A few weeks ago retired taxi driver Harry Soobransingh was given a new lease on life after emergency endovascular repair of a ruptured aortic aneurysm. The 88-year-old man from San Fernando had an infra-renal aortic aneurysm measuring ten centimeters. He was taken to a private medical facility with a rupture of the aneurysm. He was bleeding profusely and could have died. An aortic aneurysm is called the "silent killer." Many people are unaware they have it until it ruptures and leads to exsanguination (bleeding to death). An aneurysm is caused by a weakened area in the wall of a blood vessel. The wall swells like a balloon and can burst if it gets too big. Major risk factors for the development of an aneurysm are hypertension and smoking. Emergency endovascular repair of ruptured abdominal aortic aneurysm is performed in special centres in developed countries but on November 13 it was done for the first time in T&T.
An endovascular team headed by interventional cardiologist and vascular interventional specialist Dr Shane Gieowarsingh and consultant vascular surgeon and university lecturer in surgery Dr Michael Jimmy Ramdass performed the life-saving procedure. Soobransingh had a pre-existing lung disease which placed him at very high risk of conventional open abdominal surgery and general anaesthesia. In an interview at the T&T Guardian last week, the surgeons explained how the procedure was done. The technique was a minimally invasive procedure (keyhole surgery) done while Soobransingh was awake. Gieowarsingh explained that access was gained via the femoral artery in the groin under local anaesthesia and a specially-designed stent with a multifilament polyester graft covering was implanted inside the aneurysm achieving an excellent result with complete seal of the leak. Soobransingh's normal blood flow was re-established. Gieowarsingh, who recently returned from the United Kingdom and Italy, said repairing the ruptured aneurysm was "remarkable" for T&T.
He said: "There are only several top centres that have established services for that situation, so it's remarkable that in Trinidad we can achieve that state-of-the-art procedure."He added that the procedure lasted about two hours and "in two or three hours the patient was sitting up comfortably." He said it was a common disease often misdiagnosed. Ramdass said it was an exciting time for endovascular surgery in Trinidad. "We have been able to put together the logistics," he said. "The three necessary components to make it happen were ensuring a cath lab was open as an emergency in the middle of the night with its operating staff, having the stent graft device distributors in Trinidad and having a stock of the necessary equipment and having medical staff with the necessary skills and knowledge."
About the aorta
The aorta is the largest artery in the body. It is the super-highway via which blood ejected out of the heart is distributed throughout the body. After arising from the heart, the aorta courses up to the base of the neck, giving off branches to the brain, continues down the chest and abdomen from which branches go to the lungs, kidneys, liver and intestines. After supplying the abdominal organs it divides in the pelvis, supplying the organs in that region, and thereafter exits in the groin giving rise to arteries supplying blood to the legs. The normal diameter of the aorta is about 1.5 to 2 cm. The standard approach when an aortic aneurysm ruptures is emergency open surgery under general anaesthesia in which the abdomen is opened to control the neck of the aneurysm and repair the aorta using a dacron graft material. This carries a poor survival rate since these patients are usually elderly with serious co-morbid conditions related to the heart, lungs and kidneys.
About the surgeons
Dr Shane Gieowarsingh:
• Master of endovascular techniques, University of Milan;
• Bicocca certificate of completion of training cardiology (UK);
• British Cardiovascular Intervention Society;
• European Society of Cardiology; and
• International Society for Vascular Surgery.
Dr Ramdass:
• Master's of science in surgery, England.
• Fellowship Royal College of Surgeons of Edinburgh;
• Fellowship Royal College of Surgeons of England;
• Consultant general and vascular surgeon, and lecturer in surgery, based at Port-of-Spain General Hospital and Medical Associates; and
• 54 international scientific papers in surgery to date.