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Ken, Postgraduate doctor
Category: Medical
Satisfied Customers: 6559
Experience:  Working as a Doctor who Cares since 2001.
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Hi Doctor, I am hoping you can help me. I am a 56 yr old male

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Hi Doctor, I am hoping you can help me. I am a 56 yr old male who had a big operation this May to address three Abdominal Aortic Aneurisms. I had an aortic graft and I have recovered well and an now back at work. However, my scan which discovered my AAA also showed a dissection of the descending aorta which is being monitored via annual re-scan, the first of which I will probably have this coming May. I am very anxious about having to have further surgery to fix the dissection. Please can you help me with two things: Firstly, how likely is it that further surgery will be required? I am normal weight, normal blood pressure (130/80), exercise well and don't smoke. There is no family history of vascular problems. I am currently not on any medication other than monitoring of my blood pressure. Secondly, if further surgery is required, what are the risks? My cardiac consultant has been cagey about this, and information on the internet is frankly terrifying! I understand that individuals vary greatly, but if you could help me to understand broadly what the risks are, and how likely they are, it would greatly ease my anxiety, which I find hard to cope with at times. Many Thanks in advance. Dale.
I am Dr Ken and I will be helping you today.
Aortic dissection is separation of inner walls of aorta. There are mainly two types - Type I which affects ascending aorta and may extend at descending aorta while type II - which affects distal or descending aorta only. Treatment depends on multiple factors BUT generally the one affecting ascending aorta is better treated surgically and that affecting descending aorta is medically treated. Acuteness also is the main factor in deciding treatment. Acute ones lead to death in many patients while as the dissection becomes older or chronic chances of death reduce significantly. Third factor is to keep blood pressure in normal range. Hypertension increases severity of the disease.
In your case as the dissection is chronic and affecting descending aorta - I see a very good chance that it will be managed medically and no surgery will be needed. I am happy that you are not over weight and your blood pressure is in control. This relieves me and further reduces chances of needing a surgery for sure. To give you the numbers mortality with type II disease is below 10 percent in medically treated patients while it is 30 percent in surgically treated patients.
Please do not worry.
Customer: replied 3 years ago.

Dear Doctor Ken, thank you so much for your answer, and for coming back to me so quickly, please can you clarify one area, I am working hard to improve my fitness, which suffered after the op this spring, as I had a lot of pain and needed to recover. I am now back to walking and swimming every week, and have just rejoined my local gym. Can vigorous exercise, such as gym classes, aerobic machines such as cross trainers and treadmills put me at any risk or worsen the dissection, or can I safely train as much as I like as long as I am in no pain? Many Thanks, DALE

Following factors need to be avoided -
1. Raised blood pressure
2. Altered cholesterol levels
3. Obesity
4. Stress or anxiety
5. Vigorous exercise - This increases heart rate and blood pressure and thus puts you at risk of further increasing the severity of dissection. I would avoid it. Walking, swimming are fine. I would avoid any exercise which increases blood pressure/ increases pressure in thorax {due to raised heart rate or breathlessness}. Practice meditation to stay away from stress or anxiety.
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