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Aortic Aneurysm: A difficult disease with a high mortality rate

This article first appeared in the medical column “Ask-the-Doc” in the World Journal

There is a risk of rupture and internal hemorrhage should the aneurysm become too large. Most people are unaware that they may have an aortic aneurysm because it is asymptomatic (lacking obvious signs or symptoms of disease). Sometimes, relatives are unaware that their family members have passed away from aortic aneurysms and simply assume that it was a “heart attack.”

“I’m not sure how grandpa passed away, I think it was a heart attack and he died very suddenly, people often recall,” says Dr. Pei H. Tsau, a cardiothoracic surgeon. The truth is most actual heart attacks do not lead to sudden death. Instead, such descriptions more likely point to a cause of death by rupture of an aortic aneurysm. If the aorta bursts, it can cause serious bleeding that can quickly lead to death. Treatment for an already ruptured aortic aneurysm is extremely difficult with a high mortality rate. Therefore, the only way to prevent tragedies from occurring is to receive surgery early.

“Aortic aneurysms do not have obvious signs and most people find them by chance during exams or tests done for other reasons,” Dr. Tsau continued. Sometimes patients see a doctor for cough and have an incidental finding on x-ray. Risk factors for aortic aneurysms include: over age 65, hypertension, former or current smoker, family history (not necessarily those with aortic aneurysms but any family history of sudden death should be noted given that most are unaware that aortic aneurysm is the cause of death). Aortic aneurysms are often identified first through chest x-ray with follow-up tests as needed.

While those ages 60-65 and greater have the greatest risk, some people have a genetic component. These people can be in their twenties or thirties and have an aortic aneurysm. If there is a family history of aortic aneurysm, it is important to make your family doctor aware.

“The aorta is above the heart with a normal diameter of 3-3.5cm,” says Dr. Tsau. A diameter greater than 3.5cm is considered to be an aortic aneurysm. The aorta behaves similarly to a rubber band. Once stretched, it is hard to return to its original shape. More importantly, once it has widened, it will continue to do so. Once the diameter exceeds 6cm, the risk of rupture or dissection is extremely high. The disease cannot be treated by medication and requires surgery. Surgery is recommended once the diameter exceeds 5.5cm. The cutoff is sometimes 5cm for Asians due to a smaller body frame.

“Aortic aneurysms must be treated by surgery before tragedies occur,” Dr. Tsau emphasized. “It is extremely dangerous to defer the operation while knowing of an aortic aneurysm because aortic aneurysms do not recover. If a 65 year old has a 6cm aortic aneurysm but refuses surgery, the patient will suffer from an aortic aneurysm rupture or dissection before reaching today’s average life span.”  

Surgical repair of an aortic aneurysm involves replacing the aneurysm with a man-made graft. The surgery can be completed within 3.5 to 5 hours, requiring 4-7 days in the hospital with an extremely high success rate.

Doctor’s Profile: Born in Taiwan, Dr. Pei H. Tsau moved to the United States at age 12. She graduated from the University of Arizona, College of Medicine, and is Board Certified in Thoracic Surgery. Dr. Tsau joined the Palo Alto Medical Foundation in 2012.  

World Journal
Monday, March 28, 2016
by Richard Lee

This article first appeared in the World Journal and the Summer 2016 issue of Chinese Health Initiative Wellness eNewsletter. Learn more about the Chinese Health Initiative.