Correspondent Xie Xiaozhen
When an abdominal aortic aneurysm expands to a certain extent, the walls of the blood vessels may become weak, causing the aneurysm to rupture and blood leaking into the abdominal cavity or into the spaces around the tissues. In layman's terms, an abdominal aortic aneurysm is a dilating vascular pack in the stomach, which is life-threatening and has a mortality rate of up to 90% once ruptured and bleeding. A few days ago, the team of Director Yan Jingqiang of the Department of Vascular Surgery of the East Hospital of Qingdao Municipal Hospital performed emergency surgery on a patient with a ruptured abdominal aortic aneurysm, and the patient turned his life around.
The "bomb" counts down the seconds, and the life counts down
73-year-old Mr. Jiang (pseudonym), who lives in Laixi, was diagnosed with an abdominal aortic aneurysm at the end of 2023 during a routine physical examination, and the diameter of the aneurysm has reached 5cm, and there is a risk of rupture at any time. During the physical examination, the doctor repeatedly told him that surgical intervention was needed, but as the New Year approached, the old man thought that he would be treated again after the year, so he returned home with this "time bomb".
Schematic diagram of treatment for ruptured abdominal aortic aneurysm
One night in March this year, Mr. Jiang suddenly had severe pain in his abdomen and lower back, and he was sweating profusely, and his family rushed the old man to the nearest people's hospital in Laixi City. After an initial examination, the worst came out: the abdominal aortic aneurysm ruptured!
The vascular surgeon of Laixi People's Hospital knew that the survival rate after the rupture of the abdominal aortic aneurysm was extremely low, so he immediately contacted Yan Jingqiang, director of the vascular surgery department of the Eastern Hospital. After a brief communication, Yan Jingqiang immediately decided: "Emergency surgery as soon as possible, use a stent graft to cover the aneurysm rupture!"
5mm incision, 50 minutes extreme surgery
Yan Jingqiang checked the patient's condition: heart rate was 70 beats/min, blood pressure was 110/75mmHg, and vital signs were relatively stable, which created conditions for the next emergency surgery.
Abdominal aortic aneurysm before rupture
Combined with the CT of the patient's out-of-hospital hospital, Yan Jingqiang judged that a large amount of blood gushing out after the ruptured aneurysm was temporarily wrapped by a tough posterior peritoneum around the aorta, and had not yet broken into the abdominal cavity, forming a fragile state of balance. But he knows very well that the calm on the surface is actually the dark tide is turbulent - the posterior peritoneum may be broken through at any time, once the aneurysm breaks into the abdominal cavity, thousands of milliliters of blood can fill the abdominal cavity in an instant, and everything will be over at that time.
At the same time, Dr. Sun Bo, the attending physician of the same treatment group, actively contacted the anesthesiology department, intensive care medicine department, interventional operating room and other relevant departments to make preoperative preparations as soon as possible, and quickly sent the patient to the interventional operating room after explaining the patient's condition and surgical plan to the family.
Director Yan Jingqiang's surgery (data map)
The surgery is done through two small incisions of only 5mm in both groins. In addition to covering the aneurysm with a stent graft in the shortest possible time, intraoperative maintenance of blood pressure is also the key to the success of the operation, otherwise excessive blood pressure fluctuations may cause the aneurysm to rupture again. Under the anesthesiologist's superb anesthesia skills, the surgery was completed within 50 minutes. In the covered aneurysm cavity, Yan Jingqiang also filled the spring coil to ensure rapid thrombosis of the aneurysm cavity and prevent complications such as endoleakage.
Postoperative reexamination, the aneurysm was completely isolated
In order to prevent complications such as hypoperfusion after surgery, the patient was sent to the ICU for monitoring and treatment, and was transferred back to the general ward after his condition stabilized the next day, and the re-examination CT showed that the aneurysm was completely isolated, and he was discharged from the hospital three days later. Before being discharged from the hospital, the old man sighed sincerely: "I really picked up a life, and I still have to treat my illness early in the future!"
The "inside bomb" was found to be defused immediately
Ruptured abdominal aortic aneurysm is a critical clinical disease, often accompanied by severe abdominal pain, low blood pressure, vomiting, palpitation and other symptoms. For a ruptured abdominal aortic aneurysm, treatment is generally surgical, interventional, and supportive. The interventional treatment for Mr. Jiang only requires a small incision or puncture, which is more minimally invasive than surgical treatment, and the patient's recovery time is shorter, which helps to quickly control internal bleeding and stabilize the patient's condition. However, this minimally invasive procedure is not suitable for all cases, especially if the rupture is severe or the location of the tumor is specific.
Yan Jingqiang reminded that the best time for the treatment of abdominal aortic aneurysm is before the aneurysm ruptures, once the abdominal aortic aneurysm is found to reach the indication for surgery, surgical treatment as soon as possible, otherwise once rupture, it may lead to hemorrhagic shock, intra-abdominal infection, multiple organ dysfunction syndrome (MODS) and other serious consequences. Even if they are taken to the hospital immediately, the success rate of resuscitation is not ideal.
Founded in 2006, the Department of Vascular Surgery of the East Hospital of Qingdao Municipal Hospital is one of the earliest independent units in Qingdao, with rich experience in the diagnosis and treatment of various diseases in the field of vascular surgery. Interventional surgery and compound surgery effectively reduce the treatment pain of patients, improve the success rate of diagnosis and treatment of vascular diseases, and allow patients to return to a healthy life.
Yan Jingqiang, Director of the Department of Vascular Surgery and Deputy Chief Physician of the Eastern Hospital
Specialty: Minimally invasive treatment of abdominal aortic aneurysm, aortic dissection, thoracic aortic aneurysm, carotid artery stenosis, peripheral arterial disease, deep vein thrombosis and varicose veins of the lower limbs.
Clinic Hours: Monday and Wednesday Mornings (East Hospital)