Doc: What measurements trigger surgery for aneurysm?
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.
Dear T.R.: 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: I noticed my right clavicle is larger than my left and show it to my primary physician. He checked it and wasn’t concerned. He did order an ultrasound, and nothing was found. I’m not usually alarmed, but would like some type of explanation.
Dear B.B.: I see this fairly frequently. We all are slightly asymmetrical, and this may seem to get worse over time. Changes in muscle (including muscle spasm), posture and in the spine can accentuate the appearance of asymmetry. I have checked X-rays a few times in people where I, too, noticed a difference in the appearance of the clavicle and have yet to find anything seriously wrong, so my experience suggests that this is unlikely to be a problem. Check the height of your shoulders when looking in a mirror — a significant difference could indicate scoliosis, which can happen in older adults.
Email questions to ToYourGoodHealth@med.cornell.edu.