Thoractic Aortic aneurysm

[Tom1116]

My Ascending Aorta has an aneurysm measuring 4.5 cm. This reading has not changed over 4 years, from a CT scan in 2005, 2007, and 2009.  Would you recommend continuing regular CT scans and at what diameter should I take action. Also, is that type of aneurysm repaired by the newer method of inserting a tube in your abdomen,feeding it to the aorta and placing it, or is "Open" surgery the only answer.

[Stratman1949]

A related discussion, Aortic Root Aneurysm was started.

[DavesMom]

Thanks for the info.  I'll bet your right and that it is close to the arch.  There are a couple of other arteries (braciocephalic and origin of left common carotid artery) that were also shown to have aneurysmal dilations.  

In any case, I am just glad I suggested the CT so it was caught and can now be monitored.

Thanks again.

[nickppatel]

Normally, I'd attribute this to echo technician error, but the fact that repeated echos didn't pick it up tells me that the aneurysms are in a spot not easily detected by echo.  Echos generally visualize the root and some of the ascending aorta ; I think they stop near the arch.  So if it's the asc. aorta near the arch, you'd need a CT to catch 'em.

[DavesMom]

I've always read that 5.0 - 5.5 cm is when surgery is recommended. I don't know how true this is (and perhaps the doctor can correct me) but I've also read that you need to take a person's size into account.  For example, I'm not even 5' tall and weigh less than 100 pounds, so a 4.5 cm aneurysm on me might be worse than on someone who's taller and weighs more. Therefore, repair may be needed before the 5 cm threshold.

What I don't understand is why my aneurysm never showed up on an echo. I've had yearly echos since my valve replacement/aneurysm repair in 1999 and they were always great.  

A couple of years ago I read that people with BAV like myself have a higher risk of developing aneurysms so I asked my cardio if I should have a CT.  She agreed and I was shocked to discover that I have a 4.5 cm aneurysm of the ascending aorta as well as aneurysms of two of the "great vessels."  These have never shown up in my echos and I don't understand why they would only show up in the CT.

Anyway, best of luck!

[Cleveland Clinic]

You should continue yearly screening, but maybe with echocardiograms instead of CT scans, as these have significant radiation exposure. The guidelines recommend operation in asymptomatic patients at 5.5 cm. There are options for closed surgeries in patients who have planned surgeries. These involve large accesses in the femoral arteries and placement of a specially designed stent in the aorta. In the ascending aorta this is still fairly experimental and performed only at large tertiary care centers such as ours.

[nickppatel]

You would benefit from reading some of my recent posts in the "Aneurysm" forum.  It may be possible to avoid surgery altogether with recent pharmacological developments.