Early surgery: Can I get aortic aneurysm repair before it's 5.0?

Posted by ontogenyx @ontogenyx, Sep 26, 2020

I have a 4.1 ascending aortic aneurysm, and my local cardiologist tells me what every other one tells me, including Cleveland Clinic and Mayo. No surgery considered until 5.0, if valves are in good shape (mine are, except for 5% regurgitation).

The rationale offered for waiting: the risk of the surgery is greater than the risk of an event resulting from the aneurysm before it reaches 5.0. Meanwhile, I am told to limit myself to moderate exercise and to take drugs, in hopes of slowing growth of aneurysm.

I will be 71 next month, in good health, and very active. I am more interested in getting the repair done now so that I can resume a full life, rather than waiting around until I get feeble and less likely to have a good result when they eventually open me up for repair. I am much more willing to accept the risk of the surgery now than I will be 10 years down the road. I know, I know--it might never even require surgery--in which case, I can continue my life of "moderate exercise" until my number is finally up. Not interested.

Does anyone know a top surgeon who is willing to talk with me about getting this done now or in the near future?

Interested in more discussions like this? Go to the Aortic Aneurysms Support Group.

@nealkantor

I have a 5cm aorta aneurism grown from recent 4.8
A aortic artifical valve since 1990 34 years old
Been leaking,they say not much
Living with heavy breathing and exhaustion
People tell me to turn my head because i breathe so hard
72 years old
Should i have surgery or wait

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This is a question you should be asking a good cardiologist and surgeon about.

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I have a 5cm aorta aneurism grown from recent 4.8
A aortic artifical valve since 1990 34 years old
Been leaking,they say not much
Living with heavy breathing and exhaustion
People tell me to turn my head because i breathe so hard
72 years old
Should i have surgery or wait

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@realitytest

Thank you for your reply.
I thought there were also abdominal aneurysms, in which case the aneurysms wouldn't show on echocardiograms (not true?).

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There are abdominal aneurysms, but this thread is referring to aortic aneurysms. I believe that they both can be viewed via ultrasound.

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@breick

Start with an echocardiogram first. It should identify an aneurysm if present and well as any valve issues. Insurance will usually cover those.

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Thank you for your reply.
I thought there were also abdominal aneurysms, in which case the aneurysms wouldn't show on echocardiograms (not true?).

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@realitytest

Wow! That certainly IS young. Is a CT scan the usual way to check for aneurysms? How else do people find out?

My ex-husband died suddenly of a burst aneurysm a few months ago, and our sons were advised to be checked for aneurysms. I hope their insurance covers a. CT scan on grounds of their being hereditary high-risk.

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Start with an echocardiogram first. It should identify an aneurysm if present and well as any valve issues. Insurance will usually cover those.

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@jgreenwalt

What about the Endovascular (TEVAR) procedure? I've been reading about this procedure and it seems to be much less invasive. Like so many people in this forum, my aneurism diagnosis (even though it's under 5 cm) has really changed how I live my life and if this was a treatment option now, I'd probably do it.

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I've been told an operation can be dangerous so best to wait. I have waited and now i am close to an operation and older than when it was first diagnosed. I would have preferred an operation earlier but i am not the surgeon. I hope they know what they are doing. They tell you to avoid stress, in this world? Good luck with that, and also not to lift over 50 pounds. That gives me a good excuse at the gym

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@douglasebaker

Believe me, do not get the surgery, .you are fine. The surgery is as invasive as open heart surgery. My Aorta is 5.1 cm and my cardiologist will not be concerned until 5.5csm. However, I do have a ct scan check every year to monitor any changes, So far no changes. Furthermore, No one has any idea if this has been the size of my Aorta for years. I would take the yearly monitoring route and ease your worry.

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What about the Endovascular (TEVAR) procedure? I've been reading about this procedure and it seems to be much less invasive. Like so many people in this forum, my aneurism diagnosis (even though it's under 5 cm) has really changed how I live my life and if this was a treatment option now, I'd probably do it.

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@realitytest

Wow! That certainly IS young. Is a CT scan the usual way to check for aneurysms? How else do people find out?

My ex-husband died suddenly of a burst aneurysm a few months ago, and our sons were advised to be checked for aneurysms. I hope their insurance covers a. CT scan on grounds of their being hereditary high-risk.

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Insurance I think should cover. I had to have both my kids tested for bicuspid aortic valve because I have that- insurance did cover both of their 2 d echos to rule that out. I am guessing also it is dependent on what caused the aneurysms. For me it was a congenital heart defect- my aorta was kinked- CoA- because of that and not a generic link they didn’t have to get the scans for the aneurysm. But any tests that was recommended by my cardiologist the pediatrician had no problem getting them ordered and covered- I am sure it would be the same for adult children as well.

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@mermaid1

I have no symptoms but chose to have a CT scan, that insurance won't pay for, because friends died suddenly, not because they had aneurysms. When friends die suddenly in their 50s you feel your own mortality.

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Wow! That certainly IS young. Is a CT scan the usual way to check for aneurysms? How else do people find out?

My ex-husband died suddenly of a burst aneurysm a few months ago, and our sons were advised to be checked for aneurysms. I hope their insurance covers a. CT scan on grounds of their being hereditary high-risk.

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@realitytest

Do you mean the friends who died (presumably from a burst aneurysm) had aneurysms below the recommended-for-surgery level?

Or even that they hadn't known they had an aneurysm at all? Why did you have the self-pay CT scan? Because you didn't trust your docs' measurements or because their testing intervals were too far apart to make you feel safe in your present measurements?

Not really pertinent, but a personal anecdote - my ex-husband just passed away two months ago from a burst aneurysm. In his case, he knew very well he was past medical recommendations (a reputable local hospital and the Cleveland Clinic. had told him he was in great danger owing to the size of his aneurysm, but he just didn't have the nerve - afraid he's die in surgery.) Finally, his wife ramped up the pressure and he returned to the Cleveland Clinic, which lined up surgery for two weeks after that date (I think they insisted he stop smoking for that period). Whatever, not far from the Clinic while returning home to wait, he collapsed while filling his tank with fuel.

Before this, I was ignorant about this condition - now I've read a good bit including this online conversation. I have tremendous sympathy for you sufferers. The surgery really is a terrifying "Damocles Sword" to have hanging over your heads - also pre-surgery, quality of life-limiting, to never know what activity level is safe.

I'm glad you can support each other here. Perhaps if he'd been a member, he could have been reassured enough to go through with surgery despite the risks. Also to quit smoking at least before the operation. My sons were of course told to be checked. Without such recommendations, how else do people get the diagnosis? It's not that common a condition.

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I have no symptoms but chose to have a CT scan, that insurance won't pay for, because friends died suddenly, not because they had aneurysms. When friends die suddenly in their 50s you feel your own mortality.

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