DR PARKER: Mrs H is a 75-year-old woman weighing
the risks and benefits of proceeding with an elective surgical repair of an
abdominal aortic aneurysm. She lives in the greater Boston area with her husband
and has her health care insurance through Medicare.
Mrs H's physicians have followed the size and extent of her thoracic
and abdominal aortic aneurysms carefully for several years. By angiogram,
the aneurysm involved the origin of the celiac and superior mesenteric arteries,
down to the level of the renal arteries. An arteriogram in 1992 revealed a
diameter of the thoracic section at 5 cm to 6 cm. An ultrasound in 1995 showed
an increase to 6.5 cm. The abdominal aortic aneurysm was measured at approximately
5 cm. By 1996, a magnetic resonance angiogram estimated the thoracic aneurysm
at 9 cm, and a computed tomographic (CT) scan estimated its size at 8×12
cm. Mrs H remained asymptomatic during this period with regard to the dilated
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