Week 6: Lost his guts!

This week was characterized by a couple of unique cases. For instance, I shadowed a procedure for the youngest patient I've observed in vascular surgery, an 11-yr old girl. This young girl had a previous history of neuroblastoma, which had been successfully treated via removal of 1 kidney. However, treatment of the neuroblastoma led to stenosis of her thoracic aorta, requiring treatment with a graft from her thoracic aorta with anastomoses to her remaining kidney and iliac artery. Unfortunately, she developed high blood pressure, elevated creatine (indication of poor kidney function), and claudication. These symptoms indicated occlusion of blood flow within the graft, and were successfully treated with angioplasty and stent placement. Fast forward to today, in which she is again hypertensive, indicating that restenosis of the stent may have occurred. Indeed, restenosis was observed during angiography, and treated with angioplasty. The procedure itself used much of the same techniques I have observed such as angiography, angioplasty, etc. but her story contrasts greatly with the treatment of aneurysms and atherosclerotic lesions I have observed thus far.

I also had the opportunity to observe the most invasive vascular surgery I could imagine, an aortobifemoral bypass graft placement. In this procedure, the patient's abdomen was exposed, and the intestines were put aside so as to expose the aorta. From there, a polyester vascular graft was utilized to provide a conduit for blood flow from a point just inferior of the SMA to both femoral arteries. This procedure addressed advanced atherosclerosis in the distal aorta that led to occlusion of blood flow and ischemia in the legs.