Lucille Ball Died Of A Dissecting Aortic Aneurysm, Aortic dissection has been in the news again lately after the condition involving bleeding into and along the wall of the aorta, the major artery leaving the heart, took the life of Ambassador Richard Holbrook.
Holbrook, 69, the U.S. special envoy to Pakistan and Afghanistan, died in mid December after experiencing chest pains while in a meeting with Secretary of State Hilary Clinton. Despite being rushed to emergency surgery to replace the aorta, Holbrook didn’t survive.
“Unfortunately, that is the way dissections often occur,” said John Eidt, MD, head of vascular surgery at the University of Arkansas Medical Sciences (UAMS) Medical Center. “There are no early signs. It just happens. It presents as sudden, severe chest pain, oftentimes between the shoulder blades. Patients will often describe it as a tearing pain. If unrecognized, it is commonly a lethal condition. When it happens, you need to get to appropriate medical care as soon as you can.”
Many things can go wrong with the aorta. In addition to experiencing an aneurysm, it can get clogged up with debris and become blocked. It can get infected, leading to degeneration, and it can be injured in an accident. There are also occasional tumors that can affect the aorta.
Dissection occurs when the aorta tears due to high blood pressure or a trauma, and blood leaks into the layers of the wall. Blood tracks down the wall of the aorta and causes numerous problems. It can reduce or stop the blood supply to the kidney, extremities, brain and bowels.
Another well-known celebrity who died of aortic dissection was the actor John Ritter, only 54 years old when he had a sudden onset of nausea and chest pain that was misdiagnosed as a heart attack. There was hope after Ritter’s death in 2003 that awareness about aortic dissection would increase.
Most people who have chest pains have had a heart attack.
“The problem is some people don’t have heart attacks,” Eidt said. “There are other sources of chest pains, and one of those is aortic dissection. The aorta is the largest blood vessel in the body. It is 18 inches long and an inch in diameter. It is the water main where all the blood supply to vital organs comes from. When it gets sick, it has significant adverse consequences for your vitality and well-being.”
Over the past few years there has been a great emphasis on decreasing the time from between when a patient presents with chest pains, and a diagnosis leading to a cardiac catheterization.”
Other famous persons to die of aortic disease include Albert Einstein, Conway Twitty, George C. Scott, Lucille Ball and Harvey Korman. Back in the 1950s when Albert Einstein had an aortic aneurysm, there was no technology for replacing the aorta. Einstein was opened up, and his aorta wrapped in cellophane to keep it from enlarging. After a period of time, the aorta completely ruptured, and the man considered to be the most famous scientist of all time died.
Today the prognosis would have been very different for Einstein, and he probably could have been treated successfully.
“Einstein would have lived longer,” Eidt said. “Rather than conventional surgery, increasingly in the past few years we have turned to endografts to treat aortic dissection because these can be inserted with minimally invasive endovascular procedures that are fluoroscopically guided or x-ray guided. These procedures are typically performed in an endovascular operating room that provides the ability to use conventional open surgical techniques, as well as minimally invasive endovascular techniques. This ability to perform surgery with real time fluoroscopic or x-ray imaging dramatically expands our treatment options. You can do less surgery, and get more done with smaller holes to get good results.”
Eidt said the purpose of the UAMS Aortic Center is to focus the resources that are in the institution toward taking care of the complex conditions involving the aorta. In the past, there was no one specialty that was ideally suited to dealing with all of the kinds of conditions that affect the aorta.
“By pulling in resources in cardiac surgery, vascular surgery, cardiology and interventional radiology, we have been able to put a team together that is better able to manage these complex patients than in many places around the country,” Eidt said. “It provides comprehensive management of complex aortic conditions from aneurism to trauma to dissection to infection.”
Another important development at UAMS is the development of an aortic pathway to facilitate transfer of patients for treatment to the UAMS Medical Center. Since time is of the essence, UAMS has made it a priority to improve its ability to handle these patients by streamlining the transfer process. The system is similar to the Angel Network developed for complex obstetric patients.
“We use a system wide emergency notification system to simultaneously alert all the critical players including the ICU, the operating room, the blood bank, the ER and the anesthesiologists that urgent cases are on the way so that we can reduce the time to eventual treatment.”
These are very labor-intensive patients who take a lot of critical care and energy. Many practitioners in private practice, despite the necessary knowledge and skills, simply don’t have the manpower and resources to be able to care for these complex patients.
“The advantages of being in a center like UAMS with residents, fellows and specialists in multiple fields is we do have the manpower to deal with these kind of complex aortic problems,” Eidt said.
UAMS is also involved in a couple of different clinical trials using devices that are not commercially available yet in the U.S. for treatment of aortic conditions. UAMS became the first in Arkansas to place a custom made fenestrated graft in the aorta of man with a type I endoleak and severe cardiac disability.