Frequently Asked Questions about Aortic Surgery
Q: What is the difference between emergent surgery and elective aneurysm surgery?
A: With the increased expertise of healthcare practitioners, more aneurysm are diagnosed than every before. This does not mean to say that the diseases are increasing in number; they are just being identified in greater numbers. Most patients who have aneurysm do not require surgery; in fact most will never require a procedure. It is essential, though, to properly follow patients with aneurysm to ensure that all will have the opportunity for elective surgery, rather than emergent intervention. Mount Sinai has a dedicated Aortic Aneurysm Surveillance Program to monitor patients with thoracic aortic aneurysms.
An elective procedure allows you to choose the right surgeon and hospital for your care. It allows psychological preparation and control over your own destiny. A date may be chosen and adequate information can be provided to loved ones and work colleagues, etc. More options exist with the procedure, as you are involved in the process without being in harms way. The primary goal of an elective procedure is to reduce the risk of aneurysm rupture.
In contrast, an emergent aortic procedure is generally performed at the nearest hospital. In most cases, you will not get to choose your surgeon and the procedure will be performed as soon as possible after your arrival to the emergency room. In emergency situations, the primary goal is not a perfect procedure, but rather to save your life. On occasion, this limits the number of options available to you.
Q: My doctor says I need to see an aortic specialist. Do I need surgery?
A: Being sent to an aortic surgeon does not mean that an operation is required or even indicated. Most patients with aortic aneurysms will never require surgery. It is important, however, to accurately measure the size of your aorta with accurate imaging, most commonly with an MRI or CT Scan. Afterwards, an echocardiogram may be performed to assess the quality of the aortic valve. In some cases, the valve may be abnormal such as the case with a bicuspid valve. In other instances, the aneurysm may be causing the valve to leak. This is important information to have, as it will allow the aortic specialist to tailor a treatment plan. This often includes certain lifestyle changes, such as stress management, tighter blood pressure control, and a limitation on the amount of straining, including reduction in weight-lifting and control of constipation.
Q: How do I know if I need surgery?
Many pieces of information are required before surgery is recommended. The indications for surgery aneurysm surgery are well established. For most people, surgery is not indicated until the aorta reaches 5.5cm in maximal diameter. There are exceptions to this rule, as in folks with family history of aortic dissection, bicuspid valves, and genetic disorders. The most important piece of information, though, is that the aorta grows quite slowly. There is often adequate time to get a few opinions and then decide where and when to proceed with surgery.
Q: Will my aorta burst while I'm waiting?
The incidence of aortic dissection occurring during the period of evaluation is quite low. There are some things that can be done immediately to prevent a complication. The first is to reduce stress. Of course that's easy to say before you found out there was an aneurysm! But stress reduction will lower your risk for an aortic complication and reduce the rate of growth. If you are the person who gets to airport late and stresses about the security line, get there sooner. In short, control the stress in your life that is controllable. Secondly, control your blood pressure. It is not just the top and bottom number at rest that we are after. We wish to prevent the large changes that may exist when you “blow your top” so to speak. If you have been prescribed blood pressure medication, than take it. Try to reduce straining. It is unnecessary to live completely serene, but don't take the air conditioner out of the wall. If you have to move furniture get another pair of hands to help. If you are prone to constipation, increase the fiber in your diet. If you strain during urination, see your urologist about reducing the size of the prostate. Cardiovascular exercise is still okay, but increase the time of the warm-up and slowly ramp up the intensity. Running, swimming, cycling, and the elliptical are all okay. Avoid weight lifting as part of the routine.
Allan Stewart, MD
Director, Aortic Surgery Program
Department of Cardiovascular Surgery
The Mount Sinai Health System
1190 Fifth Ave: Box 1028
Assistant: Debra Segreti