What kind of doctor to see for abdominal aortic aneurysm?

December 9, 2014 9:40 AM

My SO was diagnosed several years ago with an abdominal aortic aneurysm and had been going for monitoring ultrasounds every 6 months or so. However we need a new doctor now -- what kind of specialist can/should we be looking for?

The prescription at the time of diagnosis was regular monitoring to make sure the aneurysm didn't grown in size -- too big or too quickly. It has remained stable, at a not-too-worrisome size (3-4cm).

However, the doctor he was seeing for this monitoring was a total jerk. Lousy bedside manner, barely looked up from his paperwork, spent max 5 minutes in the examining room with us, and has never once, in at least a dozen visits, said one word to me. We finally said "enough" and stopped seeing the guy.

I wouldn't put up with a car mechanic who treated us this way. I certainly don't want to put a loved one's life in the hands of someone like this.

So now we need to find another doctor for his monitoring. Our primary care doc can only recommend doctors in her own hospital group (@#$%$# US insurance system -- but I digress...) and the only other option we had was the other doctor in the same practice, who we tried, but was just as bad, only younger.

We are looking on our own outside the hospital network now. The previous doctor was a vascular surgeon, but is there another type of doctor we could/should be looking for? My main concern is that the biggest problem with the previous doctor is that he treated my SO's aneurysm as if he were just waiting for a fruit to ripen so he could pick it -- like we were of no interest to him unless it was actually time to cut.

So, is it only a vascular surgeon we should be looking for? Or is there another specialty we should look into who could handle monitoring an aneurysm of the abdominal aorta?

posted by leticia to Health & Fitness (9 answers total)

A vascular surgeon is the one who would perform any operations to repair the aneurysm, so they seem like a good choice. They're best suited to monitor the aneurysm, and will be able to discuss and perform any surgical procedures that may be required.

Unless a AAA reaches a size where the benefits of surgery outweigh the harms then there's nothing that can be done to activley prevent disease progression, other than risk factor reduction (smoking, hypertension, diabetes etc.). Risk factor reduction is best managed by your GP, under the advice of a vascular surgeon. Given that your SO's AAA is stable and fairly small the likleyhood of surgery being benificial overall is small, though obviously monitoring the AAA is a good idea.

IANAD IANYD

Edit: Citation
posted by DrRotcod at 10:17 AM on December 9, 2014 [2 favorites]

You might look through the resources for people with Marfan Syndrome, since AAA is a looming threat with Marfan.

Also, maybe start with a cardiologist? Find one in-network with good reviews (look at Yelp, but don't take it as gospel) and let them route you to a recommended surgeon.

Honestly, a lot of great surgeons just aren't good with conscious people. So maybe a cardiologist is your best middleman anyway.
posted by Lyn Never at 10:25 AM on December 9, 2014

Dealing with a very similar issue right now. I'm planning to use a cardiologist for monitoring. I think that might eliminate some of that scalpel-happy mentality (though certainly plenty of internists have bad bedside manner, too.)
posted by i_am_a_fiesta at 10:52 AM on December 9, 2014

Response by poster: Thanks for the answers so far. I will check out the references suggested. I get that surgeons aren't always the best ad bedside manner, but I'm holding out hope that we can find one more like a human being. :)
posted by leticia at 12:32 PM on December 9, 2014

My father had an AAA and died at 94 of other causes, which I hope encourages you. He of course had to have the AAA monitored, and complained about the "bedside" manner of most of the specialist doctors he had to deal with, surgeons and cardiologists. He finally found a cardiology practice he felt was decent at communicating with him, but it took some effort.

His advice was generally that you want a good primary care doctor/internist, because a good primary care doctor will oversee your care in general, including keeping up to date on what the specialists are up to.
posted by gudrun at 1:02 PM on December 9, 2014

You want a vascular surgeon. You might be able to get your GP to organise the monitoring and refer you back to a vascular surgeon for advice if the AAA gets above 5cm, but this would generally be under the supervision of a specific surgeon, who had set specific criteria for referral back. No other specialist is going to take this on. It is bread-and-butter vascular, sorry. A cardiologist is no more interested in monitoring AAAs than they are interested in doing PAP smears.
posted by tinkletown at 3:25 PM on December 9, 2014 [1 favorite]

Best answer: Having a vascular surgeon you like will help you should you ever (god forbid) need to have the surgery done, and that is the reason for the monitoring, there's really nothing else that can be done for a AAA - a cardiologist can't fix it or do anything differently than a primary care physician, pretty much any doctor can order the ultrasound but only a vascular doc has the power to make recommendations about what should be done based on the results.
posted by treehorn+bunny at 5:45 PM on December 9, 2014 [2 favorites]

Best answer: Yes, a vascular surgeon is the appropriate specialist for this. I would recommend asking he/she if they also do endovascular work. That's the less invasive way many AAA's can be repaired, if it comes to that. (Done via catheter through a large blood vessel in groin, like a cardiac cath).

You should have a doctor that you trust, and whom you feel comfortable working with. The visits with the vascular surgeon will be fairly perfunctory, though: the aneurysm will either be big enough to warrant intervention or it won't. They will address risk factor modification (blood pressure control, don't smoke, etc), but those are things your primary doc should be managing.
posted by maryrussell at 7:03 PM on December 9, 2014 [1 favorite]

Response by poster: Found a "vascular associates" practice in our city that had some good feedback on Angie's List, so we'll be trying that.

You should have a doctor that you trust, and whom you feel comfortable working with. The visits with the vascular surgeon will be fairly perfunctory, though: the aneurysm will either be big enough to warrant intervention or it won't. They will address risk factor modification (blood pressure control, don't smoke, etc), but those are things your primary doc should be managing.

@maryrussell, we would be satisfied with a surgeon that was capable of doing this with some human emotion ;) Fingers crossed for the new guy...

Thanks!
posted by leticia at 8:59 AM on December 10, 2014