AN ENDOSCOPIC vascular surgery for removal of plaque (unwanted deposit) in a blood vessel of a 65-year-old man was performed for the first time in the City and the region, at the Bhandari Heart Hospital here by Dr Kishore Sieunarine from Royal Perth Hospital, Perth, Australia.
Due to the plaque (unwanted cholesterol deposit) in the artery below his left ear, there was a narrowing and thickening of the common carotid artery involving bifurcation. The patient was suffering from weakness and also suffered from near paralytic attacks (although for temporary periods) on the right limbs.
The surgery, which was performed by Dr Kishore, a team of about 7-8 doctors and paramedical staff at the Bhandari Hospital, lasted for about one and a half hours. An angiogram of the patient taken yesterday had enabled Dr Kishore to locate the exact place and hence, only that area where a small incision was required to be done was exposed.
The surgery was shown live via videoconferencing at two places –Sri Aurobindo Institute of Medical Sciences (SAIMS) for the benefit of medical students and at a special room at Hotel Sayaji for the medical fraternity.
Dr Kishore continued interaction during the surgery and also answered queries raised by the viewers at both the venues. He also gave details about the way he prefers to do such surgeries generally – “I prefer local anaesthesia but here we have given General anaesthesia” – and clarified doubts raised by the doctors, who sought to benefit from the latest technique being carried out and shown.
Dr Kishore and his team comprising Dr Tarun Gandhi and others; first made a small incision below the patients left ear. Tearing layer after layer, the surgeons reached the concerned artery and removed the plaque, which was a few millimetre long and had caused narrowing of the carotory artery. Once this was removed, the doctors sealed the artery again with non-disposable sutures, maintaining a steady blood pressure of 180-200 – “raise it artificially if it goes below” – all the while and keeping a tab on other vital parameters of the patient.
The patient is stable and would soon be able to lead a normal life, Dr Dheeraj Gandhi of the Bhandari Hospital said. Coinciding with the surgery, a workshop and conference on “Vascular and Endovascular Surgery” was held at Hotel Sayaji on Saturday wherein apart from Dr Kishore, interventional radiologists from Mumbai Dr Girish Warwadekar spoke on “Endovascular Repair of Dissecting Aneurysms.”
Speaking to Hindustan Times on the sidelines, Dr Warwadekar made it simple saying, “In common man’s language, aneurysm means bursting of artery due to any reason. It can happen in any part, but the mortality rate in chest region is high.”
The job of the interventional radiologists is to insert a stent graft in the affected artery (something akin to bypass surgery), which enables regular blood flow through the graft instead of the balloon like formation causing problems. The balloon left to it self turns into a clot, which heals naturally inside the human body.
The procedure is particularly applicable to high risks patients, Dr Warwadekar, who recently treated Madhya Pradesh Governor Balram Jakhar for some artery problem, said adding, there are two types of grafts, thoracic and abdominal.
While Thoracic grafts are common for heart ailments, the pyjama-shaped abdominal grafts are mostly used in case of old-age related problems.
However, all these procedures are still costly in India as these are imported, he said. Just the graft costs somewhere between Rs 3.5 to Rs 5 lakh and add to it other incidental costs, the radiologists added.