KEM docs use injection to fix aortal pseudoaneurysm

Indore shopkeeper Mustanseer Bohra is supremely impressed with KEM Hospital, the city's premier medical school in Parel. As far as the 41-year-old is concerned, KEM Hospital doctors "fixed a blood-spewing boil" in his chest. What KEM doctors actually did was to daringly rescue Bohra during a medical emergency that developed when an aneurysm in his aorta 

started leaking. 

    Most important, 

the doctors didn't use 

expensive consumables but a simple injection with glue to 

save Bohra's life. 

"Actually, Bohra had 

a pseudoaneurysm or 

a false aneurysm (see 

box) because of an operation he underwent a year ago," said Dr Hemant Deshmukh, head of KEM Hospital's radiology department who operated on Bohra along with Dr Krantikumar Rathod on April 4. 

    In May 2011, doctors in Indore had replaced Bohra's poorly functioning aortic and mitral valves that control blood flow. As is the practice during such a valve operation, the doctors had inserted a cannula or tube to route the blood flow during the surgery's duration. But the site where the cannula was fitted to the aorta never healed. In January, it started oozing blood with a raw external wound as well. 

    "When Bohra came to us, we found a 7x7cm pseudoaneurysm in his sternal breastbone) area," said Dr Deshmukh. As he had just had a bi-valve surgery, doctors ruled out the gold standard method of surgery to fix his bleeding pseudoaneurysm. The team tried to fix a special graft that is normally used to shut out such aneurysms. 

    "As this failed, we devised a novel way," said Dr Deshmukh, who specializes in interventional radiology. 

    The team decided to inject Thrombin, a clotting agent, and N-Butyl Cyno Acrylate (NBCA)—also called super glue—to close the pinhole. "We approached the pinhole through the right arm artery with a small micro-catheter with a diameter of 0.67mm," the team said. 

    The medical fraternity outside KEM Hospital is quick to point out that the method cannot be used all the time. "There was a risk of Thrombin entering the blood in the aorta. It could have caused a clot," said a doctor who didn't want to be identified. The country's senior-most vascular surgeon who is based in Trivandrum, Dr K Neelakandhan, said, "Classically, doctors would operate on such a pseudoaneurysm, but as this patient had a recent surgery they obviously had to innovate." 

    Bohra, on his part, can't stop smiling. He had excruciating pain and could barely walk a few steps without feeling breathless. "Now, I can feel no pain and can walk freely," he said.