Do I need surgery now?

[Howling8]

I have a 3.9cm aortic aneurysm and a 3.5 right iliac aneurysm.

My civilian surgeon and internist tell me to get it fixed now as the iliac aneurysm is too big.

My VA surgeon (who is also the Professor of Vascular Surgery at two local hospitals) wants to wait and see.  He assured me that he has seen thousands of these and that he would not let me leave the office if I was in any danger.

I'm stuck in the middle, scared of a time bomb in my body, complications from EVAR (impotence) etc....

I'm leaving on a 4 week work trip and now I'm worried.

What should I do?



This discussion is related to CAD/Aneurysm repair.

[kenkeith]

Correction to HBO s/b HMO. A health maintenance organization (HMO) is a type of managed care organization  that provides a form of health care coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. From what I have heard an HBO doctor gets a bonus if they keep costs down.  I'm not aware of VA doctors having an arrangement with any source.

[Howling8]

Thanks, anymore recommendations would be appreciated.  Thinking of getting a third opinion too.

[kenkeith]

The guidelines are when size is the criterion of an aortic aneursym is 4.0 cm,  and if an when the size grows to 5.0 cm there is consideration given for intervention to prevent rupture.  If there is tissue desease that would also be a consideration.  And if the growth is 0.5 cm in a year can be another indication for intervention.

Indications for endovascular repair of the iliac artery are to repair the iliac artery if the aneurysm is greater than 4 cm in diameter, and if the aneursym has increased in size by 0.5 cm in the prior 6 months, etc..

I don't know if the perspective I have given helps you distinquish the right decision.  It seems either can be correct, but the risk might be more than your VA surgeon indicates, but (s)he has more information about your general health, concomitant health issues, etc. and one should not second guess the opinion.  It is confusing as you point out, but a VA surgeon may be under pressure to keep costs down...I have read other posts regarding the care of patients associated with VA, and it appears risk/benefit analysis favors the side of the risk more than a civilian doctor with HBO not withstanding.  

I don't mean to confuse, but it is your health and you should know the options.  I think one almost always find a difference between doctors associated with an HBO or the VA group.
The civilian doctor may have profit motivation, and the VA is cost conscience!  

Thanks for your question, and if you have any further questions or comments you are invited to respond.  I wish you well going forward.

Ken

[is_something_wrong]

Hard for us to say, we are not physicians and most important, we can't make decisions regarding your life and health.

My dad recently had surgery for his aortic aneurysm (7 cm). Though it is considered a major procedure it went surprisingly well, he actually called me 5 minutes after he wake up and told me he was fine. He got some complications with infections afterwards, but some antibiotics took care of that too.

From what I've read, aortic aneurisms >5,5 cm requires surgery. If they are less than 5 cm, they almost never rupture. Not sure what the rule is regarding iliac aneurisms. I'm not sure if they only will take care of the iliac aneurism, or if they fix both at the same time with a so-called Y-graft (like my dad did). That's a major procedure, but at least they will both be fixed.

In the meantime, keep in mind:

- NO smoking, what so ever.
- Keep cholesterol low.
- Avoid weightlifting and other situations where you strain the abdominal muscles (as this greatly elevates blood pressure). Eat a healthy diet with fiber so you avoid this when doing bowel movements.
- BP should be kept low, the 140/90 rule doesn't apply here. Preferably below 120/80
- Do regular ultrasounds of your arteries if you decide to wait and see.