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Update on conflicting surgery recommendations
Quick recap. I am 57. My TAA was discovered in 2021. I think it was 4.1cm at the time. I have been seeing Dr. Joseph Coselli at Baylor Medical in Houston since and I have a CT done annually. This March the CT relieved my TAA was at ~4.8cm depending on who is doing the measuring. As I left Dr. Coselli's office he gave my wife a wink and said "he will be fine." I won't go into the reasons why but I have gotten two second opinions in the last six months. One from Dr. Joseph DeRose at Montefiore Medical in the Bronx. He looked at the CT images and said if I were his patient it would not be up for discussion, he would insist I have surgery. He cited recent research that shows the length of the aneurysm is a better predictor of dissection than diameter (if anyone is interested send me your email and I will be happy to share it with you). My length was 11.2-11.3 cm. Dr. DeRose and this newer research is suggesting that 5.5cm in diameter should not be the magical number when it is time for surgery. Since I had two conflicting recommendations I went for a third from Dr. Leonard Lee at RWJBarnabas in NJ (he repaired a TAA for someone I know a year ago). Dr. Lee 's recommendation was to wait until the aneurysm grew >5.0cm. So two of three are saying to hold off, but the two that are recommending that I wait haven't said anything about the length and are not concerned about the length even after I pressed them on it. My wife and I are scheduled to travel to Italy in September and to help us make the decision I had a CT Angiogram last week. The person who read the images from Baylor Medical said there has been minimal growth from when I had a CT with contrast in March 2024. They read my aneurysm at 4.5cm. So frustrating how multiple people keep reading my images and give me different sizes. Now I am waiting on Dr. Coselli and Dr. DeRose who both have copies of my images to get back from vacation to tell me how they interpret my aneurysm. Here is the real kicker. The logical side of my brain is aware of the risks of walking around with this thing and that I am taking a chance every day but the emotional side of my brain is scared to go ahead with the surgery. The person I mentioned above who had their TAA repaired a year ago, his brother had the same surgery and died months after from a blood clot. That's what I am focusing on. Not the person I know who survived, recovered and is living a healthy life. Why? I almost wish this thing would grow more so all the doctors tell me its time to have surgery. No question. Then I would have no choice.
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Since you went to Baylor, is Houston a convenient place for you? Just my own experience, I saw Dr Anthony Estrera (I believe we have discussed this before), he is part of the UT Physicians group and works at Memorial Hermann in Houston. In my personal experience, the man is just incredible, not only his demeanor and bed side manners and the time he takes to spend with his patients and answer all the questions, but in my case my surgery couldn't have gone any smoother. Just something for you to consider if it is convenient for you.
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4 ReactionsWhew. I sympathize with you as you face this dilemma: surgery or wait. Wouldn't it be nice if you could get all the doctors in one room and have them talk it out--with you listening? This is so scary. I hope that whatever decision you make, you'll feel comfortable with it. Doubt is very destabilizing.
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4 ReactionsIt is a very stressful and difficult decision to make. I went through it 6 months ago and finally decided to have surgery. My surgery was in April and everything went well. One thing to consider is that size is not the only factor to consider on whether to have surgery. Other factors include whether you have certain genetic disorders, how fast the aneurysm is growing, other heart conditions, your overall health and your age. These should also be items of discussion with your surgeon. I wish you the best whatever you decide.
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3 ReactionsI appreciate the feedback. I am comfortable with all the surgeons I am speaking with, I just wish they were all recommending surgery
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4 ReactionsThank you for listening.
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3 ReactionsYou are correct there are other factors to consider. I did not mention that because they have not been an issue for me. What was the size of your TAA when you decided to have surgery and if you are willing to share, your age? How would you describe the recovery? Length of time and routine. Did your recovery entail physical therapy or just daily walking.
My aneurysm was discovered in 2012 at 4.5 cm. It very slowly grew to 5.2 cm by last fall. I was 72 when I had surgery and the surgeon also repaired my aortic valve since he was already there. I was in the hospital for 5 days and I was never in much pain, just tired and weak. They had me sitting up in a chair most of each day and had me walk the hallways a couple times a day. For the first 4 weeks at home I walked. I started off slowly and increased my distance a little each day. I also did my breathing exercises and followed all the restrictions I was given like no driving, not lifting more than 10 pounds, no stretching. I started cardiac rehab in the 5th week. I went for about an hour three days a week for 6 weeks. It consisted of walking on a treadmill, using an exercise bike and lifting light weights. I have continued that exercise routine on my own since completing rehab. Overall the recovery went a lot better than I had feared. I am now almost 4 months post surgery and I am about 95% back to normal. I still get tired a little faster than I used to, but that may just be my age. I also feel some minor discomfort in my sternum if I do to much with my arms. My cardiologist says it can take 6 months or more for the sternum to fully heal.
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6 ReactionsAn AA will likely lengthen, rather that increase in circumference, the longer you let it go.
If I were 57 I'd do it now.
Everyday increases your risk of getting OLDER. The older you get your body has less reserve to heal quickly and easily. You are worrying about the wrong risk factor: your age is the biggest risk factor, IMHO.
We age slowly from 26-50; aging speed increases as you age.
I appreciate the perspective. That’s why this group is invaluable.
I understand your worries. And…September is next month; that’s so soon! If your aneurysm isn’t growing quickly, it seems that you at least have time for an amazing vacation in Italy. Whether or not you decide to schedule surgery soon, it is not an emergency and doesn’t need to happen within 4-6 weeks. Right? Gotta live and enjoy life now. Have you asked the doctors if there’s additional risk for you to travel and enjoy a relaxing time with your wife? Another way to view this is more time to take care of your overall heart and body health to prepare you for the possible eventuality of surgery- whether it’s within the coming months or years. My doctor advised me to focus on this.
The issue of length is very interesting and I am curious about what each of the doctors would say about it. I am in Chicago and found this resource very helpful. If you want a 4th opinion or fast answers to current questions, they reply within a day or two and connect you with a knowledgeable cardio nurse: https://www.nm.org/conditions-and-care-areas/heart-and-vascular/appointments
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