It just never slows down; not even for a second. I have been meaning to post for a while now and something always kicks in the door to trump card my thoughts.
I received some feedback several weeks ago now from the doc at UPMC who did the last Angiogram, and he told me somethings about how my Hepatic Artery was placed that i didn’t know. If you remember, there is a narrowing in my artery caused by the length of it so my RI values are a bit low. So I asked him about why it was left so long, and what could really be done about it. Rather than rewrite it:
If the narrowing continues to be troublesome and requires further action, what would that be?
If you begin to start showing signs of liver dysfunction (elevated liver enzymes, jaundice, or other problems) you would be brought back to Interventional Radiology and we will attempt a balloon angioplasty. If we get a satisfactory result, we would stop. If we get an unsatisfactory result, we would proceed to intravascular stent placement. Although the sharp angulation can make angioplasty and/or stent placement difficult and with increased risk to the vessel, it can usually be done successfully. Because your liver function was so good at the time of the exam, it did not seem reasonable to undertake a procedure with some degree of potential risk, but very little immediate potential benefit.
Is vascular surgery an option to shorten the length of it? Or would a stent be tried first to see if that is an acceptable corrective measure?
Well, surgery can be done, but this is a sizeable and complicated operation, and one which the surgeons would rather not perform if there is a safer or less invasive option, such as balloon dilatation with or without stent.
It also came to mind as to why the length of the artery was left so long? Could it not have been shortened during the surgery?
It is often difficult to get the length of the artery the perfect length. The surgeon will frequently make the connection of the artery to the most proximal portion of the donor artery using a technique called a Carel patch. This allows for a larger arterial connection, but does often make the whole artery a little longer and slightly prone to kinking. Also, as the liver settles into place after transplant, it is sometimes difficult to predict exactly how the artery is going to sit.
So that’s it in a nutshell. It was good to get this information and he has been great answering my questions quite quickly.
More recently, I have been off and on tired still, and was feeling a bit crappy the last week or so but have gone back to somewhat near normal. It’s still hard to find the energy to get back on the bike, and I have ridden to work once so far this year – and I tell you it was a workout. Makes a guy feel old….
I’m a bit more determined now to get back into some semblance of good shape, so I will be hopefully ridding to work 2 or 3 times a week – and getting in on some of the local rides. We’ll see.