Surgery not indicated until aneurysm reaches certain size

DEAR DR. ROACH

» I am a very active 78-year-old woman. I had a

CT scan for calcium and an aneurysm of the ascending thoracic aorta was found. In 2014 it measured 3.6 cm and in 2019

3.7. My doctor flippantly said “I’ll see you in five years.” No other comments from him. Is there anything I can do to slow it down? All I’ve read is that with an aneurysm, you will just drop dead. Why can’t I have surgery? I take 20 mg of simvastatin for cholesterol and my blood pressure is 101/60. My family doctor told me not to take aspirin. —

S.A.

ANSWER» The aorta is the major artery of the body, coming directly off of the left ventricle of the heart, forming an arch, then descending through the chest into the abdomen. There it splits into the two femoral arteries at about the level of the bellybutton. Any abnormalities of the aorta are taken very seriously. Weaknesses in the wall of the aorta, which is so thick that it contains both muscles and blood vessels of its own, may cause the progressive expansion of the aorta’s wall: an aneurysm.

The larger an aneurysm, the more dangerous, as it becomes more likely to rupture. The normal ascending aorta — the part between the left ventricle and the arch — is 2.9 cm. The usual definition of an aneurysm is a 50% increase in the expected size, so at about 4.4 cm. Once an aneurism reaches 6 cm, it becomes very likely to rupture, which leads to almost instantaneous death. Most experts recommend annual evaluation of the aorta to look for enlargement.

At 3.7 cm, the risk of rupture is negligible, and surgery is not indicated. Nonetheless, your doctor should not have been flippant with you and should have taken the time to explain your risks. With an enlargement of the aorta of your size, the risks are very small. The risk of an operation is significant: About 2% to 6% of surgical patients will die within 30 days, depending on what type of surgery is done.

The two best-studied strategies to slow progression of aneurysm are careful blood pressure control and statin drugs.

You have excellent blood pressure and are already taking a statin. Both of these have probably protected you from having a much larger aneurysm.

Keith Roach To Your Good Health