Doc: Risk of aneurysm rupture based on its size
Dear Dr. Roach: My boyfriend recently was diagnosed with an aneurysm. The report says the abdominal aorta is 3.02 cm in largest dimension and recommends screening every six months. Do we need to see a cardiologist for a second opinion? Is there medication to help?
Dear B.S.: The aorta is the largest blood vessel in the body. It comes directly off the left ventricle of the heart and supplies blood to the entire body. It may become enlarged either in the chest (a thoracic aneurysm) or in the abdomen.
Abdominal aortic aneurisms are more common in men, especially over 65, and smoking is the biggest risk factor. There are contributing familial conditions as well, such as Marfan syndrome.
Most people have an abdominal aorta that is no bigger than 3 cm, so your boyfriend is just barely over the cutoff. His risk for rupture, the dreaded complication of an AAA, is negligible at this size. I agree with the screening recommendations, and would advise tobacco cessation if he smokes, regular moderate exercise and control of blood pressure if high.
Seeing a cardiologist would be very reasonable: Your boyfriend could get personalized advice on risk reduction. Although aspirin and statin drugs may have a benefit, the evidence for it is weak. Most experts do not recommend them unless there are other indications for taking them.
Dear Dr. Roach: I had a hernia operation in 2015. The repair included insertion of mesh patches that now have been recalled. Since the operation, I have had many health issues. Is there a blood test or other test to see if the mesh is the cause of my problems? Should I have it removed and replaced? I turned 83 in May.
Dear J.C.L.: Surgical mesh is commonly used in hernia repair, as well as in many gynecologic surgeries. Mesh reduces the need for re-operation. However, there is an increased rate of long-term complications that partially offsets the benefit of using mesh.
Complications related to the mesh can be very serious, such as bowel obstruction, perforation or bleeding; these usually require urgent surgery. However, symptoms also may be less specific, and include pain, non-healing wounds and infection. Four to 6 percent of people with a mesh repair had evidence of complications after five years of follow-up, according to a well-done study from Denmark.
I am aware of recalled mesh products (49 out of the top 50 results on a web search were from personal injury law firms; the 50th was from the Food and Drug Administration) and reports of significantly higher complication rates from recalled (as well as from counterfeit) mesh.
Without knowing more about your health issues, it is difficult to weigh in on whether the mesh is likely to be causing it. There is no simple blood or imaging test that will give a definitive answer. However, if your symptoms are among those possibly related to mesh complication, it absolutely would be appropriate to have a discussion with your surgeon about the upsides and downsides of a re-operation. I would be cautious about recommending another surgery for an 83-year-old, unless the symptoms are significant and your surgeon feels they are likely due to mesh complications.
Email questions to ToYourGoodHealth@med.cornell.edu.