Compressed abdominal artery leads to aneurysm surgery
DEAR DR. ROACH: What is celiac artery compression syndrome? I'm told I have this, and it's causing an aneurysm that needs to get repaired. I found out on a scan taken for another reason. I have had some pain after eating. -- I.J.M.
ANSWER: The celiac artery is one of three large arteries that provide blood to the abdominal organs, especially the stomach, parts of the small intestine, liver and spleen. The artery can be compressed from the outside by a structure called the median arcuate ligament. When this happens, other blood vessels take over the job the celiac artery can't do because of the compression, but sometimes people can get abdominal pain after eating due to low blood flow. People with symptoms due to celiac compression benefit from opening the artery, usually using a stent to keep the artery open. The celiac artery may also become blocked by atherosclerosis, cholesterol and calcium deposits within the blood vessel.
The increased blood flow in the other blood vessels can occasionally cause abnormal dilatations, called aneurysms. Unfortunately, these aneurysms can rupture, which is a catastrophic event. The risk of fixing the aneurysm is much smaller than the risk of rupture, so it's recommended to first fix the celiac compression, and then treat the aneurysm, usually by a coil embolization. The coil causes a blood clot around and within the aneurysm that protects the weakened part of the blood vessel wall and reduces risk of rupture.
Vascular surgeons perform this surgery, usually endovascularly (through the blood vessels), without the need to open a person's abdomen.
DEAR DR. ROACH: I had a prostatectomy over 10 years ago. After the surgery, I required 10 sessions of radiation treatment. My incontinence is not going away. I tried Kegel exercises, but that didn't help. I am using pads regularly, and also using Cunningham clamps. Unfortunately, the leakage is still there. I have to change pads three or four times a day. I heard about the product called AMS800. I am 84 years old. Don't know how to solve this problem. It's very frustrating. -- Anon.
ANSWER: Incontinence after prostate cancer surgery is common, and often improves in the year or so after surgery. Some men continue to have moderate or severe long-term symptoms. You have already tried some of the treatments: Pelvic floor (Kegel) exercises can be helpful for men as well as women, but when the nerves are more severely damaged, these may not be very helpful. A Cunningham clamp, an external clamp that closes the urethra in the penis, is usually effective, but many men find it uncomfortable. Condom catheters are a good solution for some men.
When no other treatments are effective, surgical solutions are considered. There are several options, but one of the most effective and reliable treatments is an artificial urinary sphincter. The AMS800 is a brand name of one of these devices, which is placed surgically. More than 90% of men report satisfaction with the device. Complications include infection, and erosion of the surrounding tissues, both of which happen 5% or less of the time.
Only your urologist has the expertise to say whether this is a potential treatment for you, but it is an effective treatment for many men with long-term incontinence that has not responded to other treatments.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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