Abdominal Aortic Aneurysm - prognosis advice please

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Patient is a 92 year old male, recently diagnosed with a 5.5cm AAA and has declined the open surgery needed, as believes strongly he would not be able to cope with both the operation and recovery. His concern is, having wanted and agreed to having a Consultant's letter (see text below), stating no medical intervention if it ruptures, that he is uncertain as to what would happen medical-care wise if the AAA were to lead to medical problems short of causing a fatality. In other words, if it leaked slowly, causing problems over days or more or affected his longer term health in ways other than iust growing / being a health threat (atherosclerosis etc).

Thanks for any help.

Text of letter: XXXX is known to have an abdominal aortic aneurysm. He has refused any interventions, even if the aneurysm ruptures. This letter is to be shown to whom it may concern, in particular the medical team that may be involved in his further care, that this patient would not like to be considered for any intervention for his abdominal aortic aneurysm.

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  • Posted

    When I was being refused travel insurance by Saga when my AAA was only about 3.2cm the girl on the phone understood how stupid that was and said that her grandmother had the open surgery successfully when she was 92. Mine has had a little spurt from 3.6 to 4.3cm in the past eighteen months but hopefully as I'm 83 I'll outlast it.Is he aware of endovascular repair ?

    https://patient.info/health/abdominal-aortic-aneurysm#nav-9

       

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  • Posted

    I also wondered if he considered endovascular repair. This may be worth talking to his physician about if it was not already discussed.
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  • Posted

    Well that’s goofy. One year ago I had a 5.2 AAA repaired using a stent it, there was nothing to it. I was 67 and was back to work in 3 weeks. Although I was only 67 I was concerned about the open procedure. At 92 I really can’t say what I would do, it would be a lot to consider, for sure
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  • Posted

    Thank you all for your concern and support. In this case my relative has been told the endovascular option is not possible, as well as the fact he is adamant he doesn't want any more surgery. Amongst other things he has previously had a quadruple heart by-pass but would find any further hospital stay too much to cope with he says. Most appreciated would be an idea of what obvious AAA-health complications may arise short of a fatal AAA event. He understands such a fatal occurence may be relatively instant or happen over hours and accepts that. He would not want a resuscitation operation or respite care either and just wants to benefit from being cared for in his own home. His wishes are being respected in this, as he has full mental capacity and believes he has made an informed choice.

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  • Posted

    My partner had the open, at 61 years , 5.6 cm. Surgery went well but then he declined over the next 24 hours, was in a coma 8 days,  on dialysis for 2. It was touch and go but he pulled through. He got c diff from all antibiotics and 8 months on recovery has been slow, he hopes to return to work soon.  It is very individual and is not easy. There are times Jon wishes he had never had the operation, his scar split after they took out the staples so he had an open wound for 5 months. Choosing not to have the operation is a personal decision, but sometimes you have to look at quality not quantity. We wish you all the best.
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  • Posted

    I'm confused by this. The title on this post clearly states this is an abdominal aortic aneurysm. That does not require open heart surgery. Unfortunately there is a clear confusion over the abbreviation AAA. In the UK it mean abdominal aortic anuerysmin the US it refers to ascending aortic aneurysm - just above the heart which is far more difficult to treat and to operate on as it requires open heart surgery. I thought I was on a forum for ascending aortic aneurysm as that is what I have. I wish this could be clarified by posters because it is getting very confusing. Some posts refer to ascending and some to abdominal and their operative solutions are vastly different. Also the abdominal anuerysm can withstand a larger size more safely than the ascending.I know of many people who have had abdominals discovered at 7 8 and even 10 cm before operating. In London a very quick op often through the thigh or keyhole.

    So back to the 92 year old relative. If he is suffering no ill efects and his blood pressure and diet are under control and he does not have the desire to fix it then let it be.

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