Accurate assessment of aortic size is a key component in the detection of aneurysms and in guiding therapeutic decisions. And for patients with degenerative or traumatic aneurysms of the descending thoracic aorta exceeding 5.5 cm, saccular aneurysms, or postoperative pseudoaneurysms, endovascular stent grafting should be strongly considered when feasible ( 4). According to the American College of Cardiology Foundation/American Heart Association guidelines, for patients with isolated aortic arch aneurysms between 3.5-4.4 cm in diameter, it is reasonable to reimage using computed tomographic imaging or magnetic resonance imaging at 12-month intervals to detect enlargement of the aneurysm. Recently, the incidence of thoracic aortic aneurysms has been estimated to be increasing and there are around 10.4 cases per 100000 person-years ( 3). Aortic aneurysm is a common, potentially lethal, but treatable disease, particularly if detected before dissection or rupture. Diagnosis of an aneurysm is a frightening thing to many patients, but in the majority of cases, it is a dilated aorta that can be monitored with CT scans, and will not worsen to a point that requires surgery.After introduction of helical computed tomography (CT) in the late 1980s, imaging of the aorta has become an accepted and widely used procedure for the evaluation of patients with aortic dissection, stenosis, or aneurysm formation ( 1, 2). In fact, most patients who are evaluated for aneurysms do not need surgery. If an aneurysm is very small, it may not require surgery initially. Some patients benefit most from repair using a stent, others need traditional open surgery, and still others benefit from hybrid procedures that blend open repair with the use of stent grafts. Evaluation usually begins with a CT scan or MRI, during which the surgeon carefully checks to see which type of repair may be best. Surgery for a Descending Aortic AneurysmĪneurysms in the descending aorta generally result from atherosclerosis ("hardening of the arteries") in older patients. More precise determination is based on the ratio between the normal diameter compared to the abnormal vessel size. Surgery is usually performed if the diameter of the aorta reaches 5.5 cm (or more or less, depending on the person's height). 2) If the valve is functioning well, surgical intervention is not considered until the diameter of the aorta exceeds 5cm. When operating because of bicuspid valve disease, an aortic root procedure is usually considered necessary if the root diameter is enlarged to 4 cm or greater. 1) If there is an aneurysm in the aortic root and the aortic valve is calcified or stenotic, replacement of the aortic root may be necessary. Aortic Root Surgeryįor patients who have aneurysms of the aortic root (the place where the ascending aorta meets the heart muscle), there are two main indications for surgery. The decision to monitor a patient instead of performing an operation is made on an individual basis, but is guided by factors listed below. This page discusses the evaluation process by which the need for non-emergency surgery is determined. Emergencies occur when an aneurysm ruptures or the aorta dissects, requiring immediate surgery. The advantage of being seen in a Center of Excellence early in the process is that it begins a relationship with your medical/surgical team. Surgery for aortic aneurysms may be done on an emergency basis, or if detected in advance, it may be planned as an elective procedure.
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