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Aortic Disease – Drs. Mastracci & Roselli

Monday, June 9, 2014 - Noon

Description

It has been reported that between 43,000 and 47,000 people die annually in the United States from diseases of the aorta and its branches and the number continues to increase. It is crucial to know and understand the latest treatment options available if you have been diagnosed with a condition related to the aorta or the aortic valve. Dr. Roselli and Dr. Mastracci answer your questions about aorta disease.

More Information


Aortic Root

Lauriem: I have been diagnosed with a 4.9 cm aortic root dilation. There is multiple mild valve leakage noted. I have been put on blood pressure medication. I do have left hand numbness and intermittent pain in my arm and chest. I have been scheduled to see a local cardiologist in three weeks. I am 53.

Eric_Roselli,_MD: I don't see a question here but want to reassure the patient that it is a good idea to see your cardiologist – the symptoms of numbness and intermittent pain are not necessarily related to the aorta.

GTClay: I am a 44 y.o. male diagnosed with a 42 mm aortic root dilation. I am 5'10" and lost from 210lb to 170lb, and keeping my BP generally below 110 now. I have had an MRA at Emory and will have an echocardiogram at six months and another MRA at 12 months. I have read that Cedars Sinai recommends surgery at 43mm. Should I be doing anything else at this time?

Eric_Roselli,_MD: Congratulations on the weight loss – 43mm is too small to intervene on most aneurysms unless there are very specific high risk conditions that are met.

bjsheart: Born with bicuspid aortic valve 1946. Endocarditis in 1997. Dr. D. Cosgrove did aortic valve repair 5/1997 at Cleveland Clinic. FAILED. Redo by Dr. D. Cosgrove at Cleveland Clinic 9/1997 with homograft & part of aortic root. Echo shows "BORDERLINE DILATED AORTIC ROOT". Aortic Root Diameter MM, 2.8cm. At what point should I be concerned that the aneurism would rupture? And as it is in the area of the cut down, does that make it weaker than say a "normal" aneurism? Sincere Thanks, bj.

Eric_Roselli,_MD: I'm not worried about the 2.8cm root – the need for reoperation after a homograft is more often related to the valve failing.


Ascending Aorta

xdwl: Hello, doctor, I am 56 years old female. Here is my series MRI results:

  • Jun. 2012: ascending aorta 4.0 cm. Then I undertook septal myectomy in Sep. 2012 for HOCM. My LVOT obstruction has been well relieved.
  • May. 2013: ascending aorta 4.4 cm (post-myectomy surgery
  • Nov. 2013: ascending aorta 4.8-4.9
  • May 2014: ascending aorta 5.0 cm now. Recent echo shows mild-moderate MR, mild-moderate AR and mild TR. LVEDD 51 mm, EF 59%. I have no Marfan and no BAV.

I would like to ask: 1) Should I have aorta surgery now? Or I can wait till ascending aorta increase to 5.5 cm? 2) I had myectomy less than 2 years ago, and my NYHA II. Would these factors be big concerns for my second heart surgery? Thank you very much for taking time to answer my question!

Eric_Roselli,_MD: Aortic growth from 4cm to 5cm in only two years’ time is concerning and would require careful review before making a recommendation about timing of surgery. Redo status and persistent symptoms after myectomy may also warrant further evaluation.

BOB42: At my age (71), how difficult is a repair of an ascending aorta aneurysm and how would it affect me physically???

Eric_Roselli,_MD: Seventy-one is very young – risks for surgery are more dependent upon other medical conditions than your age alone. Patients who undergo elective ascending repair have had a risk of mortality of less than one percent in Cleveland for quite a long time and most return to a very active lifestyle after recovery.

skdavis01: I have a stable 3.9cm ascending aorta dilation. It’s been the same size for four years, I’m 53 yr. old female in good health, never smoked. My mom died of a ruptured AAA at 63 and her brother also had an AAA repaired. I know there can be a genetic link, but does that connection also include ascending and abdominal aneurysms? Basically I want to know if my aneurysm/dilation could have been an inherited trait?

Eric_Roselli,_MD: 3.9cm is quite small – in young patients we always consider a familial component as the possible cause but the connection between abdominal and thoracic aneurysm is not as clear as if a family member had thoracic aneurysm or dissection. We still have a lot to learn about the heritability of these conditions.

jameso: In November of 2013, I had a cat scan showing an ascending aorta aneurism of 4.9 This scan was performed because of a lung infection. I am scheduled for another scan in November 2014 to determine if the size of the aneurism has grown. I am 81 years old in reasonably good health. BP 112/65 Pulse 65, Cholesterol and all blood tests are well within the normal range. I do have a standing six month appointment with my primary care doctor and my pulmonologist. Infrequently (once a month) I feel a very slight chest pain that goes away within five to 10 seconds. No other symptoms are present.  My question---Is the infrequent pain a result of the aneurism growing? What are your recommendations re: advancing the scheduled cat scan from November 2014 to an earlier date? Thank you kindly.

Eric_Roselli,_MD: It is unlikely that the brief episodes of slight chest pain are related to your aorta. When a new diagnosis of aneurysm is made, we prefer to get the next study at about six months after the first to document stability since we can never really know how long the aorta has been dilated and at what rate it is growing. If it is stable after the six month interval then we may stretch it out to every 12 months.

dcherepon: How evasive is the surgery for a thoracic aneurysm and what is the general recovery time?

betsyRN: There are opportunities to do minimally invasive surgery for thoracic aneurysm depending on the location and extent of the aneurysm. The average hospital stay is five - seven days. This depends on the patient's overall health, extent of surgery, and other conditions.


Aorta – General

vizier: What size aortic aneurism does the Clinic use to trigger surgical treatment?

Tara_Mastracci,_MD: This really depends on where the aneurysm is. In patients with aneurysms below the renal arteries, the evidence shows that repair shouldn’t be considered until it is 5 or 5.5cm, unless there are special circumstances like rapid growth or rupture. For thoraco-abdominal aneurysms, which are more complex, we usually wait until they grow larger than 6cm, because the risk of surgery is higher.

chambiges: In 2010, during my annual physical, my internist detected that I had a heart murmur that could indicate an aortic dilation. He then had me undergo an echocardiogram to measure my aorta and it confirmed that I had a 4.4 cm dilation of my ascending thoracic aorta at the root. For the next three years, my internist had me undergo an annual echo to follow this dilation. My aortic root dilation has remained at 4.4 cm. My last annual physical with my internist was in Nov. 2013. I did not have an echo or other type of test to measure my aorta at that time. My internist will have me undergo another echocardiogram in one to two year’s time to re-evaluate the aortic dilation. My aorta has always been evaluated via echo. Is there any other type of test that you would recommend that I undergo to evaluate my aortic dilation? Also, is it o.k. to wait two years before any further testing re: my 4.4 cm. Aortic root dilation? I am female and 54. Thank you.

Eric_Roselli,_MD: Because the entire aorta is usually not visible with echocardiogram (due to “shadowing” from air in the trachea) a cross-sectional imaging study like CT or MR with contrast is best.

JW44: Does Cleveland Clinic or any other US hospital "wrap" the aorta rather than cutting out the distended section thus not having to place the patient on a heart/lung machine?

Tara_Mastracci,_MD: Wrapping of aneurysms is not a technique that is used anymore. Instead, our team has helped developed "aortic stent grafts" which are essentially tubes placed INSIDE the aorta to create a new lining and repair the aneurysm. This technique is useful because it does allow us to repair very complex anatomy without big incisions or the heart/lung machine, all under X-ray vision (fluoroscopy).

mgtrans01: Endo surgery requires an ICU stay?

Tara_Mastracci,_MD: The best answer to this question is, "it depends".  Standard infrarenal stent grafts (deployed below the kidney arteries) are pretty common, and usually simple procedures. Most people can spend the night in the step down unit after this procedure. If the stent graft is more complex -- like the "branched and fenestrated grafts" we discussed earlier -- there may be a need to be in the ICU for monitoring after the surgery. Of course, it always depends on your baseline risk, which is best discussed with your surgeon before surgery.


Bicuspid valve and Aorta

dstrauch: I have a suspected bicuspid valve and my aorta has increased from 4.4 cm to 4.9 cm in the last year. Is it OK to wait for 12 months to see if the aorta continues to grow larger? My wife is concerned that I should do something sooner. Thank you for your time and consideration. Dan in Western New York.

Eric_Roselli,_MD: 5mm of growth in a one year period may be an indication to operate, but it is difficult to say whether there is definite growth as it is dependent upon the method of imaging – have you had a ECG gated contrast enhanced CT scan or an MRI to assess this?

NY3740: I am 6’-2”, 188 lbs and was diagnosed approx. six months ago with an ascending aortic aneurysm measuring 5cm located near the root. I had a TEE exam in Jan that confirmed I also have a bicuspid aortic valve, apparently working fine. The doctors told me that I would require a CAT scan every six months to monitor the aneurysm but at that time didn’t limit my activity or exercise except for lifting weights over 70 lbs, and told me that it would be years before I would require surgery if ever. Is that reasonable? Based on information I have read and viewed on your website, I could potentially be near the surgical threshold based on the current diameter, my height and the existence of a bicuspid valve correct?

Eric_Roselli,_MD: In an otherwise healthy patient with bicuspid aortic valve, we typically recommend elective repair when the maximum aortic area to height ratio is greater than ten. You probably are reaching that threshold but the timing of when to intervene is not purely made based on the diameter – it is a guide. If your bicuspid valve is functioning well then we would do what we could to try and salvage it.

JW44: I am a 62 year old male with an ascending aortic aneurysm due to a bicuspid valve. Currently no change past five years. Diameters; ascending aorta (5.0 x 5.3), aorta at the arch (2.8 x 3.0), descending (2.6), at hemidiaphram (2.3 cm). At what size of the aneurysm would you recommend surgery?

Eric_Roselli,_MD: See answer to NY3740 above.

DFurm: I have a bicuspid aortic valve and, as of January, moderate aortic stenosis. I also have an aortic aneurysm that is 4.7 cm. Almost daily, I experience feelings of light-headedness and, occasionally, feel my heart beating rapidly. I also sometimes feel like my blood is pooling when I lay on my right side at night. Would these symptoms be caused by my valve/aorta condition? Also, my mom (age 87) tells me that all of the men on her side of the family died suddenly and unexpectedly -- within several minutes of feeling chest pain -- of heart-related causes: her twin brother (age 58), her father (age 55), her grandfather (age 46), and her uncle (age 46). I am 54! They are not first degree relatives, but there is a clear pattern! What does the research say about my chances? Thanks.

Eric_Roselli,_MD: Those symptoms are not typical for a 47mm aorta but may warrant further investigation. With your family history, you should be evaluated.


Aortic Valve

tedP: I am 90 years old and have serious aortic stenosis (non- symptomatic.) At my age does it make sense to do anything, and if so, what is it I should do. I also suffer from CAD with four stents. I understand that CAD significantly increases the risk of a stroke. I rather be dead than becoming a dependent invalid in a nursing home. I am independent right now and hope to stay that way until I die. I described my condition as serious but asymptomatic. This statement needs correcting in that I do suffer from shortage of breath. Ted.

Eric_Roselli,_MD: If you have become symptomatic from severe stenosis it may be time to treat it – the decision making process for a 90 year old and potentially high risk patient is best done by a multi-disciplinary team made up of cardiologists and cardiac surgeons, imaging specialists, etc. The risk of stroke is relatively low but different for each individual and present with both open surgery and TAVR.

Old Man: My last echo showed my valve opening to be 0.9 which I believe is about 40% open. I have no symptoms. My Dr. said it's OK to do cardio exercise and lighter weight lifting with more reps. My friend's Dr. said not to do any cardio exercises. I'm confused.  I also heard that a reading of one or less is an indication for surgery. Is that so?

Eric_Roselli,_MD: Listen to your cardiologist – if the valve stenosis is not symptomatic it may not require an operation, on the other hand sometimes the stenosis can be significant enough to warrant an operation but you may not be aware of it with symptoms – a closer assessment of valve and cardiac function with an echocardiogram and a stress test may help with the decision making process.

gap: Are statins necessary if aortic valve has been replaced? Does CoQ10 help prevent side effects of statins?

Eric_Roselli,_MD: Statins should be taken for hyperlipidemia issues only at this point.

kahuna8: I am 77 years male, excellent overall health; ECHO five months ago - valve 0.9, mean gradient 54, EJ 62% No symptoms. Just checking for the latest info. I have not had a cardiac cath. I understand that is necessary to get a "STS" score as to qualifying for TAVR. I also have had 1 episode of PMVT on last stress test. Thanks.

Eric_Roselli,_MD: I do not see a question. However, we are happy to evaluate you for TAVR. Please contact our heart nurses at www.clevelandclinic.org/heartnurse if you would like a surgical review.

MattK: Many years ago I had a four way bypass. About three years ago I was told I needed a new aortic valve replacement. The valve has been at stage seven for those three years. Because I am 88 years old and not in good health, it was determined I could not have the normal operation. Tests were done to see if I would qualify for the TAVR procedure. They found the valve was enlarged and that my arteries were too narrow to accommodate the groin TAVR procedure. The doctor said he was taking part in experimental TAVR procedures that enter the heart from around the heart area. My question is: Since I am in no pain, and feel relatively well, should this procedure be considered at this time, or is it advisable to wait till the new procedure is more effective? Thank you.

Eric_Roselli,_MD: Alternative access strategies for TAVR have been used in the US since 2005 at Cleveland Clinic, but a more detailed answer to your question would require a thorough evaluation by our team.

gap: I am told Cleveland clinic is experimenting with an aortic valve replacement without having to cut open the chest - what is the progress?

Moderator: I believe you are talking about the TAVR procedure. This procedure is in interventional procedure approved for high risk symptomatic patients with aortic stenosis.

nanc107: Please explain who can do a TAVI procedure? Is there an age limit and can it be done with severe regurgitation and stenosis?

betsyRN: We just did a webchat on valve interventions- please see http://my.clevelandclinic.org/heart/webchat/1632_heart-valve-disease-and-non-surgical-interventions.aspx for questions and answers about TAVR. In addition, this page on our website describes the procedure and who is a candidate: http://my.clevelandclinic.org/heart/percutaneous/percutaneousvalve.aspx.

tedp: I am 90 years old with serious aortic stenosis. Except for shortness of breath I am asymptomatic. What are my options? Ted P.

betsyRN: Ted - you may be a candidate for traditional heart surgery, minimally invasive heart surgery or TAVR, a percutaneous catheter based procedure - we would be happy to evaluate you to determine the best procedure for you.


Descending Aortic Aneurysm

JayJay: Are there any new or experimental therapies for treating (or healing) a descending aortic dissection other than surgery, a graph stent, or blood pressure medication? How is this condition normally treated at the CC and what is the probability it will regress or not experience any progression in future just by using this medication?

Tara_Mastracci,_MD: You've identified most of the major ways we repair dissection -- surgery and endovascular stent grafts. Blood pressure control is a major focus of your treatment until the time of surgery, and afterward, because we want to reduce the damage the high blood pressure might cause on the already diseased vessel wall. There are some experimental drug treatments that are being tested in Europe and the USA which show some promise for the future, but we won't know the results of those trials for a few years still.

KareninB: I am 68 years old and have two small fusiform aneurysms on my ascending (and descending near the arch) thoracic aorta. They measured 3.8 and 4.2 in April, 2012. For the past 15 months I have begun eating a whole food, plant based diet and can tell my immune system is much stronger as a result. I have also been able to get off all medications and get my BMI down to 22 as a result of this new diet lifestyle. Can I assume that my arteries will heal themselves too?

Tara_Mastracci,_MD: Congratulations on undertaking such great lifestyle changes! There is no question that adopting a heart-healthy lifestyle will serve your health well into the future. Unfortunately, there are no treatments or habits that we know that can reverse the aneurysmal degeneration of the aorta -- thus if you have an aneurysm, it is important that you get regular imaging (every six months or one year, depending on your doctor's recommendation) to follow these aneurysms. Some experts believe that controlling your blood pressure might reduce the rate of growth of aneurysms, but much research still needs to be done.


Abdominal Aortic Aneurysm

mgtrans01: I have read about the treatment options for an abdominal aortic aneurysm - the open surgery and endovascular surgery. How do these surgeries compare to open heart surgery that one hears more about as far as the complexity, recovery period and risk?

Tara_Mastracci,_MD: Open and endovascular surgery for treatment of AAA is a very different procedure compared with open heart surgery. Incisions will be made in the abdomen (open) or groins (endo). For open surgery, the average time in the ICU after surgery is two – three days, whereas for endo surgery, most people don’t require an ICU stay. In either case, this is major vascular surgery and your doctor will want to be sure your heart is fit for this operation.

trundanely: I have a 3.0 AAA.  It grows at that point on less than two years, what can I do to fix it without waiting for it to grow bigger. Is there any reason for me to wait? It was diagnosed two weeks ago. But I did have a screen test less than two years ago.

Tara_Mastracci,_MD: Fixing small aneurysms has been shown to have no benefit. Thus, your best choice is to continue surveillance until it grows larger.

stamploverbarb: I have a 3 cm dissected aortic aneurysm that has not enlarged for at least two years. Not sure how long I have had it - it was only uncovered two years ago. My question is, are most aortic aneurysm procedures done through the femoral artery now and not cutting through the abdomen?

Tara_Mastracci,_MD: Aortic dissection is a variable disease, and it usually requires an aortic specialist reviewing your anatomy before these decisions can be made. It is true, however, that many treatments for dissection are being done with stent grafts.

lutherbear: I have an abdominal aortic aneurysm, measuring, 4.2 cm ap by 4.4 cm tmvs. It has not grown in a year as I quit smoking and drinking when diagnosed. How dangerous does it become the longer they put off surgery, I am almost 72.

Tara_Mastracci,_MD: The evidence shows that it is not necessary to consider repair of infrarenal aortic aneurysms until they reach 5 or 5.5cm. Thus, if your aneurysm is stable, there is no need to consider surgery yet. You should get checked at six month intervals by a vascular specialist.

Eric_Roselli,_MD: 72 is young and it is especially great to hear that you quit smoking. 4.4cm is not typically a very big aneurysm but without reviewing the actual images it is hard to comment further.

JAS: I have (as of April 24th, 2014) a 5.8cm abdominal aortic aneurism, as measured by a PET Scan. I am wondering if the hospitalization for surgery along with the post-surgery hospitalization for five - 10 days would be considered as ONE hospitalization ADMIT under Medicare as "part A", with a $1,184.00 deductible/ or /If the hospitalization for surgery would be considered under Medicare as "part A" as a hospitalization ADMIT with an $1,184.00 deductible, and if the post-surgery hospitalization for five - 10 days would be considered under Medicare as "part A" (a hospitalization ADMIT with another $1,184.00 deductible), / or / If the hospitalization for surgery would be considered under Medicare as "part A" as a hospitalization ADMIT with an $1,184.00 deductible, and the post-surgery hospitalization for five - 10 days would be considered a hospitalization for OBSERVATION (with 80% covered under Medicare "part B", and the other 20% paid by me). I am on VERY limited income! Thank you, JAS.

Tara_Mastracci,_MD: We have a fantastic team of financial counselors to help you through these issues. As an Aortic Specialist, my greatest concern is that we get you good care. Call 1-866-289-6911 and talk to our heart and vascular nurses!

JAS: My AAA grew from 5cm in late March to 5.8cm by April 24, how large do they usually get before bursting?

Tara_Mastracci,_MD: Every aneurysm is different, which is why careful follow up by an aortic specialist is so important. However we have two really good studies from USA and the UK which tell us that aneurysms below the kidney arteries (known as 'infrarenal aneurysms') should be repaired when they reach 5.5cm.

trundanely: I am 64 years male, recently was diagnose with aortic aneurism it reads: The exam is limited due to body habitus. The proximal abdominal aorta measures 2.1 cm in diameter. The mid abdominal aorta measures 1.9 cm in diameter. An aneurism of the distal abdominal aorta is again noted which measures3.2 cm in diameter. Calcification and an intimal flap are noted in association with this aneurism. The aorta bifurcation is patent. The common iliac arteries are normal in size. What is all this mean ,and is recommendable that I try the tent now, instead of wait to grow until it reach 5 or 6 cm? How long it will grow yearly, what can I do to slow the growing of this animal? In general, what is going on and what is better for my situation?

Tara_Mastracci,_MD: We usually recommend repairing infrarenal aneurysms when they reach 5.5cm. Thus, you sound like you fit into the group of patients who needs regular imaging follow up. This is usually done with an ULTRASOUND for abdominal aortic aneurysms. A family doctor or vascular specialist should help set this up!

meadrealty: How many people have stents grafts in US yearly?

Tara_Mastracci,_MD: I don't know that I can answer this with a number directly, but i can tell you that, since 2006, vascular surgeons across the united states have been choosing endovascular repair (stent grafts) over open repair for most infrarenal aneurysms.

gm3 : 1) A recent Ultrasound color Doppler interrogation of the iliac limbs of my Aorta Graft show some element of color signals posterior to the iliac lumia.....could this be an imaging error or possible Endoleak? Aortic Graft is patent. No well-formed fluid collection was seen around the Aorta and iliac arteries. 2) An incision bulge was checked with the Ultrasound and no apparent hernia was noted.....what is causing bulge above incision area that has been in place for over seven months and will this bulge go down over a longer period of time?

Tara_Mastracci,_MD: That is a very difficult question to answer over the web! Please call your vascular surgeon and he/she will have more insight into the causes of this anatomic problem.

Pmac103: What is the determining factor for when surgery is necessary for an abdominal aortic aneurysm?

Tara_Mastracci,_MD: Usually, the biggest factor to consider is size.

Pmac103: Is it possible to reduce the size of the abdominal aortic aneurysm to avoid surgery? My father's is currently measuring at 5.2, and he is facing potential surgery in September.

Tara_Mastracci,_MD: Unfortunately, there are no drugs to decrease the size of AAA.

Pmac103: If the abdominal aortic aneurysm is in close proximity to the iliac arteries is the less invasive surgery out of the question?

Tara_Mastracci,_MD: We very frequently fix aortic aneurysms with coincidental iliac aneurysms.

Pmac 103: What is the success rate for AAA repair, and how long is recovery?

Tara_Mastracci,_MD: It depends on the patient and the type of surgery. Your surgeon can discuss your specific risks after choosing an operative plan that is the perfect fit for you.

Mhdimino: I would be interested in comments on aortal morphology issues, which might preclude endovascular treatment as an option for an infrarenal AAA.

Tara_Mastracci,_MD: Sometimes, when people’s iliac arteries are too small to allow us to deliver a device to the right location, this can make infrarenal stent grafting difficult. Also, if people have had clots or occlusions to their iliac arteries, the use of open surgery is preferred.

Pmac 103: What increases the risk associated with AAA repair?

Tara_Mastracci,_MD: Depending on the modality used to repair the AAA, the risks are different. For endo surgery, the risks of bleeding, infection of wounds and kidney dysfunction predominate. For open surgery, lung problems, bleeding, and heart problems would probably top the list.

Jindalrk: Does every Type A Aortic dissection need a surgery or are there Type A dissections which can get healed over time with patient being on medicine?

Tara_Mastracci,_MD: Very rarely would the preferred treatment for TAD be medical – this is usually considered a surgical emergency.

Mgtrans01: What percentage of AAA's would you estimate, in your experience or overall if you know, are repaired with endo surgery?

Tara_Mastracci,_MD: At CCF, most of the aneurysms we fixed are done so using stent grafts, but it really does depend on anatomy.


Supra-renal Aneurysm

coljake1: I have a suprarenal aneurysm. An angiogram indicated a size of 3.5cm 07/09/12. Three CTscans--02/04/13, 09/12/13, 04/21/14--size 4.5cm diameter and 2.4cm height and has not changed. Do you agree--oblong shape calculates to a circle shape of 3.45cm? Which shape (oblong or circle) has the strongest resistance to blood pressure? Generally what size would the aneurysm be when the endoscopy procedure is recommended, assuming age 85+? Heart, vessels, kidneys, lungs, liver are ok, no diabetes. I had open AAA surgery--2000. I have seen Cleveland Clinic pictures of stent grafting for this complicated surgery. Endoscopy would apply at my age. Do you see advances forthcoming in the next five years that may reduce the risk of kidney dialysis? Presently, what percentage of people (85+) that undergo the aorta procedure involving renal arteries avoid kidney dialysis? Does my existing AAA stent graft reduce the efficiency and results of a suprarenal endoscopy procedure? Thank you.

Tara_Mastracci,_MD: It is not uncommon for people who have had previous aneurysm repair to develop aneurysm in other parts of their aorta. In fact, we find this to be more true as people are living longer over the years. We have helped develop great methods for doing second operations after an initial AAA repair. The threshold to intervene really depends on where the aneurysm is. This is best assessed using a CT scan and special software that the Aortic Specialists can use to measure the aneurysm diameter. This takes the 'circle versus oblong' question right out of the equation.

larryws: 67 year old male on Medicare. Quad bypass in 2003 and open aortic aneurysm repair in 2008, so I'm pretty high risk. Now have a 6-7 cm aortic aneurysm where renal arteries attach and have been told that if I survived, it's likely I'll lose kidney function with an open repair - not interested. Any possibility of a endovascular repair?

Tara_Mastracci,_MD: It is challenging to answer this question well without looking directly at your anatomy -- so I would recommend that you see an aortic specialist right away to get an opinion tailored to you. However, in general, I routinely placed stent grafts into suprarenal or thoraco-abdominal aneurysms using a technique called "Branched and Fenestrated Stent Grafting". This involves creating a custom stent graft that is specially made to fit the branches off of your aorta. I can then implant it under fluoroscopy (x-ray vision) to give your aorta a new lining. This is often an option for people who are too high risk for conventional surgery.

Reviewed: 06/14

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