Rupture rate or rupture risk and surgical indication for an aneurysm of the ascending aorta
March 31, 2022 | 50,00 EUR | answered by Dr. med. Frauke Gehring
Hello,
I am 50 years old. An enlargement of the ascending aorta (39 mm) was detected in my case (incidental finding). The radiologist said that an aneurysm is assumed in this area once it reaches 40 mm. What is the rupture rate for an aneurysm of the ascending aorta with a diameter of, for example, 40 mm? As far as I have researched, rupture rates are usually given per year. Does this mean that, for example, with a 1% rupture risk, the risk over 10 years would be 10%? I have also read that open surgery is done when the rupture risk exceeds the risk of surgery. In my case, this would likely be the case at around 6%. I am physically fit, have no other illnesses (except for controlled high blood pressure) and have not undergone any surgery so far. Does this mean that in my case, after 6 years (rupture rate 6%), surgery might be recommended even if the aneurysm has not grown further? The rupture rate would also increase each year, reaching 20% by the time I am 70 years old. Additionally, there is the age-related expansion of the aorta. But maybe my assumptions are incorrect... I have an appointment with a cardiologist in June. However, as this question is on my mind, I am taking this opportunity to ask in advance. Thank you and best regards!
Good day,
Your assumptions are incorrect, as the risk remains constant and does not accumulate over the years.
Surgery is considered when the aneurysm exceeds a diameter of 5 cm, which is not the case for you. Your rupture risk is so low that, according to guidelines, ultrasound checks will be done every 2 years (at 4 cm it is annually, and I would also recommend this frequency). At 5 cm, the decision for surgery depends on accompanying conditions, the presence or likelihood of covered perforations, and the speed of aneurysm growth.
Regarding risks: The rupture risk at 3.9 cm is truly negligible, and I do not have specific numbers above that. This is why monitoring at long intervals is sensible, as aneurysms grow slowly, around 10% per year if at all. Some remain the same for years.
In men, the rupture risk at 5.5 cm is 5 to 10% per year. This means that out of 100 patients with an aneurysm of this size, 5 to 10 will experience a rupture each year. However, it cannot be concluded that all will rupture after 10 years, as some aneurysms never rupture and new patients may develop one next year (and may be more likely to rupture than those who have had it for a long time).
In summary, I would not worry too much and have a check-up every year.
Warm regards, Dr. Gehring
