5.3 mm abdominal aortic aneurism, prognosis?

The risk factors for a AAA are pretty much the same ones for coronary heart
disease. Any of the ones that she could modify (improving diet, exercise,
etc.) should help.

The problem with a AAA is that Aorta has a tendency to rupture. Not good. In
most people, it is a fatal event. Unfortunately, the surgery is very
extensive and risky. One has the weigh the risk of the surgery vs. the risk
of the AAA.

You can read more about this condition here:
http://www.aafp.org/afp/970915ap/santilli.html
http://www.clevelandclinic.org/health/health-info/docs/0300/0391.asp?index=3930

An alternative to open repair (if I needed this surgery, I would definitely
ask my doctor about this - but I don't know your mother's history or
circumstances, so I don't know if this applies):

http://www.dcmsonline.org/jax-medicine/2000journals/dec2000/endovascular.htm
http://www.riversidecardiology.com/archive/01192000.htm

And the importance of choosing the right surgeon and hospital here:
healthandage.comgm=1!gid1=4956;! 768323858!174479238!7537!7038Open ↗
http://www.eurekalert.org/pub_releases/2003-10/uomh-aad101303.php
http://www.healthcentral.com/news/NewsFullText.cfm?id=515571

Jeff

"Patrick Coghlan" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

My mother (81) has been living with an aneurism for the past 18 months
which was < 4.7 mm when first detected. In the past 6 months it grew to
5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
until 5.6-5.7 mm.

What does 5.3 mm actually represent (increased diameter of aorta at
femoral branch)?

Because of her age, she may not be able to survive the surgery. If the
aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
etc. years? Are there stats available?

Thanks in advance.

In article <[email hidden]>,

Patrick Coghlan said:

My mother (81) has been living with an aneurism for the past 18 months
which was < 4.7 mm when first detected. In the past 6 months it grew to
5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
until 5.6-5.7 mm.

What does 5.3 mm actually represent (increased diameter of aorta at
femoral branch)?

Because of her age, she may not be able to survive the surgery. If the
aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
etc. years? Are there stats available?

Note: I think you mean cm, not mm.

In the U.S. the usual recommendation is to operate on most AAA's when
they reach around 5 cm. The usually quoted figure for yearly rate of
rupture for a 5-6 cm AAA is around 7%--very high. Think about it; this
translates to a 35% chance of rupture in 5 years and roughly a 50%
chance of rupture within 7 years. And this is the cumulative risk; it
doesn't mean the aneurysm couldn't rupture tomorrow. Mortality from a
ruptured AAA is between 70-90%.

The 5 cm rule is not a hard and fast rule, but with the decreased
morbidity and mortality of AAA repair and new endovascular techniques
for fixing them without major abdominal surgery, the threshold for
recommending repair is lower than it used to be, and even octogenarians
can do pretty well, especially if they are good candidates for
endovascular repairs. This is particularly true if the patient is
relatively healthy and therefore a good operative risk. (Of course, as
my vascular surgery faculty told me when I was a resident, if you have
atherosclerotic disease bad enough to cause a AAA big enough to consider
repair, you probably have atherosclerotic heart disease or
cerebrovascular disease; vascular patients almost by definition are not
truly healthy.)

What is more worrisome than the AAA's size is that the aneurysm has
grown from 4.7 to 5.3 cm in a pretty short period of time. Rapid
increase in size of an aneurysm (more than 0.5 cm in 6 months) is a
pretty strong indication for operation in a patient with more than 2-3
years of life expectancy, unless the operative risk is very high. From
the surgeon's reluctance to operate, I can only infer that your mother
has comorbid conditions that render her to be a very high operative risk.

--
Orac |"A statement of fact cannot be insolent."
|
|"If you cannot listen to the answers, why do you
| inconvenience me with questions?"

I wonder if relying upon one single opinion might be a bad idea.
Where is "abdominal"? If the aneurism is where I think it's
"abdominal," then it wouldn't be hard to reach. Is there a
comorbidity factor between the surgeon and the aneurism, like a
morbidly obese person? (Which seems unlikely at age 80.)

If this were my mother, or any friend, I'd be keeping an eye out for
a surgeon with a good track record dealing with such aneurisms; in
a hospital of good reputation. You can find out a *lot* if you can
find opinions from *nurses* about who and where is good.

Cheers -- Martha Adams

On Tue, 28 Oct 2003 19:39:44 -0500, Patrick Coghlan <[email hidden]>

Quoted message said:

My mother (81) has been living with an aneurism for the past 18 months
which was < 4.7 mm when first detected. In the past 6 months it grew to
5.3 mm, and the vascular surgeon said that surgery wasn't mandatory until
5.6-5.7 mm.

What does 5.3 mm actually represent (increased diameter of aorta at
femoral branch)?

Because of her age, she may not be able to survive the surgery. If the
aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
etc. years? Are there stats available?

Thanks in advance.

Frankly, I would take you mother to another vascular surgeon for a second
opinion, and then seek out an interventional radiologist trained to place
abdominal aneurysm stents.

http://www.wfubmc.edu/neuro/departments/neuroradiology.shtml

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

"Martha H Adams" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

I wonder if relying upon one single opinion might be a bad idea.

Usually is.

Quoted message said:

Where is "abdominal"? If the aneurism is where I think it's
"abdominal," then it wouldn't be hard to reach.

Actually, it is really hard to reach. The aorta lies near the back You have
intestines and stuff in the way. In addition, there are major branches of
the aorta that branch off to supply vital organs, like the instestines and
spinal cord with blood. You have to take care that these are not blocked off
after the surgery.

Quoted message said:

Is there a
comorbidity factor between the surgeon and the aneurism, like a
morbidly obese person? (Which seems unlikely at age 80.)

No, but people who have AAAs often have coronary heart disease or similar
vascular disease elsewhere.

Quoted message said:

If this were my mother, or any friend, I'd be keeping an eye out for
a surgeon with a good track record dealing with such aneurisms; in
a hospital of good reputation. You can find out a *lot* if you can
find opinions from *nurses* about who and where is good.

You can find a lot of opinions about which cars are good and who the best
dealers are from nurses too. It does not mean that they are best opinions
out there. What really counts is the experience and record of the hospital
and surgeon, not what the nurses think. Don't get me wrong, nurses have a
lot of information. Unfortuantely, they usually don't have the actual
statistics, which is what you need.

I would definitely try and find the best hospital for the surgery and the
best surgeon, even if it means going out of state. The doctors should be a
good source of information.

Jeff

Quoted message said:

Cheers -- Martha Adams

In article <[email hidden]>,

(Martha H Adams) said:

I wonder if relying upon one single opinion might be a bad idea.
Where is "abdominal"? If the aneurism is where I think it's
"abdominal," then it wouldn't be hard to reach.

It sounds to me like a standard abdominal aortic aneurysm. What wasn't
said was whether or not it involved the iliac vessels and whether it was
completely below the renal arteries. If it involves the area where the
renal arteries branch from the aorta, then the surgery will require
clamping the aorta above the renal arteries, cutting off the blood flow
to the kidneys for the time it takes to sew the vascular graft in. This
increases the risk of postoperative renal failure and is technically
more challenging, particularly if the renal arteries have to be
reimplanted.

Quoted message said:

Is there a
comorbidity factor between the surgeon and the aneurism, like a
morbidly obese person? (Which seems unlikely at age 80.)

Well, most patients with AAA's have vascular disease elsewhere (such as
the coronary arteries or the carotids). As one of the vascular surgeons
at my residency program used to say when we rotated on his service: If
the patient has bad enough atherosclerotic disease to get a AAA, chances
are good that he has it in his heart or carotid arteries as well.

[Snip]
--
Orac |"A statement of fact cannot be insolent."
|
|"If you cannot listen to the answers, why do you
| inconvenience me with questions?"

Patrick Coghlan said:

My mother (81) has been living with an aneurism for the past 18 months
which was < 4.7 mm when first detected. In the past 6 months it grew to
5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
until 5.6-5.7 mm.

May not be mandatory but should be considered.

Quoted message said:

What does 5.3 mm actually represent (increased diameter of aorta at
femoral branch)?

The diameter of the aneurysm.

Quoted message said:

Because of her age, she may not be able to survive the surgery.

Risk would be higher.

Quoted message said:

If the
aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
etc. years?

Depends on when the rupture occurs. Rupture has very high mortality rates
(in 81 year olds, probably greater than 95%).

Quoted message said:

Are there stats available?

Yes. Try the Pubmed link on my web site.

Quoted message said:

Thanks in advance.

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

In sci.med Patrick Coghlan <[email hidden]> wrote:
: My mother (81) has been living with an aneurism for the past 18 months
: which was < 4.7 mm when first detected. In the past 6 months it grew to
: 5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
: until 5.6-5.7 mm.

My uncle had an AAA (abdominal aortic aneurysm). Apparently the surgeon
told some family members that they can run in families.

He suggested all the siblings get imaging done.

-Emma

Orac said:

In article <[email hidden]>,

Patrick Coghlan said:

My mother (81) has been living with an aneurism for the past 18 months
which was < 4.7 mm when first detected. In the past 6 months it grew to
5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
until 5.6-5.7 mm.

What does 5.3 mm actually represent (increased diameter of aorta at
femoral branch)?

Because of her age, she may not be able to survive the surgery. If the
aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
etc. years? Are there stats available?

Note: I think you mean cm, not mm.

I thought it was cm, too. However, there are different types, one of
which being saccular (sp?), which perhaps is measured in mm, no?

Orac said:

In article <[email hidden]>,
[email hidden] (Martha H Adams) wrote:

It sounds to me like a standard abdominal aortic aneurysm. What wasn't
said was whether or not it involved the iliac vessels and whether it was
completely below the renal arteries. If it involves the area where the

The surgeon showed her a sketch which showed the "ballooning" just above
the femoral branch. What's confusing is that she is adamant that the
techs told her that the units were mm, yet most aneurisms of this type
seem to be measured in cm (except for, perhaps, saccular?).

Quoted message said:

renal arteries branch from the aorta, then the surgery will require
clamping the aorta above the renal arteries, cutting off the blood flow
to the kidneys for the time it takes to sew the vascular graft in. This
increases the risk of postoperative renal failure and is technically
more challenging, particularly if the renal arteries have to be
reimplanted.

Quoted message said:

Is there a
comorbidity factor between the surgeon and the aneurism, like a
morbidly obese person? (Which seems unlikely at age 80.)

Well, most patients with AAA's have vascular disease elsewhere (such as
the coronary arteries or the carotids). As one of the vascular surgeons
at my residency program used to say when we rotated on his service: If
the patient has bad enough atherosclerotic disease to get a AAA, chances
are good that he has it in his heart or carotid arteries as well.

[Snip]

Emma Chase VanCott said:

In sci.med Patrick Coghlan <[email hidden]> wrote:
: My mother (81) has been living with an aneurism for the past 18 months
: which was < 4.7 mm when first detected. In the past 6 months it grew to
: 5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
: until 5.6-5.7 mm.

My uncle had an AAA (abdominal aortic aneurysm). Apparently the surgeon
told some family members that they can run in families.

He suggested all the siblings get imaging done.

All *10* of her siblings have passed away. The 2nd last to go was her
brother, who died in his 70s of a ruptured AAA. None of the other 9
died of this, but might have had they not died accidentally (drowning,
run over by a felled tree, run over by a grader, suicide...).

Orac said:

It sounds to me like a standard abdominal aortic aneurysm. What wasn't
said was whether or not it involved the iliac vessels and whether it was
completely below the renal arteries. If it involves the area where the
renal arteries branch from the aorta, then the surgery will require
clamping the aorta above the renal arteries, cutting off the blood flow
to the kidneys for the time it takes to sew the vascular graft in. This
increases the risk of postoperative renal failure and is technically
more challenging, particularly if the renal arteries have to be
reimplanted.

Ah, I wondered what they did while repairing the artery (clamping).
This must be why they don't want to operate if the patient's heart is
not in good condition.

"Patrick Coghlan" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Orac said:

It sounds to me like a standard abdominal aortic aneurysm. What wasn't
said was whether or not it involved the iliac vessels and whether it was
completely below the renal arteries. If it involves the area where the
renal arteries branch from the aorta, then the surgery will require
clamping the aorta above the renal arteries, cutting off the blood flow
to the kidneys for the time it takes to sew the vascular graft in. This
increases the risk of postoperative renal failure and is technically
more challenging, particularly if the renal arteries have to be
reimplanted.

Ah, I wondered what they did while repairing the artery (clamping).
This must be why they don't want to operate if the patient's heart is
not in good condition.

It is one reason. But the other reason is that this surgery is extremely
stressful. TO get at the AAA, the abdominal contents are moved out of the
way (mostly the intestines). This perturbs their function for a few days.
There are also major fluid and electrolyte changes, with lots of fluids and
blood and plasma administered by IV (the last time I saw this operation,
there was something like 10 units of blood and 20 liters total fluid
administered to a patient -- that is about 5 gallons of fluid, which is
about 1/3 of the entire fluid volume of the patient (you know that those 5
gallon buckets around -- it is that big.) I usually make around 3 liters of
urine a day. That is the volume of urine I make in an entire week. And 10
units of blood is a lot, too That is a lot of fluid. That is very stressful,
especially if the kidneys' function is compromised for a few hours, because
of temporary loss of blood flow. Remember, the kidneys play a major role in
the regulation of the body's electrolytes and fluids.

This is very stressful surgery.

And the heart and kidneys are not the only organs that are at risk If the
blood pressure drops too much because of the blood loss, the brain might not
get enough blood. Let us just say this is not desirable.

Jeff

In article <[email hidden]>,

Patrick Coghlan said:

Orac said:

In article <[email hidden]>,

Patrick Coghlan said:

My mother (81) has been living with an aneurism for the past 18 months
which was < 4.7 mm when first detected. In the past 6 months it grew to
5.3 mm, and the vascular surgeon said that surgery wasn't mandatory
until 5.6-5.7 mm.

What does 5.3 mm actually represent (increased diameter of aorta at
femoral branch)?

Because of her age, she may not be able to survive the surgery. If the
aneurism reaches 5.6-5.7 mm, what % of such individuals survive 1, 2,...
etc. years? Are there stats available?

Note: I think you mean cm, not mm.

I thought it was cm, too. However, there are different types, one of
which being saccular (sp?), which perhaps is measured in mm, no?

No. They're all in cm. The normal diameter of the aorta in an adult is
around 2-3 cm, as I recall.

--
Orac |"A statement of fact cannot be insolent."
|
|"If you cannot listen to the answers, why do you
| inconvenience me with questions?"

Orac said:

In article <[email hidden]>,
Patrick Coghlan <[email hidden]> wrote:

Quoted message said:

Quoted message said:

Quoted message said:

Note: I think you mean cm, not mm.

I thought it was cm, too. However, there are different types, one of
which being saccular (sp?), which perhaps is measured in mm, no?

No. They're all in cm. The normal diameter of the aorta in an adult is
around 2-3 cm, as I recall.

I assume that's OD (outside diameter, as in plumbing). Either way,
that's a whopping big blood vessel.

In article <[email hidden]>,

Patrick Coghlan said:

Orac said:

In article <[email hidden]>,
Patrick Coghlan <[email hidden]> wrote:

Quoted message said:

Quoted message said:

>Note: I think you mean cm, not mm.

I thought it was cm, too. However, there are different types, one of
which being saccular (sp?), which perhaps is measured in mm, no?

No. They're all in cm. The normal diameter of the aorta in an adult is
around 2-3 cm, as I recall.

I assume that's OD (outside diameter, as in plumbing). Either way,
that's a whopping big blood vessel.

Yes, which is why a ruptured abdominal aortic aneurysm is so fatal. Only
around 70-90% of patients with a ruptured AAA who actually make it to
the hospital alive survive. To me, having seen the aorta and how much
blood passes through this hose of a vessel, it's amazing that anyone
survives a ruptured AAA. And almost no one does survive a large rupture;
it is the smaller ones that are temporarily contained by the surrounding
tissues that are survivable.

--
Orac |"A statement of fact cannot be insolent."
|
|"If you cannot listen to the answers, why do you
| inconvenience me with questions?"

"Jeff" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

"Patrick Coghlan" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Orac said:

It sounds to me like a standard abdominal aortic aneurysm. What wasn't
said was whether or not it involved the iliac vessels and whether it

was

Quoted message said:

Quoted message said:

Quoted message said:

completely below the renal arteries. If it involves the area where the
renal arteries branch from the aorta, then the surgery will require
clamping the aorta above the renal arteries, cutting off the blood

flow

Quoted message said:

Quoted message said:

Quoted message said:

to the kidneys for the time it takes to sew the vascular graft in.

This

Quoted message said:

Quoted message said:

Quoted message said:

increases the risk of postoperative renal failure and is technically
more challenging, particularly if the renal arteries have to be
reimplanted.

Ah, I wondered what they did while repairing the artery (clamping).
This must be why they don't want to operate if the patient's heart is
not in good condition.

It is one reason. But the other reason is that this surgery is extremely
stressful. TO get at the AAA, the abdominal contents are moved out of the
way (mostly the intestines). This perturbs their function for a few days.
There are also major fluid and electrolyte changes, with lots of fluids

and

Quoted message said:

blood and plasma administered by IV (the last time I saw this operation,
there was something like 10 units of blood and 20 liters total fluid
administered to a patient -- that is about 5 gallons of fluid, which is
about 1/3 of the entire fluid volume of the patient (you know that those 5
gallon buckets around -- it is that big.) I usually make around 3 liters

of

Quoted message said:

urine a day. That is the volume of urine I make in an entire week. And 10
units of blood is a lot, too That is a lot of fluid. That is very

stressful,

Quoted message said:

especially if the kidneys' function is compromised for a few hours,

because

Quoted message said:

of temporary loss of blood flow. Remember, the kidneys play a major role

in

Quoted message said:

the regulation of the body's electrolytes and fluids.

This is very stressful surgery.

And the heart and kidneys are not the only organs that are at risk If the
blood pressure drops too much because of the blood loss, the brain might

not

Quoted message said:

get enough blood. Let us just say this is not desirable.

Jeff

There are many risks to AAA repair, but the one that causes death most often
is related to the cross-clamping of the aorta with resultant lack of blood
flow to the lower extremities for the amount of time it takes the surgeon to
sew in the graft. This lack of blood flow forces anaerobic metabolism to the
unperfused parts of the body with resultant buildup of lactic acid. When the
aorta is finally unclamped, a large load of lactic acid is dumped into the
circulation with resultant deleterious effects on the cardiovascular system
nor for the kidneys. The longer the clamp time, the more the ischemia, the
more lactic acid. Throw in a huge dose of the body's post-op reparative
hormones such as ADH, MDF, bradykinins and other such stuff and the body has
a lot of work to do in the post-op period.

It's a dangerous operation by comparison to most others, but AAA is a
dangerous condition with a *cumulative* mortality of 5-8 percent each year
once the aneurysm reaches 5 centimeters. Such an operation is done when is
represents a lesser risk than the disease it's going to fix.

HMc

Howard McCollister said:

It's a dangerous operation by comparison to most others, but AAA is a
dangerous condition with a *cumulative* mortality of 5-8 percent each year
once the aneurysm reaches 5 centimeters. Such an operation is done when is
represents a lesser risk than the disease it's going to fix.

By "cumulative", I assume this means that up to 48% of any sample group
of patients would not be alive after 6 years.

In my mother's case (age 81), she has often said that she doesn't want
to live much beyond age 85, so she runs up to a 24% (ballpark) risk of
not surviving the AAA for another 4 years.

I'm not a doctor, but my guess is that these are better odds than having
the surgery (history of high cholesterol, one of her heart valves has
"narrowed" - I assume due to a buildup of plaque).

In article <[email hidden]>,

Patrick Coghlan said:

Howard McCollister said:

It's a dangerous operation by comparison to most others, but AAA is a
dangerous condition with a *cumulative* mortality of 5-8 percent each year
once the aneurysm reaches 5 centimeters. Such an operation is done when is
represents a lesser risk than the disease it's going to fix.

By "cumulative", I assume this means that up to 48% of any sample group
of patients would not be alive after 6 years.

In my mother's case (age 81), she has often said that she doesn't want
to live much beyond age 85, so she runs up to a 24% (ballpark) risk of
not surviving the AAA for another 4 years.

I'm not a doctor, but my guess is that these are better odds than having
the surgery (history of high cholesterol, one of her heart valves has
"narrowed" - I assume due to a buildup of plaque).

Not necessarily. An 81 year old woman these days has an expected
additional life expectancy of approximately 8.5 years (source: Office of
the Actuary of the Social Security Administration), which means a 50%
chance of living 8.5 more years or longer. Although I don't know enough
about the case to make a determination, even if your mother is not that
healthy, as long as she has a good performance status, the risk-benefit
equation still probably favors operation. I also suspect that your
mother's risk of dying of AAA rupture is likely to be higher than the
usually quoted figure of 7% per year, simply because, according to your
earlier post, the AAA enlarged rapidly (0.6 cm) over the last six months.

These decisions are rarely easy, because patients with AAA's are rarely
perfectly healthy, and they are usually old. It takes an examination of
the patient's overall medical condition versus the cumulative annual
risk of dying from rupture of the AAA, coupled with the patient's
wishes, to come to a decision.

--
Orac |"A statement of fact cannot be insolent."
|
|"If you cannot listen to the answers, why do you
| inconvenience me with questions?"