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Aortic Aneurysm (cont.)

Aortic Aneurysm Medical Treatment

The treatment of this condition depends on the patient's overall health, the size and location of the aneurysm, and whether the person is having symptoms. The risks and benefits of surgery for abdominal aortic aneurysms (AAA) are different than those for thoracic aortic aneurysms and are listed below.

Abdominal aortic aneurysms are unlikely to rupture if they develop slowly, are less than 5.5 cm (about 2 inches) in diameter, and are causing no symptoms.

  • In these cases, the risk of rupture over the next 5 years is considered negligible. The risks involved with surgery outweigh the risk of the aneurysm rupturing.
  • Close monitoring of the aneurysm size is the proper treatment for most people.
  • Ultrasound/CT scan every 6 to 12 months is the usual monitoring strategy. This may vary by individual patient and doctor.
  • As the aneurysm enlarges to greater than 5.5 cm, surgical correction is the usual treatment of choice. However, small adults (women) and large men may be judged as candidates for surgery with either less or greater aortic diameters, respectively, by their consulting surgeon.
  • However, asymptomatic patients with inflammatory abdominal aortic aneurysm or abdominal aortic aneurysm that have caused symptoms of emboli, pain, or bowel obstruction usually require emergent repair regardless of aneurysm size.

Any abdominal aortic aneurysm larger than about 2 inches (5.5 cm) in size requires surgery to repair it. Aneurysms that are enlarging rapidly, causing symptoms, or showing signs of probably rupture (such as leaking) require immediate surgery. Delaying this surgery puts the patient at even greater risk of a rupture.

  • The risk of rupture of an abdominal aortic aneurysm greater than 2.7 inches (7 cm) in diameter in average-sized individuals is almost 20%.

Thoracic aortic aneurysms may originate in either the ascending or descending aorta and, because of their closer proximity to the heart than abdominal aortic aneurysms, they have greater potential to harm the heart or create other problems related to the heart.

  • The need for more aggressive treatment is balanced by the higher risk of surgery closer to the heart.
  • Generally, about 2.3 inches (6 cm) is the critical size for atherosclerotic aneurysms.
  • Any thoracic aortic aneurysm 6 cm or larger requires surgery, but if the patient has Marfan syndrome or a familial history of aneurysms, 5-cm aneurysms are considered for surgery.
  • Aneurysms at the aortic root (nearer the heart) are prone to rupture at sizes closer to 5 cm and must be treated more aggressively.

In most cases, a medication (beta blocker) that lowers blood pressure and relieves stress on the artery wall will be given to reduce the stress on the weakened part of the vessel. Lowering of blood pressure is usually done in the intensive care unit with intravenous medications and continuous monitoring of the blood pressure.

Medically Reviewed by a Doctor on 9/17/2014
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Read What Your Physician is Reading on Medscape

Abdominal Aortic Aneurysm »

Abdominal aortic aneurysms (AAAs) represent a degenerative process of the abdominal aorta that is often attributed to atherosclerosis; however, the exact cause is not known. A familiar clustering of AAAs has been noted in 15-25% of patients undergoing repair of the problem.

Read More on Medscape Reference »


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