Mount Sinai Heart Aortic Aneurysm Surveillance Program
Established in 1985, the Mount Sinai Heart Aortic Aneurysm Surveillance Program is one of the largest of its kind across the nation. This stringent Program for patients with thoracic aortic aneurysms and dissections carefully monitors changes in the size of the aneurysm in order to provide the most effective, customized treatment.
Patients from as far as Europe and Indonesia come to Mount Sinai to participate in this Program, which is comprised of dedicated aortic aneurysm specialists. We are a leading referral center for thoracic aortic aneurysms in the US (many of whom are self-referrals, as well as physician referrals), not only for our clinical expertise and long-standing history of the Program, but also for our basic and clinical research in this field. Our extensive confidential database of more than 4,000 participants has and continues to benefit patients, as the vast amount of information we have collected is helpful with identifying risks, common complications and aneurysm growth expectations – all of which can lead to better patient care.
How the Aortic Aneurysm Surveillance Program Works
Each patient in our Program receives a CT scan during their office visit and/or before discharge after surgery. CT scans are generally performed every six months for patients with relatively large aneurysms and annually for those with smaller aneurysms. If you wish to participate in the Aortic Surveillance Program, you will be reminded on a biannual or annual basis by mail to arrange their follow-up CT or MRI.
On the day of your CT/MRI, you will be interviewed and examined by one of our aortic surgeons. Volumetric analysis as well as diameter measurements of the entire aorta are performed on all CT scans. Additionally, three-dimensional reconstructions of the aorta are created from the CT images to help delineate operative approaches in patients with large aneurysms. Imaging studies are reviewed with a radiologist and your official results are given to you within 24 to 48 hours. A follow-up letter and a copy of your CT/MRI results will be forwarded to your cardiologist and internist.
Complex aortic cases are discussed on a monthly basis in a multidisciplinary meeting that includes interventional radiologists, vascular surgeons, endovascular specialists and aortic surgeons. Often a combination of specialists is involved in the care of each patient’s aneurysm/dissection.
Indications for Surgical Intervention
The vast majority (nearly 90 percent) of aortic aneurysms identified through imaging tests are small in diameter (less than 3.5 cm) and are unlikely to burst. However, for others, surgical intervention is recommended when the probability of rupture in the next year exceeds the risks of the operation or if a patient is experiencing pain or other symptoms caused by the compromised blood flow to major arterial branches, regardless of aneurysm size. Patients with aneurysms of the ascending or aortic root associated with regurgitation (leakage) of the aortic valve may also be advised to undergo early intervention, which would likely involve combined repair procedures.
The timing of corrective surgery depends on the aneurysm size, symptoms, and anticipated risk of intervention. In general, indications for surgical intervention are:
- Type A (ascending) aortic dissection, which is an emergency issue
- Ascending aortic diameter > 4.5 cm in patients with Marfan syndrome or other connective tissue disorders.
- Ascending aortic diameter > 5.0 to 5.5 cm in patients without Marfan syndrome
- Descending and thoracoabdominal atherosclerotic aortic aneurysm diameter > 6 cm, or Type B aortic dissection complicated by impaired blood flow, rupture, or rapid expansion
- Dissecting descending thoracic aortic aneurysm diameter > 5.0 cm
- Expansion rate > 1 cm per year
Allan Stewart, MD
Director, Aortic Surgery Program
Department of Cardiovascular Surgery
The Mount Sinai Health System
1190 Fifth Ave: Box 1028
Assistant: Debra Segreti