The Long Path to Diagnosis

Peter Lawrence's symptoms began in August 2005 when he started to suffer chest pains. He was admitted to Kent and Sussex Hospital where he was prescribed pain killers. These provided immediate relief, but Peter needed to have various tests to find out what the underlying problem was. An ultrasound to check his gall bladder was negative, and his chest X-ray was clear. It was decided that Peter needed a scan, for which there was a waiting list.

Whilst he was recovering at home, waiting for the scan, Peter lost his voice. By the 6th September, his voice had completely gone. Peter visited his local doctor, who thought it was some kind of infection. He prescribed antibiotics, but there was no improvement.

Peter was referred to the ear nose and throat (ENT) department at Uckfield hospital where he saw a specialist who examined him thoroughly and thought that the symptoms would improve in time. To be on the safe side, the specialist arranged a CT scan of the lower abdomen, where Peter was experiencing pain, but the scan was clear.

In January 2006, Peter saw the same ENT specialist who could see a slight improvement in the movement of Peter's vocal chord. Peter was scheduled for a follow up appointment in March with a second ENT specialist who'd just returned from maternity leave. As there was no real improvement, she recommended a scan of his upper chest and neck.

The scan took place in April 2006, and found a swelling in the aorta. At this point, Peter was immediately referred to a vascular surgeon. His notes were sent to St Thomas' Hospital, London and in July they performed an angiogram which confirmed a thoracic aortic aneurysm or TAA. Surgery was scheduled for mid-August and took place at St Thomas' Hospital in London.

The Operation

From the surgeon's perspective, Peter's case was a complicated one. His consultant, Mr. Peter Taylor, explains: "The aneurysm was in the aortic arch, which is very awkward with lots of inlets and outlets. What's more, at 76 years old, he was considered too old for open surgery due to risk factors involved with general anaesthetic and infection. This made him an ideal candidate for endovascular surgery, which is minimally invasive and so carries a reduced risk of infection and involves quicker recovery periods."

Luckily for Peter, Mr Taylor is a vascular surgeon at St Thomas' hospital focusing on aortic repair. St Thomas' is a centre of excellence for cardiovascular surgery - over 200 thoracic stent repairs have been carried out at the hospital, with a mortality rate of just 6.6% - compared to over 50% when such conditions are treated with open chest surgery.

The surgery itself was a complex procedure involving two operations, five days apart. In the first operation, conducted under general anaesthetic, a graft was inserted into Peter's neck, linking the left and right carotid arteries. This was to ensure that after the second operation, Peter would have an adequate blood supply to the left side of his brain, as the insertion of the stent would occlude the left carotid artery at the point where it leaves the aorta.

The second and more serious operation was performed five days later by Mr Taylor and his team. In this procedure, Mr Taylor repaired the five and a half cm long aneurysm using a 20cm long custom-made Cook tapered stent.

During the operation, there was a complication when Peter's blood pressure began to drop. However, this was immediately noticed. Because the procedure was minimally invasive, it was carried out under epidural anaesthetic, which meant that Peter was still fully conscious. The surgical team could tell something was wrong by Peter's decreased level of consciousness as his blood pressure dropped, and took instant action to bring it to normal levels. The surgeons also found that when they had inserted the 20cm stent, the end was occluding the artery supplying blood to Peter's right arm. They inserted a second device into his right arm to ensure that he would have an adequate blood supply.

The second operation lasted just two hours, after which Peter went straight into a recovery ward. He stayed in the hospital for just under a fortnight, and once home, he was soon feeling better. He continues to be monitored by his local consultant.

In addition to reparing the potentially life threatening aneurysm, in October 2006, Peter's voice started to come back. The aneurysm had been pressing on the nerve that serves the vocal chords, stopping them from moving properly.

Source
Racepoint Group

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