'I didn't want to know my risks'

By Jane Elliott  |

When doctors told Ronald Chapman he had an aortic aneurysm in his abdomen he was worried - he knew nothing about what it was or how it might affect him. The aneurysm, caused when the body's largest artery swells, had been detected during a scan for an unrelated kidney condition.

The abdominal aorta carries blood to the intestines and other organs nearby and if an aneurysm occurs in this area it can be fatal, with many patients dying before they get to emergency care.

When the aneurysm was detected nine months ago, Mr Chapman, 66, was told it was too small to operate on, as the risks of surgery outweighed the risk it would rupture.

But this month, he was told it had grown - and that the operation had to go ahead.

Mortality risk

The retired plumber said he did not want to know too much about the procedure.

 My son asked them what happens if I didn't have it done and they said I would have died

Ronald Chapman 

"It was my first time in hospital and I was pretty frightened. I didn't want to know what my chances were - they tried to tell me, but I didn't want to know."

Instead of the traditional open surgery, which can be too demanding for the sickest patients, surgeons carried out keyhole surgery - effectively operating on the aneurysm from inside the blood vessels through small holes made in the groin.

An expandable tube called a stent is passed through the femoral artery and into the aorta. The stent is then expanded open and blood flows through it

Around its circumference are kinked wires made of stainless steel or nitinol, a metal alloy that stiffens when heated to body temperature.

It allows surgeons to stop haemorrhaging and protect the artery wall from further damage.

They use a local anaesthetic because a general anaesthetic would relax the muscles and cause even more blood to leak away

Ronald is now recovering well: "I am happy it is all over and the aches and pains are going.

"My son asked them what happens if I didn't have it done and they said I would have died."

Surgery techniques

The cutting-edge surgery by doctors at London's Guy's and St Thomas' is reducing the risk of death for patients like Mr Chapman.

In emergency cases, where the aneurysm has ruptured they have reduced mortality to 17% from 45% meaning nearly 50 extra lives have been saved in the past year alone and in routine cases like Mr Chapman's the mortality risk is down 3% to 1.7%.

Peter Taylor, a vascular surgeon at Guy's and St Thomas', said the new procedures were helping save lives.

"The risk on the body is also a lot less. You can have local anaesthetic as opposed to general.

"A lot of cases who rupture their aneurism under general anaesthetic tend to die on the spot.

"We are one of the few hospitals in the UK with 24-hour emergency cover not just for the surgeons but also for interventional radiologists who carry out emergency CT scanning and participate in the procedure."

The condition is the third most common cause of death among older men and kills a total of 7,000 people every year. Men are six times more likely to have an aneurysm than women.

This year the government announced it was to offer screening to all men over the age of 65 in a bid to detect more of the aneurysms before they become dangerous.

The Department of Health says this will save 700 lives a year within 10 years.

But Mr Taylor said the net needs to be cast wider if cases are to be spotted.

"They have started the pilots in four centres, but they are just looking at men over 65. They are not considering family screening, which we would like to see.

"If you are a man and have a first degree male relative with an aneurysm you are more than 10 times likely to have one yourself.

"If you have a female relative with an aortic aneurysm you are 20 times more likely to get one yourself," he said.

Guy's and St Thomas' has begun its screening programme in Lambeth and Southwark, in London.

There are an estimated 25,000 men aged over 65 in the boroughs, so around 2,000 men could have an abdominal aortic aneurysm.

Any patients who identified through screening will be referred for surgery.

Jonothan Earnshaw, honorary secretary of the Vascular Society, said screening was the way forward.

"The real news is that if we had an aneurysm screening programme we would have no ruptured aneurysms because the idea is that we would find all these aneurysms before they burst and treat them before they rupture."

But he stressed that not all patients were suitable for keyhole surgery, and that the procedure could only currently be undertaken at big regional or specialist centres because of the numbers of staff and expertise needed.

 Elliott is Health reporter, BBC News