I will try to explain with the best of my ability exactly what Kurt has going on in there. Dr. Beal would always try to draw us a picture of what she was talking about and it helped to understand but it was hard to draw a 3D image. Kurt is a visual learner so he started looking for an app on his iPad that would help us to see it better. He found a great app called Visual Body. It is really cool. You can manipulate the body, rotate it, hide organs so you can see behind them, etc. We have had a lot of fun playing with it. The doctors also thought it was pretty cool when we showed it to them and they liked playing with it too. So I will be using our nifty-difty app to help explain what happened to Kurt.
Meet our friend. He will be our model today.
So we will zoom in on the abdomen. You can see the heart and the right rib cage. That big organ at the bottom of and behind the rib cage that goes under the heart is the liver.
I highlighted (in blue) part of the liver. It sees it as different lobes so it doesn't highlight it all together. Anyways, we will hide the liver.
Now the stomach is highlighted. We will hide the stomach.
That little guy highlighted in blue is the pancreas, or Kurt likes to refer it is as his pancake, ha ha! Funny guy! The pancreas is a very sensitive organ that doesn't like to be moved or touched. It is one organ they are worried about moving because it really doesn't like to be messed with. We will hide it too.
So now that we have moved those organs out of the way, we zoomed in and you can see back to the aorta. It is the blue highlighted thing in the back. This is the main artery that runs down the center of the body and delivers blood to the body.
That spot in the center that is highlighted is the celiac artery. It branches off the front of the aorta (towards your belly). It is a very short artery and it immediately branches 3 ways.
One branch goes to the liver, called the hepatic artery.
Another branch goes to the spleen, called the splenic artery.
And the 3rd branch goes to the stomach.
(The doctors said this artery isn't to scale and should be bigger).
Here is a side view of the aorta. The front of the body is to the left and the back/spine is to the right.
And the celiac, highlighted blue, in the middle.
As you can see, it isn't the easiest place to work on. You have to move the organs out of the way and then you still have all sorts of other arteries and veins to worry about damaging.
Kurt's tear started right where the celiac artery comes off of the aortic artery and tore down into the "intersection" of where all the branches are. The aneurysm is sitting right on that intersection. The original problem was that they couldn't just put a stint in because it went into the branched area and there wasn't a 3-way branch stint. They said that the stomach and the spleen have several blood sources so they weren't too worried about those but they didn't want to compromise the blood flow to the liver. After his 2 big pain attacks, they decided to put a stint in that would only go towards the liver to keep the blood flow going that direction. They would be cutting off the blood flow to the stomach and the spleen by doing this but, again, those organs have many sources of blood so they weren't too worried about them.
When they did the 2 angiograms, they were trying to get that stint put in there. Unfortunately, they were not able to do it. What they think happened was that when he had those 2 huge attacks of pain, the tear continued down the hepatic artery (toward the liver) and the blood clot moved down into the that artery, completely blocking off the blood flow to the liver, exactly what they didn't want to have happen. His liver took a hit and they watched it very closely by drawing labs frequently. Every day his liver numbers improved. His liver recovered quickly and his labs all now show normal liver function.
The original surgery plan was to go in, move the organs (very carefully) out of the way and then clamp down on the aortic artery above the celiac, completely stopping blood flow to the lower portion of his body. They said the organs can handle that for about an hour before they start having problems from lack of blood. Of course, there is always the risk that the organs may have problems anyways just from having their blood flow stopped. Then they would tie off the celiac artery so no blood flow could enter it. They would also have to tie off the splenic artery (the one that goes to the spleen) and the artery that goes to the stomach so that blood wouldn't back flow into the celiac through those sources. This would completely block off the celiac and therefore, remove any risk of the aneurysm from rupturing. You can see why they are hesitant to do this surgery. It is very invasive and the risks are great to his organs.
The second surgery idea they came up with was a little less invasive. They would reenter his artery through the leg (like the angiogram) and travel up the aorta to the celiac location. They would then block off the entrance to the celiac with a mesh like material so blood couldn't flow into it. They would still have to open up his abdomen and move the organs because they would still need to tie off the arteries to the spleen and stomach to prevent back flow. At least with this option, they are not clamping down on the aorta and stopping the blood. It still carries the risks of moving the organs and messing around deep in the abdomen.
Hopefully that makes sense. They are still just watching him. He had an appointment on Friday with his vascular surgeon and she said that usually any problems occur within the first 2-3 weeks, which is what happened with those attacks. She said once you get out of those first few weeks, things tend to settle down and remain calm. We are now almost 5 weeks out so he should remain stable and have no further complications, fingers crossed. They will rescan him in 2 months and we will see what is going on in there. Until then, he is still on restriction for what he can do which means that I am playing Mrs. Dad (like Mr. Mom) around here; hauling beds, mowing the grass, etc. And most importantly, keeping Kurt from doing anything. I think that is going to be the hardest part yet.