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Abdominal aortic aneurysm
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I couldn't find any threads on abdominal aortic aneurysm. Just over my second distal aortic surgery to correct stent graft displacement, and getting ready to start training again (carefully), so if anyone knows anyone send them my way. It's nice to talk to others in one's own situation.
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Re: Abdominal aortic aneurysm [FitOldDog_Again] [ In reply to ]
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I believe Norman Stadler had a similar surgery.
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Re: Abdominal aortic aneurysm [devashish_paul] [ In reply to ]
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Nope, Norm Staddler had an ascending AA, for which there are quite a few threads on this forum. Now that is interesting. My bike guy, Victor, says I'm yet to meet another person in my position (been searching via my blog for 3 years) because they're all dead, which, if true, would mean that people on this forum, especially if over about 45, might consider an AAA screen - you die fast, and there is no warning unless you are really lucky - I was lucky, finding it myself as the result of the 2010 Lake Placid race, but that's another story. Thanks for the comment. Can't wait to race again now the Cleveland Clinic fixed me up. Happy Holidays.
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Re: Abdominal aortic aneurysm [FitOldDog_Again] [ In reply to ]
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Funny story. At least the end is funny. Sorry for the threadjack.

Abdominal Aneurysms run in my mom's family. My mom has six brothers, and one died because of it, and two others have been diagnosed with the onset; one had surgery, the other one can't because of other health issues. So 3 out of 6, not a bad score. Thing is that this is a congenital thing that travels down the female line but only affects males. So my uncles got it from my grandma, but they haven't given it to their kids, only my mom potentially has because she was the only daughter.

Still with me?

This all came about about 10 years ago, when my surviving uncles were about 60-65. Unfortunately the one that passed away was estranged from the family; he passed away about 5 years before that but his wife (who's certifiable crazy) never bothered to tell his family what the cause of death was. We all thought lung cancer, since he was quite the smoker. This meant that they found out during a routine abdominal ultrasound of one of the affected uncles. So the whole story comes out, and I get a frantic call from my mom telling me that I need to get myself checked because OMG I may fall over and die.

As a good son is supposed to do, I do what my mom says and I go to see my family doctor, who writes a referral for an ultrasound, I get an ultrasound, and the next day or the day after my doctor calls me. I miss the call, and when I see who it is I'm fucking beside myself: I am going to fucking die. Why else would she call? My aorta is going to explode in my belly and I'm going to bleed out in minutes, if not seconds. I call her back, all trembling. And she goes, oh no, there's no signs of aneurysms, but you have a kidney stone. I'm about to throttle her through the phone. A fucking kidney stone. You call me for that? Granted, they hurt, but they don't usually kill you.

So I go to the urologist, who dismisses the ultrasound, saying something along the lines of "all those girls can do is check babies". And he sends me for a CT scan, or an MRI. One of the two, I forget. And I didn't have a kidney stone.

Citizen of the world, former drunkard. Resident Traumatic Brain Injury advocate.
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Re: Abdominal aortic aneurysm [Jan de Visser] [ In reply to ]
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Jan de Visser wrote:
Funny story. At least the end is funny. Sorry for the threadjack.

Abdominal Aneurysms run in my mom's family. My mom has six brothers, and one died because of it, and two others have been diagnosed with the onset; one had surgery, the other one can't because of other health issues. So 3 out of 6, not a bad score. Thing is that this is a congenital thing that travels down the female line but only affects males. So my uncles got it from my grandma, but they haven't given it to their kids, only my mom potentially has because she was the only daughter.

Still with me?

This all came about about 10 years ago, when my surviving uncles were about 60-65. Unfortunately the one that passed away was estranged from the family; he passed away about 5 years before that but his wife (who's certifiable crazy) never bothered to tell his family what the cause of death was. We all thought lung cancer, since he was quite the smoker. This meant that they found out during a routine abdominal ultrasound of one of the affected uncles. So the whole story comes out, and I get a frantic call from my mom telling me that I need to get myself checked because OMG I may fall over and die.

As a good son is supposed to do, I do what my mom says and I go to see my family doctor, who writes a referral for an ultrasound, I get an ultrasound, and the next day or the day after my doctor calls me. I miss the call, and when I see who it is I'm fucking beside myself: I am going to fucking die. Why else would she call? My aorta is going to explode in my belly and I'm going to bleed out in minutes, if not seconds. I call her back, all trembling. And she goes, oh no, there's no signs of aneurysms, but you have a kidney stone. I'm about to throttle her through the phone. A fucking kidney stone. You call me for that? Granted, they hurt, but they don't usually kill you.

So I go to the urologist, who dismisses the ultrasound, saying something along the lines of "all those girls can do is check babies". And he sends me for a CT scan, or an MRI. One of the two, I forget. And I didn't have a kidney stone.

Your post taught me a valuable lesson: don't judge a post by the last paragraph...as I read through the entire post, I could see that you weren't a nut and that you actually may have some credible info to share. So, can you chat about this illness?..the symptoms, causes, outcomes, etc?
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Re: Abdominal aortic aneurysm [FitOldDog_Again] [ In reply to ]
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I know a fair bit regarding triathlon(completed 13 ironmen and many shorter distance races) and AAA having operated on over 1000 patients over the last 30 years ( both open and stent-EVAR).As you probably know there is no evidence that the extreme amount of training for iron distance races contributes to cardiovascular health.More than three hours per week of "vigorous "exercise probably does little for enhancing cardiac health.I would emphasize that those with AAA's almost always have some coronary artery disease since AAA is only one component of systemic atherosclerosis.It might be wise to concentrate on olympic distance or at most half iron races and at a modest effort (ie iron distance effort for a shorter distance).Just my thoughts -nothing the matter with shorter races(although they don't do much for me!)
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Re: Abdominal aortic aneurysm [anitan1] [ In reply to ]
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Your post taught me a valuable lesson: don't judge a post by the last paragraph...as I read through the entire post,[/quote]
AGREED
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Re: Abdominal aortic aneurysm [FitOldDog_Again] [ In reply to ]
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Back in 2001 I had a abdominal aortic aneurysm rupture. No symptoms except for a dull pain in the lower abdomen for a couple days. Then bam! Major pain like I never had before. I was rushed into emergency surgery to have a graft inserted around the rupture. Woke up with 30 staples holding my stomach together. It was a really rough recovery. For the first few days I couldn't even walk 10 feet without having to sit down. That was a very depressing time for me. I had just completed IM Florida 2 months prior and was feeling really good. Even qualified for Hawaii.

Now I'm waiting for results back from a catscan I had done last week. My dr. saw a kink in my graft and is deciding if I should have a stent installed. It's always something.


18x Ironman, 3x Hawaii
US Army (Ret.), Vietnam Vet ('71-'72)
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Re: Abdominal aortic aneurysm [Jan de Visser] [ In reply to ]
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Hi Jan,

I did enjoy your story. Funny how things work out in the end, and how that which we fear the most is probably not that which takes us down in the end. I'm pleased your aorta didn't explode. Yep! Genetic. People, should I say clueless people who don't workout, often try to blame my AAA on Ironman training, which I found just in time BECAUSE of the 2010 Lake Placid race. I'd be dead now for sure, otherwise.

Enjoy the holidays if you have holidays.

Btw, I didn't do everything my Mom said, only the good bits.

Cheers,

Kevin
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Re: Abdominal aortic aneurysm [carbonsport] [ In reply to ]
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Hi Carbonsport,

I appreciated your comment, though I'm unlikely to drop Ironman as my condition is almost certainly genetic in nature. At 70, I appear to have little evidence of cardiovascular impairment through they minds of multiple cardiologists (I only really trust the athletes!), but my AAA was 6.9 cm when I found it in 2010 (thanks to the Lake Placid race and my medical background - I'm a veterinarian).

I am really pleased about my recent stent repair at the Cleveland Clinic by an athlete surgeon (you might enjoy my surgery story via this link), which was trouble waiting to happen (short left common iliac, with minimal stent branch length of 1.5 cm., slight progression of aneurysm into the left common iliac, and the clincher, a nice bike wreck in the Las Vegas 70.3 Worlds about 3 months ago, where I landed in just the right way to displace my stent.

I spend a lot of time thinking this through, and in my opinion it is more about how I move and train than how hard I train. I do recommend the move from intensity to volume as we age.

Let's see how I do with my new stent extension, which will be researched in some detail as I consider modification of my approach to the bike as part of my involvement in the ongoing clinical trial on my branched stent extension, and other things involving hip flexion.

Have a great holiday season if you manage to get time off.

Kind Regards,

Kevin
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Re: Abdominal aortic aneurysm [gonzaleziam] [ In reply to ]
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Made me laugh! You and Anitan! Happy Holidays.
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Re: Abdominal aortic aneurysm [IronRod] [ In reply to ]
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Hey, could you write your story on my blog (the link is in my profile) - you are the person I needed to talk to in August 2010 when I was wondering if I would ever race again.

Great story, and yes, I know, always something to deal with. You can read my latest surgerical adventures in my newsletter as I workout the safest approach to train for Eagleman, Lake Placid, and Mont Tremblant this summer with my new stent extention - people say, "Why do you do this Ironman stuff?" I say "What do you love to do, yourself?" They answer, then I reply, "Why do you do that?"

Great story and thanks very much for your comment.

Way to go!

Cheers,

Kevin
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Re: Abdominal aortic aneurysm [FitOldDog_Again] [ In reply to ]
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I am impressed with your courage.Quite the surgical experience.I probably would have recommended an open operation for you but your team is extremely experienced and you will almost certainly do well.I wonder if opening up your hip angle with a much shorter crank could help.I am very familiar with the Tremblant course with the multiple very steep climbs on the out and back near the finish.I hit 400 watts spinning up the steepest hill with more gears than you could imagine(compact with 11-36 rear),but I am significantly heavier than you.Nevertheless,if you have not done Tremblant before I would recommend a compact plus 12-32 cassette so that you can get up the short but very sharp hill without undue stress.See you next year at Ironman Mt Tremblant!!
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Re: Abdominal aortic aneurysm [FitOldDog_Again] [ In reply to ]
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Hi Kevin,

Hope your recovery is continuing well over Christmas.
Like carbonsport, I am also a vascular surgeon, but with ten years consultant surgeon experience rather than 30! (And only one half IM, and one marathon under my belt so far).

I am Australian based however, and am pleased to hear that you have Australian-designed (though now US manufactured) stent graft inside you. The Cook Zenith graft was designed by David Hartley (radiographer) and Michael Lawrence-Brown (surgeon) in Perth, and Downunder we've had the good fortune to have early access to many of the branched and fenestrated devices for over a decade. My practice is largely endovascular, and over 80% of AAA's are treated by stent graft rather than open surgery. Iliac branch devices have been a particular interest of mine.

My opinion, FWIW, on strenuous exercise post endografting is that stent graft migration or failure is extremely unlikely when the aorta, common iliac arteries, internal iliac arteries or proximal external iliac arteries are the treated segments. The mid- and distal external iliac artery is a different matter, as it flexes and distorts with extremes of hip flexion, but it is unlikely that your stent graft extends that far. (I usually use an iliac branch with a 41mm length external iliac segment, but it is possible your surgeon used a 58mm length).

Failure of an endograft is most likely to occur when the 'landing zones' are compromised (short, tortuous, or dilated), and this sounds to have been the case with your initial procedure. The bike wreck at Las Vegas may not have caused any displacement, but sounds like it did cause it to be discovered.

The ongoing regular surveillance of you endograft is crucial, and the team at Cleveland are probably the best group (outside of Australia!!) to be looking after you.

Regards,

MidLife
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Re: Abdominal aortic aneurysm [carbonsport] [ In reply to ]
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Hi Carbonsport!

I was offered open and a Dacron prosthesis (my preference for sure) as an option, with only 5-10% chance of dying on the table, which was acceptable to me. Then Tara said, "But, I have to warn you that there is an approximately 40% chance of permanent impotence." Took me about a nanosecond to reject that option. Hell, I might be 70, but I'm not dead yet.

As I went over the options, a shorter crank was high on the list, and I'm even considering riding standing much of the time to reduce hip flexion. If I can manage that I'll be one hell of a runner, and may get to Boston again (on my bucket list).

I spoke to Blaine at Cook Medical in Bloomington (engineer and competitive cyclist), and he is trying to put me in touch with a guy who works on this very issue - hip flexion and distal iliac artery branch displacement. That would be great, as what we really need are data.

Cook sent a video crew (great guys, ate a lot) to our house and made a video of my post stent life - if it's of interest you can see it via this link, just click on the image.

Thanks so much for your interest, and have a merry Xmas.

Cheers,

Kevin
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Re: Abdominal aortic aneurysm [MidLife] [ In reply to ]
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Hi Midlife,

I'll track down the latest CT scans, as I have a friend who can create 3D reconstructions of high quality of these more distal vessels and the stent. Once done, would you be interested in taking a gander? I have really nice images of the stent status in 2012, which I can send if you want, via e-mail (my address is kevin.t.morgan@earthlink.net). All help appreciated.

My wife, Deb, is Australian, from Port Douglas, and feisty to boot. She was delighted that the latest addition was from Australia. What impressed me most about Australia on my only visit so far, was the wild life, flora and fauna (unbelievable) and the ready availability of steak pies, which don't exist in the USA.

Thanks a million for your comment. Wish I could get CineCT of movement of the extension during flexion maneuvers and Tara is trying to pull off some such thing via a researcher in Stamford.

Fascinating problem aging. I don't plan to stop IM until forced to do so, but I won't risk this lovely life for stupid attempts.

Thanks for the info on stent origins and your interest in my case. Keep training!

Merry Xmas,

Kevin
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Re: Abdominal aortic aneurysm [MidLife] [ In reply to ]
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Hi MidLife,

Can you recommend published guidelines for physicians regarding exercise training in people with small (3.0-5.5 cm) AAAs? I imagine post-operative guidelines are surgeon specific, but are any published that you know?

Thanks!
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Re: Abdominal aortic aneurysm [Pedalhead] [ In reply to ]
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Thanks for raising the issue Pedalhead.

I spend a deal of time reassuring patients with "small" (<5.0cm diameter) abdominal aortic aneurysms that they should get on with life as usual, rather than avoiding many specific activities.
Not only is aerobic exercise not harmful in terms of aneurysm rupture risk, a couple of small trials have suggested aneurysm growth rates may be reduced by regular exercise. At least one group has even looked at the use of High Intensity Training as 'pre-hab' before surgical repair of large (5.5-7.0cm) aneurysms, and have reported very favourable outcomes.

I am not familiar with any guidelines which give specific guidance in terms of volume, workload and intensity for the small aneurysm patients, and I place no limits on my patients. I do get them to avoid lifting or straining which requires breath-holding, as there are at least reasonable physiological reasons this may increase pressure within the aneurysm, and possibly increase rupture risk. I'm also a little nervous about activities which involve sudden deceleration forces such as bungee jumping and skydiving, though this is pure speculation on my part.

The following paragraphs are lifted from http://www.uptodate.com/...inal-aortic-aneurysm
Exercise — It is widely accepted that higher levels of physical activity are associated with a lower risk of cardiovascular morbidity and death. We agree that patients with AAA should participate in an exercise program for secondary prevention of cardiovascular disease. Patients should be counseled that moderate physical activity such as running, biking, swimming, hiking, or sexual activity and activities such as gardening, golfing, and horseback riding do not precipitate AAA rupture [78]. However, heavy lifting, especially while holding the breath, and other activities that lead to Valsalva, transiently induce significant increases in blood pressure and should be avoided.
Moderate physical therapy may also limit aneurysm expansion [79]. In experimental aneurysms, increased aortic blood flow appears to inhibit AAA expansion [80]. Magnetic resonance imaging in patients with AAA who have exercised has demonstrated increased abdominal aortic blood flow [81], and thus, exercise may have the potential to limit AAA expansion in humans as well. Although the exact mechanisms remain to be determined, exercise reduces the levels of systemic markers of inflammation relevant to AAAs. One trial that randomly assigned 140 patients with AAA<5.5 cm found no significant affect of an exercise program on AAA expansion rates over an average of 23 months [82,83]. There were marked improvements in exercise capacity in the training group, and there was a modest inverse association between the change in exercise capacity and change in AAA diameter.

Hope this helps.
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Re: Abdominal aortic aneurysm [MidLife] [ In reply to ]
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Thanks very much, MidLife, for this state of knowledge review: www.uptodate.com/...inal-aortic-aneurysm

It appears that a small AAA does not contraindicate moderate exercise for promotion of cardiovascular health and that most types of exercise programs seem safe for preoperative patients. I would like to see more research on the effect of swimming (submersion) as well as variations of breath holding (Valsalva) on AAA wall stress. I also agree with not placing exercise restrictions on recreational athletes with a small AAA who participate in non-contact sports.

Are there special exercise precautions for postoperative patients with a stent... perhaps having to do with body position?

Cheers.
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