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Aortic Aneurysms: Top Four Questions Answered

Aneurysms have a bad reputation for a reason—they’re asymptomatic until they become deadly. If you have an undiagnosed aortic aneurysm, there is a looming possibility that it could suddenly break or become weak and result in a trip to the emergency room.

Konstadinos Plestis, MD, has joined Abington – Jefferson Health, as director of Jefferson Aorta Surgery. A nationally recognized leader in cardiac and aortic surgery, he specializes in the care of patients with complex aortic disease. Dr. Plestis answers some of the most common questions about aortic aneurysms.

Q: What is an aortic aneurysm?

Dr. Plestis: The aorta is like a long tube, one inch in diameter, that starts at the heart and goes to the belly. It has branches that distribute blood throughout the body. When the aorta’s diameter increases by twice as much as normal, we call this an aneurysm. This ballooning may happen to just a segment of the aorta or to the entire aorta.

Q: Why are they called silent killers?

Dr. Plestis: In about 95 percent of patients, aortic aneurysms are completely asymptomatic. Then, out of nowhere, the aneurysm will become weak or break, and it becomes an emergency situation. The patient will suffer from severe chest pain or back pain if they have an aneurysm that breaks.

Q: Is there a way to catch them early?

Dr. Plestis: Because they are asymptomatic for the most part, they are usually caught when patients are getting tested for another reason. If you’re getting an MRI, CT scan or echocardiogram, your doctor will be able to see if you have an aneurysm.

Importantly, 20 to 25 percent of patients who have an aortic aneurysm also have a family member who has one. When we see one aneurysm in a family, it’s likely that someone else will have one. At Jefferson Health, we’re developing an aortic center where we can evaluate these patients who are referred to us. We will do genetic mapping on high-risk patients that have a family history of aneurysms and hopefully catch any aortic aneurysms much earlier.

Q: How are aortic aneurysms treated?

Dr. Plestis: It depends on when we catch them. If we find an aortic aneurysm early, we will bring the patient back annually or biannually for evaluation until it reaches a critical level, when the aorta is between 5 and 5.5 centimeters—almost 2.5 times its normal size. They can grow slowly, but consistent follow-ups are critical to managing your health with an aortic aneurysm.

If the aortic aneurysm reaches a critical level, we can treat it with open surgery, vascular surgery or a hybrid of both. When we treat patients with aortic disease, we have a collaborative team of many physicians to identify the most effective treatment for each individual. About 70 percent of operations can be done with a minimally invasive approach, which gives patients the benefits of less pain, faster healing time and fewer complications. We like to use minimally invasive techniques when we can, but we tailor our approach according to each patient’s needs.

If a patient comes to us in an emergency situation, where the aortic aneurysm has ruptured or becomes weak, in most cases we will do major surgery. Unlike with an elective surgery, emergency situations don’t warrant the time to carefully consider the best option. We must work quickly to save our patients, and sometimes that means much bigger operations.

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