When is best for aneurysm surgery?

Dear Dr. Roach: I am a 68-year-old male in good health with a 3.3-centimeter aneurysm in my internal iliac artery. I have no symptoms. It was 1.9 cm eight years ago. My physician says that an aneurysm measuring over 3 cm requires surgical intervention. I have looked at recent studies that say an aneurysm measuring less than 4 cm can be safely observed because a rupture under this size is extremely rare. — T.R.

The internal iliac artery is one of the main blood vessels in the hip. The aorta branches into two common iliac arteries, left and right, which in turn branch into the internal and external iliac arteries. An aneurism is a dilation of the artery, and the big concern is a rupture, which is immediately lifethreatening. Thus, repair is recommended before there is a significant risk of rupture.

The current standard of practice is to repair any aneurism that is over 3 cm, symptomatic or rapidly expanding. Although yours has expanded slowly over the past eight years and you have no symptoms, the aneurism is still over 3 cm.

A study presented in Finland in 2015 has challenged the current standard of practice. The author of the study said that elective treatment of an internal iliac aneurism could “quite safely be increased to 4 cm.” The average person in the study was 77 years old.

Based on this study, it appears you could hold off on surgery, for now. However, it is likely that the vessel will keep expanding. Most importantly, the one whose opinion matters most, next to your own, is the surgeon who would be operating on you. I would recommend discussing with your vascular surgeon the advisability of waiting.

Finally, people with one aneurism often have others. I am sure you have been checked, but you should continue to be evaluated, even after repair.