What measurements trigger surgery for aneurysm?

December 6, 2018 - 11:28am

  DEAR DR. ROACH: I am a 68-year-old male in good health with a 3.3-centimeter aneurysm in my internal iliac artery. I have no symptoms. It was 1.9 cm eight years ago.
       My physician says that an aneurysm measuring over 3 cm requires surgical intervention. I have looked at recent studies that say an aneurysm measuring less than 4 cm can be safely observed because a rupture under this size is extremely rare. I welcome your opinion on this matter. -- T.R.
       ANSWER: The internal iliac artery is one of the main blood vessels in the hip. The aorta branches into two common iliac arteries, left and right, which in turn branch into the internal and external iliac arteries. An aneurism is a dilation of the artery, and the big concern is a rupture, which is immediately life-threatening (about 15 percent of people will die in the first 30 days). Thus, repair is recommended before there is a significant risk of rupture.
       The current standard of practice is to repair any aneurism that is over 3 cm, symptomatic or rapidly expanding. Although yours has expanded slowly over the past eight years and you have no symptoms, the aneurism is still over 3 cm.
       A study presented in Finland in 2015 has challenged the current standard of practice. The author of the study said that elective treatment of an internal iliac aneurism could "quite safely be increased to 4 cm." The average person in the study was 77 years old.
       Based on this study, it appears you could hold off on surgery, for now. However, it is likely that the vessel will keep expanding and you eventually will need repair. Most importantly, the one whose opinion matters most, next to your own, is the surgeon who would be operating on you. I would recommend discussing with your vascular surgeon the advisability of waiting. I should mention that many times, these procedures are now done endovascularly, which means no open surgery.
       Finally, people with one aneurism often have others. I am sure you have been checked, but you should continue to be evaluated, even after repair.
       DEAR DR. ROACH: My daughter was only a year old when she was diagnosed with an autoimmune disease -- a non-life-threatening disorder that would mean she spent a considerable amount of time in and out of hospitals.
       Due to this diagnosis, she was unable to get the measles, mumps and rubella vaccine. She contracted measles in the hospital and, despite the best care available, died three months later. I am writing to educate parents on the benefits of vaccination, as every child deserves to be protected from infectious diseases. -- D.M.P.
       ANSWER: I admire your trying to make something positive out of the worst tragedy a parent can face.
       Measles is an exceptionally infectious disease. Ninety percent of people exposed will contract the disease unless they have immunity from a previous infection or vaccination. People with some immune system diseases and those who have had chemotherapy may be unable to take the vaccine. The best hope for people who cannot get the vaccine is that enough people around them are vaccinated so that the disease cannot spread. In several countries in Europe, the level of vaccination has dropped below the critical level, with a result of over 9,000 cases in the previous 12 months, as of the most recent report. About 1 person per 1,000 with measles will die and another 1-2 per 1,000 will get a serious complication.
       Vaccinating yourself and children protects them and others.
       * * *
       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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