our anesthesiology team first began trying to revive him with fluid and things to help compensate for the amount of blood he was losing. The second thing we did was insert a special surgical balloon through the femoral artery in his groin. I had to measure on his body, because there was no time to take X-rays, where this balloon would be above the aneurysm. Once the balloon was inserted into his aorta, it was inflated, which slowed the leak. Once the leak had slowed, we detected a very low blood pressure, which gave us enough hope that we might be able to save him. I opened his abdomen and was able to clamp the aorta and sew in a plastic graft to seal the leak. Because of the amount of bleeding and the fluid he received, I was unable to close his abdomen at that time. Instead, we temporarily closed it with a patch and sent him to the ICU. Later, he underwent several subsequent surgeries to completely close his abdomen.
What happened after the surgery ended?
It was a very difficult operation; there was a great deal of bleeding that had already occurred. At the end of the operation, however, Mr. Weller was remarkably making a pretty good recovery and was showing some signs of life. He had good blood pressure in his feet and his heart was working reasonably well.
What was your biggest concern after finishing the surgery?
There was a period of time in the helicopter of unknown duration when Mr. Weller had no blood pressure, and I didn't know how much brain damage might have occurred in that time. Frankly, my biggest worry was that he wouldn't wake up and that we would have a successful repair of the aneurysm in a patient without brain function, and unfortunately I've experienced that several times.
How has the patient's recovery progressed?
Over the next several days following his surgery, Mr. Weller woke up, started to respond to commands and began to move all of his extremities, indicating that his brain was working at a very basic level. He did develop some minor complications, but now he's able to walk and feed himself. He was in the hospital for about three weeks, which is what we'd expect after such a massive trauma and massive operation, but he's done remarkably well.
How will this recovery continue after the patient is discharged?
Even though Mr. Weller is ready to go home, the criteria for discharge are that he can get up and go to the bathroom, he can get up and go to the kitchen table and he can move around the house. In the afternoon, however, I told him that he will likely feel as though he needs to take a nap, and that's okay. I think he's going to be tired for one or two months, but he was fairly active before the operation, and I'm confident, despite all that he has been through, that he should make a full recovery.
What do you think this particular case illustrates about the Medical Center's ability to handle patients with the most complicated medical conditions?
This case illustrates, most importantly, that here at the University of Maryland Medical Center, we're capable of really tackling problems that would overwhelm many other medical centers. It points out the advantages that we have here at the Medical Center in terms of rapid transport -- the helicopter system that we instituted -- the superb care in the operating room and the superb care in the ICU. UMMC is a medical center that takes care of the most complicated patients, and Mr. Weller certainly was one when he arrived with no blood pressure and a very large hole in his aorta.