Stenting an Ascending Aortic Aneurysm under 5

@dew88
Hi,
I have an ascending aorta dilation at 4.6 . It was 4.1 in 2016 when I was first told about. I wasn’t even aware of how important it was. I continued my life as usual. Walking 5-6 miles, working out and carrying my grocery from the supermarket.
My cardiologist didn’t stop me doing those but he said one thing, “as long as you’re not body building working with those weights over your head and not carrying very heavy things you’ll be fine.”
All my life I was very active and still doing the most and simplified my yoga and workout routine I’m fine🤞🙏.
I do have a resting heart rate, and normal blood pressure besides clean arteries. My cholesterol is a little high.., well my cells need it and body is making it.
When I read your story I loved it. We have to continue being active for blood circulation and careful at times.. hopefully we’ll avoid the surgery which I hate so much.
May be they’ll find something to stop the dilation without surgeries🙏 by the way I’m 76
young.
I wish all the people like me a
long and a very happy life. There
are more to learn in this world.
It’s worth to live. Peace and Love❤️

Hi,
You mentioned doing a non-invasive stent implant which for abdomen and thoracic descending aneurysms has been around for some time. That procedure is entered via the groin. But how does a stent enter the ascending aorta without being invasive?
That is going to raise the hopes of hundreds of people who dread, as I do, the present procedure which is tearing open the entire chest and frequently open heart surgery. A friend of mine just had the procedure and it is no picnic, even though it was successful. Hope that is not just someone who got the location or type of aneurysm confused.

@dew88 Hi... I'm wondering exactly the same thing. A stent, or a sleeve, would be soooo much better than the standard chest-cracking surgery. How I hope it's a real alternative!

There is currently no broadly available non-invasive procedure that replaces the ascending aorta or the aortic root. Those repairs generally still require open surgery through a median sternotomy, which means the surgeon opens the chest through the breastbone and replaces the diseased portion of the aorta with a surgical graft. That is very different from stent-graft repair, where the graft is delivered from inside the blood vessel. I follow this area closely because it is of great personal interest to me after my own Type A aortic dissection and open repair, and the important distinction is that the location of the aneurysm usually determines what options are available. I've had my aorta replaced through a median sternotomy (chest cracking) and after 11 years, it's still tender, if it gets bumped, especially my xiphoid process at the bottom of my sternum.

For abdominal aortic aneurysms, there is often a minimally invasive option called EVAR, which means endovascular aneurysm repair. EVAR usually involves placing a stent graft through the femoral arteries in the groin and guiding it into position inside the abdominal aorta so the aneurysm is excluded from blood flow. For aneurysms in the descending thoracic aorta, there is a similar procedure called TEVAR, which means thoracic endovascular aortic repair. TEVAR also usually uses access through the groin, but the stent graft is placed in the thoracic aorta, most commonly the descending thoracic aorta.

The short version is that abdominal aortic aneurysms may be candidates for EVAR, and descending thoracic aortic aneurysms may be candidates for TEVAR, depending on the person’s anatomy and the judgment of the treating aortic team. But aneurysms of the ascending aorta, the aortic root, and many arch aneurysms usually still require open surgical repair through the chest. I know everyone hopes for something less invasive, and that day may come, but at present the ascending aorta and root are still generally handled very differently from the abdominal and descending thoracic aorta. Anatomy drives everything. Peace.

Moonboy gave a very good explanation regarding the ascending aorta and root. The ascending aorta and rood have a lot of movement and stress put on them due to the location and attachment to the heart. I am about a year and a half out of a Bentall procedure myself and am watching a 4.6 cm aneurysm on my remaining native distal ascending aorta just before the aortic arch. Even that is a hard no for TEVAR at this time. Plus, due to questions about the morphology of my aorta, it would likely be risky even if it were an option. My root ruptured following three other complicated procedures during open heart surgery. At the time the ascending aorta was about 4.7 at the midsection and root was 4.8. If a TEVAR procedure was available, I cringe at the thought of it rupturing during a catheter procedure. I had 3 of those a the month prior to open heart surgery.

@moonboy Thank you for your information!

How often are they checking it

The EVAR is less invasive

@jcsc I have a Juxtarenal and Pararenal abdominal aortic aneurysm This surgery(going thru groin on both sides and your neck and your wrist wasnt as bad as having to stop the blood flow and opening you up which can cause kidneys to fail or you could be paralyzed from them going in the front to your back with all those different nerves that could be compromized. I am sending 2 pictures of before and after.

And my surgery was complicated because of my kidneys. They had to put a stent there also so i didnt loose function to the left kidney.