Deciding on Treatment
Timing of Elective Surgery
Elective aortic surgery is offered when the risk of rupture or dissection is greater than the risk of surgery. Declining surgical risk and the accompanying improved outcomes allow surgery to be performed earlier in the disease today than in the past, intervening before life-threatening rupture or dissection occurs. In determining the timing of surgery, the overall condition of the individual and their aortic tissue is evaluated, considering several factors including:
- Size of aneurysm
- Rate of aortic expansion (a growth rate of more than 5 mm in 6 months or 10 mm in a year is of serious concern)
- Shape of aneurysm
- Family history of early aortic rupture or dissection
- Type of aortic disease present (Marfan syndrome, bicuspid, other connective tissue disorder, etc.)
- General health and age of patient
- Symptomatic aorta - pressure or pain in the chest or back
General guidelines regarding aneurysm size and elective surgery, when performed at thoracic aortic surgery centers of excellence, are as follows:
- 5 cm in non-Marfan patient
- 4.5 cm in Marfan or other connective tissue disorder (Ehlers-Danlos or bicuspid aortic disease with severe aortic insufficiency)
- Same as ascending aorta within + or - 0.5 cm, depending on expertise of surgeon and associated patient risk factors
- For example, in a non-Marfan patient, the size range could be from 4.5 - 5.5 cm, depending on the mortality and morbidity results of the institution
Descending and Thoracoabdominal Aorta
- 5.0 to 5.5 cm is the accepted range presently, in an average risk patient with no connective tissue disorder
- 4.5 to 5.0 cm when severe connective tissue disorder is present
- 5.0 cm when chronic Type B dissection is present
- 6.0 cm in a high risk, morbid patient
Elective aortic surgery performed by an aortic specialist in a center of excellence focuses on providing state-of-the-art solutions for those who are appropriate surgical candidates. Following surgery, through lifestyle modifications and ongoing medical care, patients under the care of aortic specialists may continue to enjoy normal, productive lives.
Postsurgical Medical Treatment
Often during the postsurgical recovery period, patients experience back pain and discomfort. They avoid physical activity when it would be very beneficial for them. They often tend to walk less and gain weight, and their blood pressure becomes difficult to manage. These factors contribute to mental depression. The hallmark of postsurgical rehabilitation for aortic aneurysm patients is good pain management coupled with appropriate physical activity. Weight reduction and improved nutritional status are very important. A diet low in fat and carbohydrates and high in fiber and protein is recommended.
A rigorous, scientific approach to blood pressure management is important for these patients. Home monitoring with a blood pressure machine equipped with an arm cuff is recommended. This device should be calibrated to ensure accuracy. Daily blood pressure readings are used to adjust the regimen of blood pressure medications, which may include beta blockers, ACE inhibitors and calcium channel blockers, maintaining the systolic pressure within a range of 105 to 115 for normal activity.