The doctors use a statistical model which shows that the possibility of a rupture is remote until the aneurysm reaches a size of 5.0 or greater. A rupture at 4.8 is not impossible, but it's not likely. The decision as to the timing of surgery is a matter of playing the odds. The risk that you will die in surgery is not zero. It is necessary to balance out which is the greater risk: operating or not operating.
If your doctors are telling you to wait to have the aneurysm repaired, it's because, in their judgment, the risk of surgery is not yet justified. They have data about the risks of different courses of action. The data that they use has been derived from the outcomes of many, many patients over the years. Again, the doctors' strategy is to wait until the risk of doing surgery is less than the risk of not doing surgery. Their judgment in most cases is that, at 4.8, it is still riskier to operate than it is to do nothing.
Thoracic aortic aneurysm repair is a very complex operation in which a small but significant number of people will either die or have life-changing comlications such as a stroke. You don't want to take that risk until you absolutely have to. If the aneurysm should start to grow faster than expected, the odds change. If you should start to have chest pain that is thought to be related to the aneursym, the odds change.
I'm sorry you have this aneurysm, and I do know what it feels like to get this news. When I was told I had an aortic aneurysm, my only thought was, "get it out." But if your doctors are telling you to wait until 5.0 or even 5.5, you are getting standard advice. If you have not yet talked to a surgeon, it would be fine to go ahead and do that, just to get the additional imput.
While you are "in the waiting room" for surgery, it is important to control blood pressure, because hypertension puts excessive stress on the vessel walls. It's important to keep your monitoring appointments, so you know what is up with the aneurysm. It's also important, and perhaps this is even the most important thing, to find a way to keep calm and be peaceful and enjoy your life.
Post again, any time you want. I will be thinking about you.
Please be aware that you posted on the peer support forum and not the expert forum. I survived a 5.5cm root/ascending aneurysm, but I'm not a doctor or any kind of medical professional.
Surgeons wait to repair an aneursym until the risk of doing nothing outweigh the risks of surgery. To my knowledge, most cardiothoracic surgeons will wait until an aneurysm is at least 5 cm in diameter, and some will wait until it is 5.5 cm in diameter. That assumes there is nothing wrong with the valve and that there is nothing else going on that independently requires open-heart surgery. If the valve were to fail, a 4.8cm aneurysm would be repaired at the same time as the valve was replaced. But with the aneurysm as the only problem, most surgeons would consider either 5.0 or 5.5 to be the point when the odds change and it is more appropriate to operate than to wait. An exception is made if an aneurysm starts to grow very fast or if the patient develops chest pains that are thought to be secondary to the aneurysm. Under those circumstances, most surgeons will operate sooner.
Thank you for your answer. If I may ask one thing more (I will post my questions in the expert forum as well, but I would appreciate it if you gave me your opinion too). How can one feel safe that a rupture will not occur suddenly at this diameter even if he is being followed and has no symptoms as far?
Forgive me if I am becoming a little "pesky"! I was wondering, have you heard anything regarding people who are taking anticoagulants (Coumadin) -because of a valve replacement- whether they are in any kind of risk if they also have an aortic aneurysm? If yes, then do you know if the time for an aneurysm repair changes; that is, does it need to be done earlier?
If you're asking whether your aneurysm surgery will be moved up because of increased bleeding risk in case of a rupture or dissection of the aorta, I don't think so. If your aorta ruptures or dissects, it is not going to matter if you are on coumadin or not. There are some things that have such a high rate of fatality that being on coumadin does not really add significantly to the risk. It's almost like, if you are skydiving and your parachute does not open, it does not matter if you forgot to put on your helmet that day. That's a rough way of putting it, so I hope you understand my intention. If your aorta were to rupture, and you were anywhere but on an operating table -- and with your chest already open -- you would be a goner. You would not be any more of a goner because you were on coumadin. You can check with your doctors, because this is just my opinion as an informed patient, but no, I don't think your being on coumadin will change the timing of your aneurysm surgery.
Man, I feel ya. I've had two AVRs, a root/ascending aneurysm repair, and I'm on coumadin. And with all that, the best I can tell you is to live your life, enjoy yourself, and try to fulfill your highest purpose on earth to the best of your ability. No one is guaranteed to live even one more day on earth, no one. You may end up living longer than some 18 year-old, totally healthy person. And a 100 year life-span is like the blink of an eye in the big scheme of things. So try your best to get the best medical care you can, as you are rightfully doing, and enjoy every day. Tell the people you love that you love them. Take time to smell the flowers. Live every day and try to make it count. All those cliches, they're true.
You're not being pesky. You can post all you want.
Obviously I wasn’t clear. What I actually wanted to ask is whether anticoagulants increase the risk of an untimely (earlier than expected) rupture.