13 October 2010
By Malathy Iyer
Mumbai, India
As he walks around the doctor’s clinic taking small, quick steps, Kalwa resident Madhukar Ghadigaonkar doesn’t give the impression of being a man who needed a drastic medical rescue operation just a week ago. But the 67–year–old had three types of blood vessels–two attached to the brain, two to the kidneys and one of the heart–operated on, all in one session, on October 7.
Stents were placed at five blockages across these arteries to "revive’’ the former government servant who had been fainting and feeling sluggish for about a month. His doctors are happy that the grandfather recovered well enough to go home within four days.
Others in the medical fraternity however, are a bit cautious. "It is lucky for the patient that everything went well. The patient could have suffered a stroke or shock during the procedure,’’ said a senior doctor who didn’t want to be identified.
Two aspects make this case different from any other. First, the extent of the patient’s disease–atherosclerosis or deposition of plaque–had spread to the arteries in his heart, brain and kidneys. The vessels had narrowed considerably, leading to Ghadigaonkar’s fainting spells.
Secondly, doctors worldwide prefer to tackle each system separately. If the brain or carotid arteries are fixed in one session, the renal or heart are done in another. But this was different.
High–Risk Procedure
- Sixty–seven–year–old Kalwa resident Madhukar Ghadigaonkar had three types of blood vessels operated on in one session–two attached to the brain, two to the kidneys and one of the heart
- Such a surgery has never been attempted anywhere before
- Stents were placed at five blockages across his arteries, which were causing sluggishness and fainting spells
- The patient’s heart ‘stopped’ five times during the operation and a temporary pacemaker was used to revive him
"Handling every single problem he had was difficult and risky as Ghadigaonkar’s heart ‘stopped’ five times during the procedure. His blood pressure dropped very low. We used a temporary pacemaker to revive his beats and as a backup, we had an oxygenator and a balloon pump ready,’’ said cardiologist Dr Vijay Surase, who led the team of doctors at Thane’s Jupiter Hospital to operate on the patient.
Surase fixed the blockage in the patient’s heart after interventional radiologist Dr Rahul Sheth fixed the blockages in the brain and kidney arteries. "It’s rare to fix so many arteries spread across different systems of the brain in one sitting,’’ said Dr Sheth.
However, some doctors have reservations. A senior doctor felt that the operation was "heroic’’ only because no one in the medical fraternity had felt the need to go in for multiple stenting in one sitting.
Dr Hemant Deshmukh, head of the interventional radiology department of KEM Hospital at Parel was concerned that stenting both the carotid arteries in one setting would result in a sudden gush of blood to the brain.
"The brain, which has for some time been devoid of oxygen and nutrients, would suddenly get a rush that could result in injury,’’ he added.
Similarly, when stents are placed in the renal arteries, the blood pressure drops and could cause thrombosis, he said.
Senior cardiologist Dr A Mehta, however, doesn’t consider treating five blockages at one go drastic. "Stenting is the preferred treatment for blockages in the carotid arteries. Ditto with renal arteries and the heart. So, I don’t see this case as an accomplishment. It is just that they got a patient with such a varied pathology. The patient’s disease, in fact, makes the case all the more interesting,’’ said Mehta.
Deshmukh, too, felt that the most significant aspect of the case was the fact that the patient had a "global’’ vascular disease. He pointed out that people with coronary artery disease never stop to think that their other vessels too could be affected.
"An international study showed that among every 100 patients with coronary artery disease, 26% of the men and 23% of the women would also have a diseased carotid artery. Around 17% men and 20% women would have peripheral artery disease. And around 5% men and 3% women would also have aortic aneurysms,’’ he said. As peripheral vascular disease (affecting vessels in the abdomen, kidneys, legs and arms) are asymptomatic, he said screening is a must to avoid complications such as paralysis or gangrene.
Ghadigaonkar’s son Suresh–who air–dashed from Sydney and was instrumental in seeking the Rs 6 lakh for the single–setting operation–is relieved that his father’s medical problems were addressed in one go. And Ghadigaonkar is certainly not complaining.
Multiple Stents Patient | Retired port trust employee 67–year–old Madhukar Ghadigaonkar Complaints | Blockages of main arteries of the brain (both carotid arteries), kidney (renal arteries) and the heart (all three arteries). In all there were five blockages Cause | Atherosclerosis, a condition in which plaque builds up inside the arteries.
Ghadigaonkar’s case appeared critical as he had "global” vascular diseases or atherosclerosis in arteries across the body Treatment | An interventional radiologist and a cardiologist used the minimally invasive procedure of angioplasty to place stents across five blockages–two carotid arteries, two renal arteries and the left main coronary artery.
In the procedure, a catheter is introduced through the skin of the groin. It passes through a blood vessel right up to the blockage. A stent or a balloon is then passed up to the blockage to remove it USP | All the blockages in Ghadigaonkar’s case were stented in one sitting. First, the carotid arteries were stented (right, then left), second the renal arteries, and lastly, the heart was tackled.
Coronary Artery Disease Refers to disease of blood vessels of the heart. Carotid Artery Disease is the narrowing of the carotid artery that supplies blood to the brain.
Peripheral Vascular Disease refers to diseases of blood vessels outside the heart and brain. Here, the vessels carrying blood to the legs, arms, stomach and kidneys become narrow due to continuous deposition of plaque. The process that blocks these arteries is called atherosclerosis
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