Dissection Rates -- Help?

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I'll let Tobagotwo or someone else answer. I do not believe in statistics or studies. They are only good if something bad doesn't happen to you.
 
Good point Ross. If it happens to you, your odd are 100%, right!? It looks like those charts are explained later in that thread.
 
Dissection Rates

Dissection Rates

If you go purely by the charts in the article, a 4.9cm aneurism would suggest an annual "rupture or dissection" rate of roughly 2% (see Fig. 3). Potentially it might be marginally higher, since you fall at the top of the 4.0 to 4.9 cm range covered in the chart.

Now, that's going only by the charts. You have a number of things acting in your favor. You posted earlier that you are 6'4"... so naturally your aorta would be a bit larger than average. Also, if your aorta is widening very slowly (I think you mentioned it was), that also reduces the chance of a rupture or dissection. So I wouldn't doubt Dr. Svensson's evaluation that your chance of a rupture or dissection could be under 1%.

However, here's the vital point... you are comparing a one-time risk (surgery) vs. a continuous risk (rupture or dissection). Let's say that you have a real one percent annual risk of rupture or dissection. Over 10 years, that's close to a 10% chance or rupture or dissection. Or if your annual risk is 0.5% percent, then that's close to a 5% chance of rupture or dissection after 10 years. Compared with the 1% mortality issue with surgery, the odds are still in your favor to get the surgery done.

That's how I think about things (as someone with a math degree, but not a medical degree!). But there are a lot of intangibles that it doesn't take into account (like quality of life, complications, psychological issues). So it's really the kind of decision only you can make for yourself. And as Ross points out, in spite of all the probability balancing, for individuals a rupture or dissection is a binary event. It will either happen or it won't - and you need to keep that in mind.

Good luck with your decision. I'm in a similar, though somewhat more precarious boat (grey zone with a slightly larger 5.4cm aneurism that hasn't changed in 7 or 8 years), and will be having surgery in June.

Best of luck - whatever your decision is!
Red
 
If you use either of the charts from that thread and use the more recent surgical mortality figures from St. Lukes or elsewhere, the changeover point is somewhere around 4.2 cm, meaning that's where there is less risk to have the surgery than to wait a year. If you're at 5.0, odds are you should be finding a surgeon, not waiting on a reluctant cardiologist.

While a bigger person might start out with larger arteries, that is not a given. Also, being large puts more stress on the aorta and the heart, so that "advantage" may be a wash.

Knowing what your odds are can spur you to do the smart thing. It can help you decide how much risk you're living with, if the alternatives are not something you are strongly against dealing with. However, Ross and Briansmom point out the grand weakness of charts and odds: if you're the one on the wrong end of the probability curve, you lose 100%.

Odds are fair: life is not.

Best wishes,
 
Take a look at the very last paragraph in the article, which is a response by one of the authors of the article to a question posed by another physician:

Your question about when we operate, at what size, is a very
important one. We use 5.5 cm as our criterion for the ascending
aorta; we use 6.5 cm for the descending, because of the corresponding
observed sizes at the time of aortic events. We use a
smaller size of 5 cm for the ascending aorta in patients with
Marfan or those with a family history. When we take the aortic
history in the office, it is impressive how often we get an
affirmative response. We inquire, have you had any family
members who died prematurely or suddenly or of unexpected
cardiac death? The reply is positive very commonly. We consider
patients with a family history or a suspected family history
to have a connective tissue disorder, and we operate on them
earlier, just like our patients with Marfan syndrome. So 5.5 cm is
what we use without Marfan syndrome or a family history, and
5.0 cm for the ascending in case of Marfan syndrome or a
positive family history.
Click to expand...

This pretty much sums up the bottom line of the study, which evaluates risk factors using regression analysis, but really has much to do with the decision in regard to when to intervene surgically. Note that in the study patients with Marfan and BAV, patients with a faster aneurysm growth rate (>0.10 cm per year), symptomatic patients (symptoms related to their aneurysm), and women in general require particularly strict attention.

The authors are quite clear in their view that thoracic aortic aneurysm is a lethal condition. If I were you assuming you are BAV, at 4.9 AA I would be setting up my surgery ASAP...this is strictly my non-professional opinion.

Jim
 
In reference to the recommendations at the end of the article that Jim quotes in the previous post: The recommended surgery thresholds have been revised downwards since the article was written. Now the conventional wisdom is to do surgery at 5.0 cm for non-Marfan patients and 4.5 cm if the patient does have Marfan. I think this is as much of a reflection of the increased safety of the surgery in recent years as an increased perception of the risk of dissection.

Again though, that's just a rule of thumb. There are other metrics that cardiologists use (like ratio of aortic diameter to body surface area, ratio of ascending aorta to descending aorta, etc...)

Red
 
Two Points:

There is NO Zero Risk position for someone who already has an aneurism. An aneurism that is 4.9 cm is minutely less likely to rupture / disect than an aneurism that is 5.0 The notion that you are SAFE at 4.9 and at Great Risk at 5.0 is BOGUS. There is Very Little Difference in Size and Very Little Difference in RISK.

It comes down to assessing the Surgical Risk vs. the Rupture / Disection / Death Risk.

The Better / More Experienced your surgeon is with doing Surgery of the Aorta, the Lower the Risk.

If you have not yet selected a Surgeon, it is (past) time to be interviewing Surgeons with experience dealing with aneurisms and possible connective tissue disorders of the Aorta.

Other than putting you on Blood Pressure Medication in an attempt to "slow down" the progression of your aneurism, and refer you to a Good Surgeon, there is Very Little that your Cardiologist can do for you at this point.

'AL Capshaw'
 
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