Aortic Dissection at Range of Sizes

[Arlyss]

The title of the paper is "Aortic Diameter >= 5.5 Is Not a Good Predictor of Type A Aortic Dissection"

http://www.circ.ahajournals.org/cgi/content/full/116/10/1120

What this paper is saying is that we need technology that can detect those vulnerable to aortic dissection before it happens. It is not where we are today.

There are limitations to any collection of data, including those in this paper. I also remind myself that these are only those who made it to a hospital and dissection was confirmed. What about all those "sudden, massive heart attacks" that are dissections/ruptures who never have autopsies. We know nothing about these people - their age, aortic size, risk factors, etc.

This information may make us feel more insecure, but it also should dispel the idea that there is some "magic number" size for ascending aortic aneurysm surgery. Patients and families have the right to be informed about the realities of thoracic aortic disease.

It is difficult for the medical community to put out a number as a guideline across the board. It has to be remembered that surgical risk is not the same in every surgeon's hands. If the number is set too low generally, those less skilled will lose or injure patients that might have lived longer. But waiting too long, patients are injured or lost because their aorta tears or ruptures.

In my own chest, I would seek two things: 1) aggressive blood pressure control to limit the stress on my aorta 2) surgery sooner rather than later, in the very most skilled aortic surgeon's hands I can find

Best wishes,
Arlyss

 

[Mary]

This study supports what Ross has always said. The conclusion:

The majority of patients with acute type A aortic dissection in our registry presented with aortic diameters <5.5 cm. Current surgical guidelines for thoracic aortic aneurysm repair (5.5 cm) would fail to prevent the majority of acute aortic dissections seen in this cohort. Even with more aggressive guidelines (<5 cm), preemptive aneurysm surgery would fail to prevent 40% of acute aortic dissections seen in our registry. Thus, aortic size is not a sufficient marker of risk for aortic dissection.

Ross, why aren't you in the Registry? You need to check it out.

 

[Phoenix]

Arlyss, thanks for this post, I was just about to post a question about my ow situation and I think you have answered it. I only discovered my 5.1x5.3 ascending aortic anerrysm a week ago. although I have a surgical first meeting in two weeks my cardiaologist is out of town untill monday and I have recied no advice on wether or not I should limit my activites and am at serious risk of disection or rupture. I was biking regularly and for my job I lift a boat load of camera equipment . Any thoughts? all of a sudden I feel like a buble that may burst at any moment.
My best to your husband

 

[Arlyss]

Blood pressure control and avoiding activity that puts stress on the aorta, i.e., "heavy lifting" are important safeguards. Blood pressure of around 105-110 systolic at rest allows some room for increase with activity.

My husbands aneurysm was 5.2 cm - he walked for an hour every day until his surgery. It is not optimal to be out of shape going into surgery. His blood pressure was brought under control with multiple medications.

You might be interested in what happened to Richard. His aneurysm was the same size as my husband's - he never knew it was there until the moment it dissected. His rescuer, Brian, also had an unknown aneurysm of that size, yet Brian escaped dissection.

http://bicuspidfoundation.com/Aortic_Dissection_-_Richard_Houchin.html

Best wishes as you do your research!

Arlyss

 

[Arlyss]

It is a very important document, published by IRAD. As I mentioned earlier, patients should be told the realities of where we are today. There is no "magic number" for surgery; there are guidelines. Each person should have a carefully thought out strategy regarding their aortic disease and when surgical intervention should be done.

Arlyss