Many Questions Answered

I had left a message with Dad's surgeon indicating that I had a couple of questions, and was very pleased to get a call back from him today. I basically had one question, but he ended up answering three for me. Overall, it was an excellent conversation.

1) Why not a bifurcated stent rather than an aortic-uni-iliac (AUI) stent?

Back in our first conversation, the surgeon had mentioned that he was uncertain from the imaging whether he would have sufficient "margins" to "land" the stent at the lower portion of the aorta. He mentioned that he would therefore be doing an iliac-iliac bypass. In today's conversation, he clarified that the bifurcated stent is definitely the first option. However he needs 17-18mm clearance at the bottom of the aorta to make that device work, which seems to be just about what there is there. So depending on what he finds, he'll install the bifurcated stent if possible. If not possible, then he'll install the AUI stent, close off the un-accessed iliac artery, and perform the iliac-iliac bypass. At least from the literature, this shouldn't impact the ultimate outcome.

2) What about the reaction to the dye?

The surgeon did mention that they are going to have to use contrast enhancers in order to do the imaging during the surgery. Given that it looks like Dad has a bad reaction to this dye, he's prescribing prednisone and benadryl before the surgery.

3) Anesthesia.

I thought I had heard of people doing this procedure a spinal block rather than general anesthesia. The surgeon said that one of the larger risks in this procedure is going to be the general anesthesia. And that he has done this with local, since that doesn't achieve the immobilization that is necessary for precise placement of the stent, that is far less preferable. The only issue about the general anesthesia is whether his heart is strong enough to tolerate the general. (At this point, I don't how those things interact, but I don't think I need to right now.) His assessment based on the input from the cardiologist, is that this should not be a problem either.

So we're all "go" for Monday morning. I'll be flying down on Saturday morning.