Where are you? ST posters will be able to recommend professionals with a history of working with endurance athletes.

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'It never gets easier, you just get crazier.'

4.5 is pretty close to the cutoff, which is usually 5. Is there no option for endovascular grafting?

Thank you for your response. I am located near Toronto, Ontario.

I have never heard of an endovascular grafting, but just looked it up and it sounds encouraging, better than the full blown surgery. I have an ascending aortic aneurysm so not sure if that allows me to be a candidate for that type of surgery. I will explore that option with my cardiologist.

Thank you

I feel for you. The diagnosis is life changing to say the least. I have heard that light aerobic exercise is still reasonable just no weight lifting and intense efforts at threshold or above. (sounds like you are already there with the restriction) but best answered by your cardiologist and an opinion from a surgeon.
I would doubt that a endograft would be an option for you and in reality the outcome for surgery is generally favorable in healthy population. however these are all questions for a cardiovascular surgeon (there are many qualified that perform this procedure) and one at University of Toronto by the name of Dr. Tirone David that has a valve sparing procedure named after him.

You're still a bit away from the size they would recommend a procedure; as someone else mentioned the cut off is usually ~5.5cm, or growth rate dependent. It's unlikely you're a candidate for an endovascular procedure. You're too young (and, seemingly too healthy as well) for that. In Canada the trend is to go open if you're able to tolerate it since it's usually a better long term fix. I would imagine you'll get referred to a cardiac surgeon, so I can't help there, but I know most of the vascular surgeons at University of Toronto and could recommend a few who do a lot of endovascular work if you're really hoping for that route.

My experience with RAAM is only as a former volunteer at the aid station at Camdenton, Missouri. I’ve seen just how brutal that race can be on the riders, no matter how good they are.

There are some hellacious climbs on that course in the Rocky and Appalachian Mountains, and some in between. I don’t know what your heart rate would reach while climbing them, but I wouldn’t be surprised if it came uncomfortably close to your danger zone.

One concern I would have is that, if you had a medical emergency related to your aneurysm mid-race, it could be fatal simply because of the time it would take for medical help to reach you. In my area alone, hospitals are about 50 miles apart.

Frankly, I think you should look to something less extreme than RAAM. That race is a beast. (Less so, however, if you’re on a team.)

I would suggest that, after you talk to your cardiologist about the idea, talk to the folks at RAAM. I don’t know if they require medical clearances for RAAM, but they may discourage you from entering. Over the years, they’ve had plenty of tragedies occur during the race, and may not want to risk one in your situation.

Good luck!

Not a stupid question at all.

The issue of what to recommend for athlete patients with mild enlargement of the ascending aorta is difficult. There are more considerations than simply the aortic diameter, although as another reader responded above, we use 5.5 cm as a general indicator for when operation to replace the aorta may be warranted. Other considerations include: family history of aortic or other blood vessel problems, your body size (larger people have larger aortas), any abnormality of the adjacent aortic valve (particularly the congenital condition know as bicuspid aortic valve, or BAV), rate of enlargement of the aorta, among others.

In some of the other replies, mention is made of endovascular repair. This is available for other portions of the aorta such as the descending thoracic aorta or abdominal aorta. This is not available for the ascending aorta. Conventional, or "open", operation is needed.

I like the suggestion made by others above to visit with a heart surgeon to get additional expert input....about what forms of exercise are safe now....about what the risk of rupture, even at 4.5 cm may be....and to help frame the discussion around what type of operation may be needed at some point down the line.

In the end, only you--armed with information--will be able to make judgements about participation in events such as RAAM. So get educated!
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Larry Creswell
http://www.athletesheart.org, @athletesheart

Thank you for your input. If you know of surgeons that come highly recommended to perform the non-endograft type of surgery. I would welcome your thoughts.

I have searched the forums and thought there would be more information. Found a few back in '08 range but not much recent. I was interested in others experience likewise.

PM sent

Thank you Larry for your input. I will explore my situation further with a surgeon prior to jumping in blindly. I am grateful that this site is full of knowledge people that don't mind sharing. Thanks again.

Thank you for your insight, much appreciated. If their are surgeons that you are aware of that are better than others I would appreciate your direction. I am getting my next scan done in February and am hopeful it is unchanged, but probably wise to know who is out there that has done this procedure with the greatest success.

this is an understatement. if it ruptures in the hospital while they are testing you it's 50% chance of survival. out on the course you will be DEAD.

I just read the waiver document to see what it says.

The first line is as follows:
"1. I hereby represent that (i) I am in good health and in proper physical condition to participate in the Event"
It's beyond my pay-grade to know how that is actually interpreted, but a plain English reading suggests that a potentially life-threatening pre-existing condition worsened by exertion is excluded, except where a doctor endorses your health as sufficient.

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'It never gets easier, you just get crazier.'

Your cardiologist should be in a good position to recommend a heart surgeon who could help with this situation.

You mentioned living in the Toronto area. If you're Canadian, the University of Toronto has a very capable adult heart surgery group with considerable expertise in this area.

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Larry Creswell
http://www.athletesheart.org, @athletesheart

I can speak on this subject. I had a aortic aneurysm of 4.5 for years and was able to complete 140.6 and multiple 70.3's races. I also had my aortic valve replaced (Ross Procedure) 16 years ago. Roughly a year ago I had my first cardiac MRI which showed my aortic aneurysm was over 5, medically this changed a lot. My doctor wanted me to have surgery immediately, I also needed to have my aortic valve replaced again. I was 100% asymptomatic an blew the surgery off and continued to train and completed a mountain bike race in late August called ORAMM. I ended up having surgery on December 12 in Houston Texas where they replaced my aortic valve and they did a 23cm repair to fix my aortic aneurysm. I am currently 39 years old at home recovering.
I would recommend getting a cardiac MRI if you have access, as it is considered the gold standard and reads in 3D vs. 2D as with a echo. My experience is that you are still good until you hit 5, once you hit 5 every thing changes. One more piece of advice, error on the side of caution unlike myself.

I am ecstatic that I found this forum. I am a 61 year old male who just had an abdominal aortic rupture repaired using a stent/graft. I am currently out of shape although I used to do various triathlons and was just getting ready to make a push back into the sport when this happened.

My surgeon said to "go back to whatever physical exercise I was doing before", but I did some research and found out 2 things: (1) There is very little scientific study on exercise, especially intense exercise, after this type of surgery, and (2) Advice from doctors on exercise is all over the map from essentially none to don't worry about it. In addition, most information refers to people who still have the aneurysm and not to people who have had it rupture and repaired.

Any advice, research leads, comments or people to discuss this with would be most appreciated. I have done some research already and unfortunately the results are not very solid.

BTW: The odds of surviving a ruptured abdominal aortic aneurysm rupture is only about 18% and the average life expectancy after the surgery is 5.5 years. For all of you over 40 years old, GET THE TEST. It is easy, inexpensive and can save your life.

first, welcome. we're ecstatic that we found you.

second, you're in luck, because we have at least TWO, and i suspect more, cardiologist/triathletes who frequent this forum. i suspect you'll hear from at least one of them.

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Dan Empfield
aka Slowman

Thank you for your support. I have to admit I am a bit frightened about getting back into it but I remember the fun I had competing and the satisfaction after the race even though I was only a mediocre triathlete. I let Tri and exercise slip away with work, travel and home life. Setting a goal to get back to that fitness level, and more importantly that fun/satisfaction level, after having been given a second chance at life (the "rupture" was an ongoing tear for 3 days before I drove myself to the emergency room, they said I should have died) seems appropriate.

Again, thank you for your support.

Well done for finding this forum.
As Dan has alluded to, we have many many medical people on this forum. However, a cardiologist is probably not the most appropriate person to be giving you advice in relation to your AAA and post-repair exercise regimen (although they have a huge amount of valuable advice to share, generally vascular events such as this are related to other risk factors for cardiac disease which may need management, however they may not be able to give you the advice you seek in relation to your surgical repair and return to exercise approach for this operation). As from what you have mentioned this is abdominal and not a thoracic aneurysm your likely best first port of call would be the vascular surgeons who performed your repair. There are a number of things to take into consideration, including the speed at which you get back into things and the intensity with which you get back into things. Intense exercise can be problematic, in part as it relates to the stress put on the vessel wall which can be a lot higher when you are working harder (hence why BP and heart rate control can be important). However, this is also related to the repair that was performed and any operative concerns the team may have, hence why your primary team is the best port of call for advice on what you can do and how much you can push things.
As an aside, and it pains me a little to say this, the odds of surviving a rupture are pretty horrible. However, these figures often relate to the unstable leaking aneurysms where the survival is often poor when compared to the stable but leaking cases. Basically, given how you presented, we would expect a much better survival than 18%, so don't be too scared by what you may have been told or read. Yes, it is a nasty thing to have been diagnosed with, but with good management outcomes are a lot better than 18% survival!
What you are most likely to find on this forum is that most medical people will tell you to see your primary caregiver/surgical/medical team for advice first and foremost. It is because we know the many nuances of diseases, presentations and co-morbidities that mean giving advice online is incredibly difficult as we often don't have the full picture of what has happened, risk factors, co-morbidities etc compared to your treating team. Only when armed with that information can a decent doctor give you good advice specific to your own situation. Examples from other athletes of what they have done after similar illnesses, whilst interesting, can be problematic as they only relate to that individual and there are many reasons why what is appropriate for one person can be downright dangerous in another (and they are likely to be oblivious to these issues).

I will offer what I think is a common sense approach: You survived a severe medical incident with only a low to lowish chance of survival. If you spoke to the surgeon who actually performed this procedure on you (and not just any doctor on your ward) they will be the best to judge how the surgery went, what the situation exactly was and how well they think they have been able to place the stent and repair the damage. So basically that surgeons opinion would be a pretty well informed starting point.

You said it yourself the scientific grounds for opinions on this topic is meager and thus the advice varies from one extreme to another to pretty much everything in between.

Besides I think its pretty remarkable already that you got a clear for resuming triathlon from your doctor as normally they would already shy away from such an advice just for the sake of covering their back end ;)


My suggestion (again just common sense) would be to take it slow at first see how things go. Generally try to not push yourself to the absolute maximum, focus more on endurance not so much sprint, be careful with the swim (no need to be afraid, but be careful). Get medical follow up and get regular general check ups (blood work, blood pressure, ecg maybe even a cardiac stress test). In a situation like this where its hard to scientifically determine which route to go you need to make extra sure you'll listen to your body's signals and apply common sense.

I want to thank "pbnz" and "surrey85" for your advice. Let me add a couple of things to the discussion as they may generate some more ideas.

I developed blood clots on my lungs as a result of the surgery. They were caught in the follow up CT scan looking at the stent/graft. I am being treated for them.

The surgeon said there was no leakage seen on the CT scan, so the next scan is one year away

The surgeon is not very versed on "exercise" let alone triathlon training. He said resume whatever physical activity I was doing before, which was little to none (he did not know that).

My weight is the only risk factor that I am aware of. They did echo testing (both external and internal) of my heart, CT scans, and MRI of my spine and lower back. All came back ok. They said my blood vessels were "pretty reasonable" considering my age.

My blood pressure is running high at 130/80 range as well as my heart rate, Resting at 74; sitting during the day at around 85 (normally RHR is in the mid 60's since I am out of shape.) They have said this is a result of recovery from the surgery as well as the blood clots.

I do not have information on the exact placement of the rupture, but I do know the stent goes into the femoral arteries in both legs (Y shaped stent).

So there you have it. I am a mess and will be spending the next 2-3 years getting back and hopefully exceeding my previous self (in a lot of areas, not just fitness). Actually, writing this down has been somewhat cathartic and I appreciate the time people spend reading and responding to this.

Again, thanks for your comments and suggestions

Not addressed to the OP but maybe someone with a background in exercise science can answer this question. What about swimming? My limited understanding is that being horizontal and having water supporting the body that the pressures needed to sustain a given effort are less. Furthermore when I swim I cannot get my HR anywhere near what I can when I bike or run. Especially running. I think it has to do with the limitations of my arms to generate work vs the bigger muscles in my legs.

BtW bp in a giraffes neck can be 300 systolic

https://www.novartis.com/...-dont-they-drop-dead

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Welcome to ST! Please know that this is still NOT the place to get your medical advice-make sure you follow up with your own MD's who know your specific situation best.


That said, I'm very glad you survived your event. I could tell you many stories about ruptured AAA and thoracic aneurysms that I have encountered over the years, but I won't.

As you noted, you fall into a high risk group, even with successful surgery, that requires close follow up with scans to ensure that the stent stays patent, doesn't leak or have other issues. Unfortunately, endograft complications are rather common but if you have excellent surveillance, your risk should stay fairly low.

Wanting to maintain or gain fitness is always a good thing. With your condition, however, there are potential limitations you will want to discuss with your physician. Intensity matters and could be risky so you should make sure you connect with a cardiologist and discuss this. Types of exercise will be important and as noted, non-impact will be better than impact, IMO. (Swim is better than Bike is better than Run)

Having had a PE just makes things a bit tougher. I have many personal friends who are on lifelong AC for DVT/PE/Afib or other reasons, some of which have significant cardiac issues and being on the blood thinner is often the least of the issues. One does have to consider bleeding risks for all activities at all times.

Regarding performing screening abdominal U/S to look for AAA:
People who fall into higher risk groups-Male; >65 years; hx of smoking >100 cigarettes, family history of AAA=high risk and should definitely be screened

Very good PSA
https://www.uspreventiveservicestaskforce.org/...c-aneurysm-screening


Good luck on your comeback to fitness!