03 October 2011
My father in law, now deceased, was a nephrologist. I met him while I was in medical school. He was a reserved guy, not prone to butt into what he saw as others' business. So I still remember that while I was considering what sort of residency to pursue, he took a surprisingly strong stance that I should go into interventional radiology. His reasoning was simple: they have a great lifestyle, they make bags and bags and bags of money, and they get to play with all the coolest gadgets.
It was tempting, I admit. As anyone who knows me can attest, I am ALL about the gadgets. I'm not averse to bags of money either. But I never gave it much consideration, mostly because I am just not real good at radiology, though for an ER doc I do OK. (A low bar, it is true.)
I sometimes regret that decision. For example, I wrote the other day about a gentleman who presented with a ruptured abdominal aortic aneurysm. We had some heroic fun in the ER resuscitating him and getting him to the OR. After the fact, I had to wonder whether it was all in vain -- the mortality on ruptured AAAs used to be upwards of 75% even if they made it to the OR. It's a huge surgery with tons and tons of blood loss, and the only people with AAAs are old vasculopaths with bad hearts and bad brains and even if they survive the surgery they stroke out or die of kidney failure or ARDS or what have you. Bad juju.
So it was with pleasure that I logged into the computer the other day and checked on my "interesting patient" list to see that he was still alive and not even in the ICU. I'm not sure which fact was more surprising. I pulled up the dictations and read the op notes and was stunned to realize that when this guy's fricking aorta exploded, the vascular surgeons/interventionalists are such badasses they didn't even open his abdomen. They fixed it all through his groin. Through his groin.
I knew endovascular grafts were around -- they're not exactly new. But I did not know they could be used in the setting of acute aortic rupture. How cool is this? They get to the OR, access the femoral artery, then throw in a balloon catheter and occlude the aorta above the level of the aneurysm:
This stops the bleeding and increases perfusion to the brain, which is good. Then they do a nice leisurely series of angios to measure things and pick the right graft to apply, hook in the contralateral iliac limb, and you are good to go: one functional artificial aorta, estimated blood loss 50 cc. (Not counting the six units in the peritoneum.)
What an amazing thing these guys have accomplished with this technology. If we can get you to the OR alive, they can fix the gnarliest vascular catastrophe standing on their heads. I have got to say, I love living in the future. This sort of coolness almost -- almost, mind you, but not quite -- makes up for not having hovercars and personal jet packs. Which we were promised.
Had I known what sort of awesomeness the future held in the world of interventional radiology, this might well be a very different blog. And I would have bags of money. And the coolest fricking gadgets on earth. (Sigh.) If you'll excuse me now, there's a ninety-year-old dizzy patient I need to go see.
Posted by shadowfax at 4:30 AM