Thursday

This morning, a consultation with Mr R, the vascular surgeon at King's, who explained the three alternatives. The first is to do nothing, but this would probably be unwise, because there is already a risk of the aneurysm bursting (at 5.8 cm, the size at the last MRI scan on June 1, the risk is one in ten per year, increasing to 1.5 in ten when it exceeds 6.0, according to www.patient.co.uk/health/Aortic-Aneurysm-(Abdominal).htm). Then there is the traditional method of opening a large incision in the stomach, cutting out the section of the aorta with the aneurysm, and replacing it with a section of plastic. This is fairly heroic, and recovery could take upwards of six months. It would carry an additional risk for me, because of the two operations I had when I was knocked off my bike in October 2002, to install a colostomy and then six months later to rejoin the loose ends of the intestine. Both of these involved rummaging around in the abdominal cavity, and I imagine particularly the first, because the bowel was leaking for three days between the accident and the operation. The third alternative, and the one I chose with Mr R's approval, was endovascular repair (EVAR), in which a section of plastic artery replacement is fed up to the site via an arterial entry point in the groin. Mr R didn't seem to think the blockage to the artery serving the right kidney was that important. And most important of all, he gave me a date, July 19, spending the previous night in the hospital. The operation does require a general anaesthetic, but the patient is well enough to be discharged after two days. I didn't ask how long after that is needed for convalescence, but the summer recess starts on July 28.