Ascending Aortic Aneurism

[itrekalot]

My father has just been diagnosed with an ascending aortic aneurism, 4.5cm.  We have the reports and the films.  He is a 94 year old retired surgeon with a pacemaker and a bovine valve.  His doctor feels his age makes surgery too risky.  My father, meanwhile, has asked me to find "the best vascular surgeon in America" to give him a second opinion.  Can you help ?  

[jutamonda]

I am a 54 year old black female who has surived an aortic dissection that ripped down.  I have an aortic aneurysm about 4 cm  on the valve leading to my stomach.  At this time everything is stable.  I am just looking for people who have gone thru this and can give me some insight as to how to deal with this on a day to day basis.  I have alot of questions but no one seems to have alot of answers since most people do not survive this type of attack.  

[MP877]

I'm a 37 yr old female dx with an ascending aortic aneurysm measuring 4.5cm. (dx in Aug. 07)  Here I am worried to death about needing surgery but I'm reading from all of you about having one 5 cm in size and no surgery?  So this means I'm fine?  

[pbanders]

I had a 5.0 cm ascending aortic aneurysm grafted about 4 years ago, at 46. At 94, if I was at 4.5 cm, I woudn't do anything other than have it monitored. If he wants to talk to an expert on this surgery (someone who has done hundreds of these cases), I recommend Vince Gaudiani in Redwood City, CA (my surgeon). You can find his contact info easily on Google.

[Seanboe]

just playing the devils advocate but think of the knowledge and experience that could be gained by the surgeon. AAA surgeries are not easy to come by in the medical world and the experience gained could save others that are younger. If you want to talk about rising health care costs think about the huge illegal alein problem that is draining our healthcare system My ambulance service right now has to right off tons of cost caused by illegal alliens. It is getting rediculous. As far as helping our seniors I agree with you to some extent that we do to much for people who are in a hopeless situation, however each situation needs to be taken on an individual basis. I have had many 70, 80, 90 year old patients who are still incredibly active. Some even more active than the fat younger generations.

[cmt51597]

As long as there are no clear signs of an aortic dissection, I wouldn't worry too much.  If you really want to be sure, you can ask your doctor to get him a CT (if you really want to be sure a 64 slice), althrough this is probably overkill.  You will be hard pressed to find a surgeon that is going to want to take a risk repairing a non-critical case on a 94 year old.  

I think this type of case raises some moral questions for our society.  How much do we do, what lengths do we go to prolong the lives of our senior population-- and what value does this add to a life or society at a whole and at what costs-- financial, personnel resources, supply, energy, etc.?  I'm sorry sir, but there has to be a limit on how much we do for our senior population.  If we as a society put so much focus, so many resources on this part of the population, what resources, finances, people resources will be left for our younger generations.  There has to be a balance for society.  I'm sorry, but that's just how I feel and I'm sure I'm not the only one.  

So, in my opinion, let the man be.  He's already lived way beyond the 77 year avg. age and from what it sounds, he can live with this condition for years to come.  You probably would be taking more of a risk putting him under general anesthisia for the surgery than just leaving this condition alone.  

I wish the best for both of you, but please take a minute to think about what I've said-- it's really an important and practical issue for the future of our society-- one that we will need to address as more and more of our citizens live into their 90s and even 100s!  Care of this segment of the population will not come without significant societal costs.  It's already carrying a considerable weight as it is and will stand to grow and grow.  Forcing health professionals to go further and further and further to undergo risky medical procedures for questionable benefits or necessities will only make the situation worse.  

[pusher]

I have an ascending aortic aneurysm at 5 cm.  The doctors told me they would want to repair it when it reaches 5.5 cm.  The ascending aorta is considered dilated up to 4.5 cm.  From then on it is considered an aneurysm.  I guess they base this on the normal size of the aorta times 150% equals an aneurysm.  

Using that, your father with an aorta measuring 4.5 and the normal size being 28-30 mm (2.8-3.0 cm) he would still have a period of time before he would be a candidate for repair since the standard elective repair isn't done until 5.5 cm.

At 94 years old he may never need to have it repaired.  It really depends on how fast or if his aneurysm is growing.  Like my doctors have told me, they don't do the repair until the risk of a ruptured aneurysm is greater than the risk of surgery.  That will vary from person to person based on lots of individual health concerns.  My ascending aortic aneurysm has grown very little in 4 years while aneurysms in my abdomen have grown quite a bit in the same span.  It really is a "wait and see" thing.