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    Suggest treatment for abdominal aortic aneurysm

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Posted on Sun, 30 Jul 2017 in Hypertension and Heart Disease
Question: I have an 89 year old father with an abdominal aortic aneurysm (AAA) greater than 5.5 cm. what is his risk ratio having or not having the surgery? My e mail is YYYY@YYYY
doctor
Answered by Dr. Ilir Sharka 33 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would explain that the risk of rupture for an aneurysm with a diameter of 5-6cm is 10% per year. It raises up to 20% per year for diameters greater than 6cm.

It is recommendable that all the patients with an aneurysm with a diameter greater than 5cm should be considered for surgery.

But, it is also important to evaluate the risk of surgical complications in every patient. This risk depends on different factors like : age, body mass, comorbidities, etc..

So, considering his age, I would explain that the risk of complications is considerable too.

But there is not a specific ratio risks of bleeding/risks of surgery. It depends on many individual factors.

Waiting until the aneurysm reaches the diameter of 6cm, can impose him at a higher risk of complications, considering the fact that he will be older.

But, you should discuss with his doctor on these issues.

In the meantime, I would recommend controlling his cardio-vascular risk factors:

- maintain a normal blood pressure
- avoiding straining physical activity
- being active (walking)
- a healthy diet (omega 3 reach food, reduce salt intake)
- lose some pounds if he is overweight (obesity can impose a higher risk for rupture or surgery complications)

Hope you will find this answer helpful!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 1 hour later
It sounds like the risk would be about 10% - 20% a year, if he has the surgery given the fact that my dad is not overweight,is still very active and generally in great health. So can you tell me what the risk is if he goes ahead with this surgery in mathematical terms please. Thank you!
doctor
Answered by Dr. Ilir Sharka 26 minutes later
Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

According to the treatment guidelines it is recommendable to treat surgically or with endovascular treatment aortic aneurysms 5.5 cm in diameter or greater in asymptomatic patients.

Patients with symptomatic aneurysms and whose aneurysms increase in diameter by 0.5 cm or greater in six months should also undergo repair, regardless of aneurysm diameter.

As for the risks associated with open surgery, the complications go up to 10%, including cardiac complications (2-6%), infection (1-4%), renal failure (2%), ischemic colitis

A good treatment choice besides open surgery could be endovascular repair.

Endovascular repair is a less invasive and less expensive alternative to open surgical repair.

The short-term technical success rate for endovascular aneurysm repair ranges from 83% to more than 95%.

Thirty-day mortality after elective surgical repair in major randomized trials ranges from 2.7% to 5.8% .

The short-term morbidity and mortality rates of endovascular therapy has been found to be better than those of open surgical repair in many trials.

Many studies have concluded that the 30-day all-cause mortality is significantly lower with endovascular repair compared with surgical repair (1.6% versus 4.8%).

Another treatment option would be wait and see. A close monitoring of the aneurysm diameter is necessary to see the progression in time and judge about repair.

Hope to have clarified some of your uncertainties!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 6 hours later
Does the patient have a choice in the matter of "open heart"or endovascular repair, or is it up to the surgeon?
doctor
Answered by Dr. Ilir Sharka 3 hours later
Brief Answer:
My answer as follows:

Detailed Answer:
Hello!

The decision is up to the patient most of the time.

But there are also exceptions, when the clinic does not have endovascular experience or related to the aneurysm morphology.

Hope to have been helpful!

Kind regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Kampana
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7394 Questions

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