Newbie ascending aorta aneurysm

[pellicle]

I’ve seen 2 different ways in my research, a stent

I've never heard of a stent to hold an aneurysm, only for enlarging a clogged or otherwise occluded artery. I'd be interested to see your research suggesting that.

 

[Unicusp]

I think you’re misunderstanding my question. I wasn’t making a case for either one, I asked what people have had done and whether their surgeon offered a choice. It’s almost like you think I am supporting a stent over the dacron graft. I am not. I merely asked the question to see what others have had done to repair an ascending aorta aneurysm.

Sorry my only point was that I hadn't heard of this option and it was never mentioned by anyone at the Cleveland Clinic. The only choices offered were on the valves.

 

[mecretired]

I had an aneurysm of my ascending aorta almost 12 years ago at age 58. I’m assuming there wasn’t a choice back then. I received a St Jude grafted valve. I haven’t had any problems with it and hope it lasts as long as a need it.

 

[deancass2000]

Sorry my only point was that I hadn't heard of this option and it was never mentioned by anyone at the Cleveland Clinic. The only choices offered were on the valves.

Good to know. Thank you for the input.
my cardiologist is from washington university in st louis, missouri.
I go april 5th for the consultation with the surgeon. I expect he will tell me what all i need to know. I guess people travel all across the US to go to the cleveland clinic?

 

[deancass2000]

I had an aneurysm of my ascending aorta almost 12 years ago at age 58. I’m assuming there wasn’t a choice back then. I received a St Jude grafted valve. I haven’t had any problems with it and hope it lasts as long as a need it.

good information, thank you for the reply.

 

[cldlhd]

I think you’re misunderstanding my question. I wasn’t making a case for either one, I asked what people have had done and whether their surgeon offered a choice. It’s almost like you think I am supporting a stent over the dacron graft. I am not. I merely asked the question to see what others have had done to repair an ascending aorta aneurysm.

I don't think he was being judgy or questioning your post . It seemed like he was just offering his opinion

 

[cldlhd]

Good to know. Thank you for the input.
my cardiologist is from washington university in st louis, missouri.
I go april 5th for the consultation with the surgeon. I expect he will tell me what all i need to know. I guess people travel all across the US to go to the cleveland clinic?

I looked the Cleveland clinic but I live in the suburbs of Philly and HUP ( Hospital if the university of Pennsylvania) is highly ranked and 45 minutes away. Plus the surgeon of my choice there ,Dr. Bavaria, was available and on the same page as me

 

[deancass2000]

I looked the Cleveland clinic but I live in the suburbs of Philly and HUP ( Hospital if the university of Pennsylvania) is highly ranked and 45 minutes away. Plus the surgeon of my choice there ,Dr. Bavaria, was available and on the same page as me

Im curious where they are ranked? Im curious if Missouri Baptist in St Louis is.

 

[djman]

I did 4 years of watch and wait. Diagnosis 2018, surgery 2022. Hardest year was the first year. After that it all kind of faded into the background. Probably depends on your personality. I even ran a half marathon on watch and wait. Just did not ever go full sprint.

 

[Chuck C]

I even ran a half marathon on watch and wait.

I trained hard at boxing and kick boxing during watch and wait. My cardiologist was not crazy about it, but he did not give me a hard "no". After observing my treadmill and how my blood pressure did not drop upon extreme exertion he was more or less ok with the hard training. The one thing that I was strictly told to avoid was bearing down, also known as the Vasalva Maneuver. So, I avoided all lifting and other activities which involved this.

 

[deancass2000]

Just to provide an update from my surgeon visit on 4/5/22. Still at a 4.2cm, no growth.

Basically the same input like a lot of you have commented. No heavy lifting and now he wants to do annual checkups vs 6 mth checkups. He also wants to switch from cta scans to mri scans because of the risk from using the radioactive dye.

He basically said it may be a few years before surgery and im in the “grey” area. Grey area meaning i could still have a dissection if i strain myself or am involved in something where i might have an impact, car crash? So nothing that really put my mind at ease, so ill still be walking around wondering, can i do that can i do this? not a good feeling……

 

[pellicle]

He basically said it may be a few years before surgery and im in the “grey” area. Grey area meaning i could still have a dissection if i strain myself or am involved in something where i might have an impact, car crash?

no not really, and you should have asked that question in there. However from:

https://www.anzsvs.org.au/patient-information/aortic-aneurysm/

A Canadian study has reported specific figures for the risk of rupture based on aneurysm size (Brown PM et al 2003). For men the annual risk of an aneurysm rupturing was 1-1.8% for aneurysms between 5.0 and 5.9cms, but increased to 14.1-15.6% when the aneurysm was 6cms or greater. In other words a man with a 5.4cms diameter aneurysm has only 1 or 2 chances in a hundred that his aneurysm will rupture in the next year. Once the aneurysm increases to 6.1cms that risk will increase to approximately 15 chances in a hundred.​

​

...​

​

When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention. This is because, at this size, the aneurysm has a greater risk of rupture. It then becomes as safe to have an operation to repair the aneurysm, as it is to leave the aneurysm alone. Surgery may also be considered if your aneurysm is rapidly expanding on regular scans or it starts to cause other complications (see above). Rapid expansion means more than 7mm in 6 months or 10mm in one year.​

​

Whether you proceed with surgery will not just depend on the size of the aneurysm. It is important that each patient is fit enough to withstand the operation. Fitness for surgery can be affected by many factors and the decision whether or not to proceed with surgery can be a difficult one, as it is a very major operation. It will only be after a detailed discussion with your surgeon, regarding your own personal circumstances and type of treatment available, that a decision can be reached.​

​

There is still some debate on the treatment of aneurysms between 4.0 and 5.5cms despite the large UK and North American trials indicating that there is no clear benefit. Looked at in another way though, there was no clear disadvantage to having the aneurysm treated at an earlier stage. Overall 60% of all patients in the trial would eventually require an operation so why not step in at an earlier stage? Taking patients with aneurysms over 5.0cms the argument is even more convincing, as over 80% of these patients eventually require surgery. However, the accepted size to initiate treatment is still 5.5cms (55mm).​

HTH

 

[deancass2000]

no not really, and you should have asked that question in there. However from:

https://www.anzsvs.org.au/patient-information/aortic-aneurysm/

A Canadian study has reported specific figures for the risk of rupture based on aneurysm size (Brown PM et al 2003). For men the annual risk of an aneurysm rupturing was 1-1.8% for aneurysms between 5.0 and 5.9cms, but increased to 14.1-15.6% when the aneurysm was 6cms or greater. In other words a man with a 5.4cms diameter aneurysm has only 1 or 2 chances in a hundred that his aneurysm will rupture in the next year. Once the aneurysm increases to 6.1cms that risk will increase to approximately 15 chances in a hundred.​

​

...​

​

When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention. This is because, at this size, the aneurysm has a greater risk of rupture. It then becomes as safe to have an operation to repair the aneurysm, as it is to leave the aneurysm alone. Surgery may also be considered if your aneurysm is rapidly expanding on regular scans or it starts to cause other complications (see above). Rapid expansion means more than 7mm in 6 months or 10mm in one year.​

​

Whether you proceed with surgery will not just depend on the size of the aneurysm. It is important that each patient is fit enough to withstand the operation. Fitness for surgery can be affected by many factors and the decision whether or not to proceed with surgery can be a difficult one, as it is a very major operation. It will only be after a detailed discussion with your surgeon, regarding your own personal circumstances and type of treatment available, that a decision can be reached.​

​

There is still some debate on the treatment of aneurysms between 4.0 and 5.5cms despite the large UK and North American trials indicating that there is no clear benefit. Looked at in another way though, there was no clear disadvantage to having the aneurysm treated at an earlier stage. Overall 60% of all patients in the trial would eventually require an operation so why not step in at an earlier stage? Taking patients with aneurysms over 5.0cms the argument is even more convincing, as over 80% of these patients eventually require surgery. However, the accepted size to initiate treatment is still 5.5cms (55mm).​

HTH

The details you provided and the link are for abdominal aorta aneurysms. Mine is in the ascending aorta. From what i understand they use different measurements and treat the ascending aorta differently than an abdominal aorta aneurysm.

 

[pellicle]

The details you provided and the link are for abdominal aorta aneurysms.

my apology. I believe that this information in this post is still current

https://www.valvereplacement.org/threads/newbie-ascending-aorta-aneurysm.888476/post-914880
additionally

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5166604/
"thanks but ..." would have been polite

 

[deancass2000]

my apology. I believe that this information in this post is still current

https://www.valvereplacement.org/threads/newbie-ascending-aorta-aneurysm.888476/post-914880
additionally

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5166604/
"thanks but ..." would have been polite

no offense intended. thanks for the reply.

 

[pellicle]

thanks for the reply.

you're welcome.

The point of posting the articles I have posted is to clarify that really nobody can exactly answer that question, but it can be answered statistically. I'm afraid that's just how it is with some thing.

Best Wishes

 

[cldlhd]

no not really, and you should have asked that question in there. However from:

https://www.anzsvs.org.au/patient-information/aortic-aneurysm/

A Canadian study has reported specific figures for the risk of rupture based on aneurysm size (Brown PM et al 2003). For men the annual risk of an aneurysm rupturing was 1-1.8% for aneurysms between 5.0 and 5.9cms, but increased to 14.1-15.6% when the aneurysm was 6cms or greater. In other words a man with a 5.4cms diameter aneurysm has only 1 or 2 chances in a hundred that his aneurysm will rupture in the next year. Once the aneurysm increases to 6.1cms that risk will increase to approximately 15 chances in a hundred.​

​

...​

​

When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention. This is because, at this size, the aneurysm has a greater risk of rupture. It then becomes as safe to have an operation to repair the aneurysm, as it is to leave the aneurysm alone. Surgery may also be considered if your aneurysm is rapidly expanding on regular scans or it starts to cause other complications (see above). Rapid expansion means more than 7mm in 6 months or 10mm in one year.​

​

Whether you proceed with surgery will not just depend on the size of the aneurysm. It is important that each patient is fit enough to withstand the operation. Fitness for surgery can be affected by many factors and the decision whether or not to proceed with surgery can be a difficult one, as it is a very major operation. It will only be after a detailed discussion with your surgeon, regarding your own personal circumstances and type of treatment available, that a decision can be reached.​

​

There is still some debate on the treatment of aneurysms between 4.0 and 5.5cms despite the large UK and North American trials indicating that there is no clear benefit. Looked at in another way though, there was no clear disadvantage to having the aneurysm treated at an earlier stage. Overall 60% of all patients in the trial would eventually require an operation so why not step in at an earlier stage? Taking patients with aneurysms over 5.0cms the argument is even more convincing, as over 80% of these patients eventually require surgery. However, the accepted size to initiate treatment is still 5.5cms (55mm).​

HTH

Makes me feel like maybe I jumped the gun , I had my surgery when the scans said my ascending aorta was 4.8cm but when measured after removal it was 4.99cm. Maybe this is a thread hijack , if so I apologize, but post surgerical repair with a Dacron graft my CT scans said it was 3.4cm (6 yrs ago) but my latest scan last month said it was 4.0cm which seems both odd and concerning a bit.

 

[deancass2000]

Makes me feel like maybe I jumped the gun , I had my surgery when the scans said my ascending aorta was 4.8cm but when measured after removal it was 4.99cm. Maybe this is a thread hijack , if so I apologize, but post surgerical repair with a Dacron graft my CT scans said it was 3.4cm (6 yrs ago) but my latest scan last month said it was 4.0cm which seems both odd and concerning a bit.

So are you saying the dacron graft section is growing?

 

[cldlhd]

So are you saying the dacron graft section is growing?

I don't know, maybe they do a little. I have to contact the surgeons team. I remember reading somewhere that they can grow some. I don't know if they stop at a certain point, one would hope. Also, I guess a certain amount of it is up to interpretation. Not sure if this relates directly to my situation but I have all my stuff done through Penn medicine at the University of Pennsylvania hospital system and I got a message from them on the portal saying they're having some issues with radiology....

 

[pellicle]

I don't know, maybe they do a little

time will tell mate ... all we can do is continue living (as opposed to being paralysed by fears and concerns and find out over time.

Best wishes