Early referral, close surveillance and coordinated care can help patients with aortic aneurysms avoid rupture and achieve the best possible outcomes.

A ruptured aortic aneurysm is a life-threatening emergency, but with the right proactive interventions, providers can help their patients avoid this dangerous scenario.

Appropriate monitoring and lifestyle choices can help patients with small aortic aneurysms avoid surgery for years or even decades. If the aneurysm grows larger, close surveillance can be the differentiator that saves that person’s life — allowing for surgical intervention before the aorta has a chance to rupture.

Fernando Fleischman, MD, a cardiac surgeon and co-director of the USC George and Meryl Young Aortic Center, part of the USC Cardiac and Vascular Institute of Keck Medicine of USC, explains how he collaborates with local providers to help monitor patients with aortic aneurysms.

Active surveillance of aortic aneurysms

Ideally, Fleischman says any patient with a detected aortic aneurysm should be referred to a specialist. “Ideally, we’d always like to see these patients early and put them in our surveillance program,” he explains. “We then work with the referring physician to closely monitor that patient.”

Noticeable growth of an aneurysm should also prompt a referral, if one hasn’t been made already. Fleischman says a referral is especially important if:

The aneurysm measures 4.5 centimeters or larger
It grows by half a centimeter over 6-12 months

Fleischman adds that when making a referral, providers should share the actual images, not just the report. “A CT scan is the gold standard for aortic pathology,” he says.

Importance of family history of aortic aneurysms

Fleischman stresses the importance of getting a thorough family history, as genetic conditions can increase the risk of an aortic aneurysm.

Patients with a family history of aortic aneurysms should be monitored for aneurysms themselves, especially if they smoke cigarettes or have other risk factors such as high blood pressure, high cholesterol, obesity or are over age 65.

However, many patients may not know whether any relatives have had aortic aneurysms. In that case, providers should ask about family members who died suddenly.

“If someone died from chest pain, it may get classified as a heart attack. But if there isn’t an autopsy, then they don’t really know what that person died from,” Fleischman explains. “It may have been an aneurysm. That’s why a family history of sudden death would also prompt an earlier visit to a specialist.”

Surgical options for aortic aneurysms

To determine next steps, Fleischman says a cardiothoracic specialist will examine whether the patient has a fusiform or saccular aneurysm, as the latter is more likely to rupture sooner.

The location of the aneurysm on the aorta determines the surgical approach. A root or arch aneurysm may necessitate an open-heart procedure to replace the damaged section of the aorta with a graft.

A descending aortic aneurysm is typically treated with a minimally invasive endovascular procedure. It involves inserting a stent to reinforce the aortic wall and prevent the aneurysm from tearing or bursting.

“A common misconception is that open-heart surgery is only for emergency patients, but that’s not the case,” Fleischman says. “We do a pretty routine aortic surgery here, and patients tend to recover very well from it.”

Professional collaboration

Before a pre-planned aortic procedure, the patient’s local provider handles pre-op steps such as the physical examination, taking preoperative CT scans and administering blood pressure medications.

The specialist and their team take the lead for the surgery and immediate recovery, but once the patient is released from the hospital, their local provider again takes the lead on their care.

However, surgeons like Fleischman will continue to provide support to the local provider to help monitor the patient. “Any aneurysm needs to be followed forever, and that’s why we have a large surveillance program,” he says. “We’re here to partner with referring physicians and make sure the patient’s aorta is watched.”

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Aortic Aneurysm Risk: When Is the Right Time to Refer to a Specialist?