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My name is James Black.
I'm a vascular surgeon here at Johns Hopkins Hospital in Baltimore.
I deal with diseases of the arteries and veins outside of the heart.
Open repair of abdominal aortic aneurysms
is performed usually through two approaches.
Sometimes we perform an incision right through the center of
the abdomen, that brings us right down to the aneurysm itself.
And the aorta is then opened and replaced with a graft.
Those grafts, we've been placing in patients since the 1950's.
And are quite durable and will last the patient their entire lifetime.
The repair of a thoracic aortic aneurysm
using open techniques, usually implies that the patient
has to lie on the right side, and then the incision comes down between the ribs.
And and thereafter, we flex the chest open and
we get to the thoracic aorta in that location.
Similar to the abdominal aortic aneurysm repair, we
also replace the aorta in the chest with a
Dacron graft, which can last a patient a
lifetime with little fear of degeneration down the road.
Routine abdominal aortic aneurysm repair, when we,
when we do an open, traditional surgical procedure.
Usually requires that the patient come into
the operating room on the day of surgery.
And then they're in the hospital usually between five and seven days.
We, usually one or two of those nights
includes a stay in the intensive care unit,
mostly so we can monitor the patient to
make sure that they're coming out of anaesthesia safely.
Then thereafter, we get them out to the regular hospital floor,
start working on moving a diet for getting people up and around.
And on average, most of our patients with a simple straightforward abdominal aortic
aneurysm repair, are going home between five and seven days after the procedure.
For a thoracic aortic aneurysm repair, when we do
an open repair, the are, the stay is usually longer.
Mostly because incision through the chest wall, is by
it's nature more painful than that of the abdomen.
So we tend to the patients in the hospital a little bit longer while
we wait to take them off appropriate
intravenous medications to help control their pain.
Move them towards oral pain medications and then go home.
Follow up after open aortic procedures is
dramatically different than that of an endovascular repair.
For an endovascular repair, we almost always have to
have the patient coming back in the first year.
A month after surgery, potentially it's six
months, then 12 months after the procedure.
For an open repair, we generally have the patients come
back between six and eight, six and eight weeks after surgery.
At that point, we're mostly beginning to discuss getting back to activity in terms
of limiting, the weight restrictions that they
have upon lifting items, getting back to exercise.
We talk about driving.
And generally, most of the patients after an open aortic repair,
are back in the workforce between two and three months after surgery.
Open treatment of aneurysms by its nature is a
more, risky procedure than that of an endovascular repair.
This has been born out in many studies throughout the last five to ten years.
The things we worry about after an open aneurysm repair, are
mostly related to dysfunction of the kidneys or trouble with the lungs.
Of course people who go into the operation is
active smokers or at higher risk for lung problems than
those who are not smokers and unfortunately, smoking is
one of the conditions that leaves people to have aneurysms.
So we have a base problem as the cause of the
aneurysm as well as the cause of most of the post-operative complications.
We have an excellent ICU team here and our nurses are quite strong
in terms of managing the pulmonary aspect and the lung aspect of the operation.
And luckily, we have had a relatively low rate of pulmonary complications,
as well as renal complications or kidney complications, after any open repair.
The best part about working at Hopkins,
is working around people who are truly excellent.
There is a very high caliber of physicians that we have here at Hopkins.
Everybody works as a team.
There is no one-upping each other to get ahead.
The patient is at the center of the game,
and everyone works to get that patient in better shape.
I enjoy coming to work because what I do is by it's
nature inherently difficult and somewhat complex,
but I like making it look routine.
The best reason the patient should consider
coming to Hopkins is because we really put the patient at the center of the equation.
We know based upon our, our own research here at Hopkins what
the best treatments are for a patient in their given medical fitness.
There are many physicians here at Hopkins who have expertise in many things.
There are many people here who are very good at what they do and
we can really bring it all together to deliver the best outcome for the patient.
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