What Is An Aortic Aneurysm – How And When Is It Treated?

My mother was diagnosed with aortic aneurysms. She has one that is 5cm, and one 2cm. The doctor stated she is too old to operate on, so she just has to live with them. This didn’t seem right to me. She is 70 years old. I’m just concerned that this is not the right answer. Other than her hypertension (that she takes medication for), she’s in decent health.

An aneurysm is a sac-like enlargement of an artery, and the aorta is of course the main large artery leading from the heart to the rest of the body. Since all of the heart’s output of blood runs through the aorta, it is an extremely important artery.

Aneurysms of the aorta most commonly occur in the abdomen, though in certain conditions like Marfan’s syndrome or syphilis affecting the aorta, they may occur in the chest near the heart (thoracic aneurysms). You don’t mention the location of the aneurysms that your mother has, but since most are in the abdomen, I will discuss those in greater detail.

Abdominal aneurysms are caused by atherosclerosis, the same type of degeneration of the arteries that leads to heart attacks and strokes. There are quite a few risk factors that lead to atheroclerosis, and new ones are being discussed, but the major ones that will be familiar to everyone are cigarette smoking, high blood pressure, high cholesterol and diabetes.

Heredity is also important in evaluating the risks for aneurysms, since about 20 percent occur in a relative of someone who has had one. Your mother has hypertension, and she has reached the age where we begin to see aneurysms in women. Men start getting them about 15 years earlier. This difference reflects the general protective effect that being female has on the development of atherosclerosis, and is also seen in heart attacks.

The great danger with an abdominal aortic aneuysm is rupture. The wall of the enlarging aneurysm is weaker than the normal aortic wall, and spontaneous rupture becomes fairly common when the aneurysm exceeds 5cm in diameter, the exact size mentioned by you. One text, Harrison’s Priciples of Internal Medicine states that the 5-year risk of rupture is 1 to 2 percent if the aneurysm is less than 5cm in diameter, and 20 to 40 percent if it is larger than 5cm. Rupture of such an aneurysm is catastrophic, with a death rate of greater than 50 percent even if emergency surgery is immediately done; so it is quite critical that the aneurysm be identified and repaired before it can rupture. Another source, Scientific American Medicine says that aneurysms of 5 to 6cm can be watched; but that, if they expand rapidly, they must be repaired.

Surgical repair of an aneurysm that has not ruptured should have a mortality of 2 to 6 percent, mostly depending on the other health problems that the person might have. Age should not disqualify someone from having such a repair, and I am puzzled by the thinking of the doctor here. It may be that she is aware of other health problems, such as angina, or a recent heart attack, which might make the surgery more risky in your mother’s case.

Recently, doctors have developed a procedure to place a stent in abdominal aneurysms, which is very effective in preventing them from rupturing. Placing a stent, a mechanical device which is run through an incision in a leg artery up into the aorta and positioned inside the aneurysm, is a much less traumatic procedure that doing a complete repair of an aneurysm. Age and even other severe medical conditions would not be contraindications for stent placement in a large aneurysm.

I would suggest that you try to pin down a bit more specifically why your mother’s doctor is against surgery. If she wants to wait and observe for awhile, monitoring the size of the aneurysm with sonograms, that might be a reasonable approach. But, if your mother’s aneurysm enlarges much beyond 5cm, it should be operated upon, and age alone should not be a contraindication.

 

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