Like many, I was challenged by the article by journalists Fanny Lévesque and Tommy Chouinard published on December 2 in Press1 regarding the drama surrounding the death of Richard Genest. I would like to offer my condolences to the family. I would also like to clarify certain points given that the management of abdominal aortic aneurysms falls under my specialty, vascular surgery.
The vast majority of abdominal aortic aneurysms are treated by vascular surgeons in my association (ACVEQ, the Association for Vascular and Endovascular Surgery of Quebec) electively in order to avoid rupture. In Quebec, we have more than 50 vascular surgeons working in 14 vascular centers. These surgeons are on call, day and night, 24 hours a day, to intervene urgently to save the lives of patients presenting with an aortic emergency. In each of these centers, complete teams including emergency physicians, anesthesiologists, respiratory therapists, nurses, technologists, intensivists and attendants are ready to intervene.
In the event of a rupture, thanks to open or emergency endovascular surgery, we are able to save the lives of more than two-thirds of the patients who enter our operating rooms, most of whom are over 60 years old and often over 80 years old. 2
It is therefore false to claim as reported in Press last December 2 that “it is a condition with a low level of survival even if everything was in place, even if the events took place in an urban environment”.
This may have been the case 30 years ago, but a lot has improved since then. Technological developments in my field now allow us to treat several aortic pathologies with a less invasive approach with improvements in patient survival, even the most frail or elderly.
Obviously, success depends on several factors: rapid access to technical facilities, but also to modern technical facilities that will follow this technological revolution and to the rapid availability of intensive care, allowing the transfer to be accepted without delay. Success obviously also depends on the rapid transfer of the patient within an acceptable timeframe. Serving a large area with a single ambulance is not prudent. What is this acceptable time frame for the transfer? Several have looked into the issue, in particular to ensure contemporary quality care in a large territory such as Quebec.
Nault and his colleagues2 proposed, among other things, a time of less than 90 minutes between arrival at the emergency room and arrival at the operating room (“DEDE 90” for door-from-emergency to door-of-EVAR [Endovascular Aneurysm Repair] 3
More recently, the Dr David Mulder had also launched a cry from the heart in favor of medical transport by helicopter, a project announced in the summer of 2018 by the Ministry of Health and Social Services. The article4 concluded that the Dr Mulder wanted the Quebec government not to wait for the worst to happen to implement such a program in the province’s health system. We, the caregivers in the vascular centers of Quebec, are always ready to save a life.
2. Nault P, Brisson-Tessier C, Hamel D, Lambert LJ and Blais C. “A new metric for centralization of ruptured abdominal aortic aneurysm repair in large territories”. Journal of Vascular Surgery. 2015 Oct; 62 (4): 862-7. doi: 10.1016 / j.jvs.2015.04.442. Epub 2015 Jul 30. PMID: 26 235 138.