My AAA choice

I have chosen to do nothing.  When I made that choice, the state of my mind, my consciousness, was hugely altered for the better, happier, quieter.

Not for long, but for an evening. And now I find I can call it up again when I think to do so.

This is not a small thing. It is very large. When I go again to that frame of mind, I am notably more at peace with the world than before when I was somehow always warring with it. I was constantly judging others and recriminating with myself over past actions that could fill me with sudden chagrin. Now, much more, I tend simply to listen to, look at, and learn from both the now and the then.

I call that discerning. 

This new state of mind was not my intention; it just popped in one evening when I decided to do nothing about the aneurysm. I had reasons for the choice -- I didn't want the constant alertness to and testing for the common endo leaks and other issues with the stent. And I liked very much the idea of knowing with good probability that I would die quickly and suddenly when the aneurysm tears at last. If the stent procedure removes that likelihood, what manner of death am I going to discover down the line? And, of course, at 87 I knew I did not have a long ride ahead.

I develop this thinking a little more in my next post, Why it feels so good to be as good as dead.

AAA options

Do nothing. Open surgical repair. Endovascular repair.
Dr. Phong Le (Lay) is the only vascular surgeon in our town. I have met with him twice and submitted myself to the appropriate exams. I like and trust him a lot.
He recommends immediate endovascular repair, a relatively simple procedure that uses the two big arteries at the groin to implant a long stent inside the descending artery. The reasons for this are pretty obvious, the size of my aneurysm, 6.2 cm, my good health otherwise, and the 15 to 20% probability that the aneurysm will rupture on its own within a year. The EVAR as it is called only requires a night in the ICU and you walk out with a little assistance the next day. Within 2 weeks you are able to return to normal activity.
Open surgery is not a good idea for a person of my advanced age, 87, nor did the doctor recommend it.
Doing nothing requires that a person be ready for the consequences of course. The doctor's nurse said the first symptom of a rupture of the Triple A aneurysm was going unconscious. The second is death. The doctor, when I mentioned this to him, pointed out that he did many open surgeries in the ER on people whose AAA's ruptured and were in great pain. The medical literature I read says that up to 80% of the people who are rushed to the ER with a ruptured AAA don't survive the operation.
The EVAR is highly rated for safety and side-effects. However, the attachment of a stent popped open from inside the artery is not as secure as one sutured from the outside in open surgery, so you do a series of follow-up CAT scans to monitor the leakage that can and often does develop over time, and even during the EVAR procedure itself. These ENDO leaks are not generally dangerous, but can become more serious.

 

My AAA choice