Abdominal Aortic Aneurysm: Endovascular vs. Surgical Repair
In plain English, here are the pros and cons of endovascular vs. open repair of abdominal aortic aneurysms, described by a vascular surgeon.
This article describes in plain English endovascular vs. surgical repair of abdominal aortic aneurysms.
From an intuitive standpoint, it seems as though endovascular repair of an abdominal aortic aneurysm would have far greater benefits than invasive, open surgery, including increased survival rate and decreased risk of infection, stroke and cardiac arrest.
“I do not believe that any vascular surgeon that performs EVAR (endovascular aortic repair), would offer this procedure to a younger, relatively healthy individual – one who is able to do bench presses or weight lift,” says Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
Dr. Gashti points out that if he himself had an abdominal aortic aneurysm, he’d opt for the open technique, given that his current state of health is otherwise good, and he also says that the open technique is the preferred method among the physicians who invented this procedure, if they too, had the condition. The world’s first EVAR was performed in Russia in 1987.
Dr. Gashti continues, “You have to realize that EVAR was originally thought of because we had patients with large abdominal aortic aneurysms but with significant co-morbidities which made them very poor surgical candidates.”
A co-morbidity is an additional ailment that has the potential to complicate a surgery beyond what are the normally-established complications.
For example, a co-morbidity might be poor kidney function. Open surgery on someone with impaired kidneys dramatically increases risk of life-threatening complications.
“So we told them to go home and hope that the abdominal aortic aneurysm did not rupture. Endovascular repair provided an alternative to this option for this group of patients,” explains Dr. Gashti.
Today, about 75 percent of abdominal aortic aneurysms are repaired via endovascular. Most patients are men over age 70.
Dr. Gashti continues, “But one has to realize that, yes, it is true that this is a very minimally invasive procedure, initially, but the rate of re-operation for things such as endoleak, migration, device separation, thrombosis, fracture, etc., is much, much higher than the traditional open repair.”
An endoleak refers to leaking blood. Migration refers to shift in position of the stent graft. Device separation means the stent separating from the aortic wall; “This is when different pieces of the stent graft separate from one another,” says Dr. Gashti. Thrombosis means blood clot.
He adds, “When I repair an abdominal aortic aneurysm openly, I do not image their abdomen for at least five years post-surgery, because there is no reason to do so. These procedures (surgical) have been proven to be very durable.
On the other hand, a patient post-EVAR needs a CAT scan of abdominal (abdomen)/pelvis with IV contrast (dye) every three to six months for the first two to three years, and every year after that for the rest of their lives; that is if everything is okay.”
Picture the hassle of all of these imaging tests, not to mention the anxiety of worrying that the next test might show a leak.
“Just imagine the amount of radiation and cost that is involved,” continues Dr. Gashti.
“This is because we still do not know what the long-term results of endovascular repair are.
“So for a younger individual – younger than 60-65, with a smaller aneurysm who wants to be active with isometric exercise, I think that it would be reasonable to consider repair, but only via open technique.”
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm. He received his medical degree from University of New England College of Osteopathic Medicine and has been in practice for more than 20 years.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/ilusmedical
Source: ctsnet.org/portals/endovascular/procedures101/exp_tech.html
Why Can’t Stent Grafts Repair Ascending Aortic Aneurysm?
A vascular surgeon explains the reasons why stent grafts are not the solution for ascending aortic aneurysms.
Perhaps you already know that stent graft repair of descending and abdominal aortic aneurysm is the repair procedure of choice for select patients.
I didn’t understand, then, why stent graft repair was apparently impossible with an aneurysm of the ascending aorta.
I thought maybe it had something to do with not being able to “feed” the catheter over the arch of this great vessel. Well, that’s hardly the reason.
Stent graft repair is also known as endovascular repair. The issue with “endo stenting” of the ascending portion of the aorta is the length of this section; it’s too short, says Seyed-Mojtaba (Moji) Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
Endovascular repair of the ascending aorta, to my surprise, is actually being done, says Dr. Gashti, but only for select patients, mostly at the Arizona Heart Institute.
He explains, “For endo stenting to work, you have to have adequate ‘landing zones.’ What this means is that you have to have ‘normal’ aorta both proximal and distal to the diseased (aneurysmal) area so that you get a good seal.”
Proximal and distal mean, in layman’s terms, on both ends of the aneurysm.
Without that good seal, a leak (called an endoleak) will occur, and the aneurysm will continue to be pressurized: a bad thing.
Dr. Gashti explains, that when he does a “TEVAR or EVAR (endo graft for thoracic aortic aneurysm and abdominal aortic aneurysm), a minimum of 20 millimeters of normal aorta is needed both proximal and distal to the aneurysm,” meaning, on either side.
The portion of the aorta that’s inside the heart is called the root. Attached to this area are the coronary arteries that feed blood to the heart.
These coronary arteries are the first branches (closest to the heart itself) of the ascending portion of this great vessel.
These first branches absolutely cannot be covered by the stent graft. After all, the stents are covered-type stents, not the bare metal type.
At the other “end” of the ascending aorta (the distal end) are branch-offs, or takeoffs, of the subclavian and carotid arteries.
Dr. Gashti says you certainly don’t want these to get covered by stent material, either.
“So by the time you add the landing zones and branches, not much room is left,” he says.
If you can visualize this scenario, it’s easy to see why stent grafting just won’t work for ascending aortic aneurysms — elongated aneurysms, that is.
“But for very focal aneurysms and particularly if they are saccular rather than fusiform, it is being done.”
- Fusiform is an elongated, more uniform bulge all around the great vessel’s circumference.
- A saccular bulge looks like a sack protruding from one side of the vessel.
Saccular can also mean a protrusion of short width encircling the vessel — imagine an expandable rubber tube the diameter of a dime, but at some point five nickels are stacked together inside it; imagine the shape this would cause to the tube.
Dr. Gashti continues, “The other problem is the aortic pressures that you have to deal with at the time of deployment — so close to the left ventricle — which will push your device away from the intended location; so these procedures usually require cardiac arrest at the time of deployment.”
In other words, the heart must be stopped for the surgeon to position the stent, and this means use of a heart-lung machine (cardiopulmonary bypass).
So now you know why stent grafting, as of 2014 when this article was published, is not a practical option for the repair of an ascending aortic aneurysm.
Update As of 2025: Stent Grafting in the Ascending Portion
- Stent grafts can be done in the ascending portion for an aortic aneurysm.
- However, stent placement here is complex and still in the experimental realm.
- The procedure is usually reserved for high-risk patients.
- The procedure involves a very customized, fenestrated or branched stent graft — and “debranching” of major arteries may be required. These arteries supply blood to the brain and arms.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm. He received his medical degree from University of New England College of Osteopathic Medicine and has been in practice for more than 20 years.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Rocketclips, Inc.
Can Exercise Lower the Risk of an Aortic Aneurysm?
If you do not do consistent structured exercise, your risk of developing an aortic aneurysm, when all other things are equal, is higher than if you were to stick to a regular exercise regimen.
Here is what a vascular surgeon says about exercise and lowering the risk of an aortic aneurysm…but first, I want to point out what I’ve read on medhelp.org.
I have read about athletes being diagnosed with thoracic aortic aneurysm – these are people in their 20s to 50s who have led active lives, including jogging or cycling, and lifting weights.
They are then diagnosed with a thoracic aortic aneurysm – a bulge or dilation in the aorta – as a result of an imaging test that was performed for an unrelated reason.
Nevertheless, can exercise actually help lower the risk of ever getting an aortic aneurysm in the first place?
“It is well-established that because exercise increases shear stress and promotes removal of lipid (fat) molecules from the luminal surface of the aorta – by increasing nitric oxide and prostacyclin (fat molecule) release – that it both directly and indirectly inhibits atherosclerotic processes and helps in both reducing one’s systemic blood pressure and risk of developing aneurysms,” explains Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
Atherosclerotic processes refer to progressive plaque buildup in the arteries — in this case, coronary.
What kind of exercise is most useful in lowering the risk of developing an aortic aneurysm?
This question mostly applies to people who do not have genetically predisposing conditions to aortic aneurysm, such as Marfan’s syndrome.
First of all, you should know that two risk factors for aortic aneurysm are high blood pressure and atherosclerosis. Plaque buildup damages the inner lining of blood vessels.
By preventing these two variables (high blood pressure and plaque buildup) from occurring, this will reduce a person’s risk of developing an aortic aneurysm.
What better way to control these variables than to exercise?
The issue then become what is the best type of exercise.
In people with normal aortic size and dimension, there are no restrictions with weightlifting workouts or aerobic activity.
A well-rounded fitness/exercise regimen should involve strength training or lifting weights (e.g., barbell, kettlebell, machine, body-weight), aerobic workouts and something extra — such as yoga or tai chi.
However, no studies have been done to determine specifically what type of activity (e.g., swimming, running, hiking, Pilates, general strength training, body-weight training, group fitness classes, martial arts, pedaling) is the best at lowering the risk of developing an aortic aneurysm.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm. He received his medical degree from University of New England College of Osteopathic Medicine and has been in practice for more than 20 years.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Iam_Anupong
Aortic Aneurysm & Blood Pressure: Is Losing Temper Safe?
A vascular surgeon comments on aortic aneurysm, and losing one’s temper and blood pressure rise.
According to one investigation, there is a strong link between aortic dissection (from pre-existing aneurysm) and extreme emotional stress—which would include a temper outburst.
A temper outburst would cause blood pressure rise. Blood pressure control is extremely important for people with an aortic aneurysm.
Patients are told to avoid heavy physical exertion such as heavy weightlifting or trying to install an air conditioner, as these can shoot up blood pressure, which can then cause conditions ripe for an aortic dissection.
Emotional stress, too, can raise blood pressure. Dr. John Elefteriades, an aortic repair surgeon, designed a survey of dissection patients.
Ninety responded regarding what they were doing right before the dissection occurred.
Thirty-six (40 percent) reported events that he categorized as severe emotional stress. Though this apparently is the only study of this kind, the results can’t be ignored.
Is it coincidence that 40 percent (although 90 is a very small number for a study) reported emotional stress (which of course is associated with high blood pressure)?
Must people with aortic aneurysms go through life tip-toeing on egg shells, suppressing their emotions, battling urges to vent their feelings about things in life?
“Losing one’s temper would increase the blood pressure and may result in aortic dissection in an individual with predisposing condition (medial cystic necrosis), but the effect on wall tension in an aortic abdominal aneurysm would most likely be negligible,” explains Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
So what does all this mean, then, as far as unleashing emotions?
“Not to say that you should go ahead and get angry all the time, but it is okay to get excited about your football team every now and then,” says Dr. Gashti.
Stress is a risk factor for high blood pressure (also known as hypertension), and that acute (sudden) stress can cause a dramatic rise, though it’s a temporary rise.
However, the transient nature of it can still have a devastating effect on a severely weakened aortic wall.
In fact, chronic hypertension can actually cause the aneurysm in the first place.
Hypertension even for people with healthy aortas can become a very serious, even life threatening condition.
It’s a powerful risk factor for stroke and heart disease, plus dementia and other major conditions.
What is medial cystic necrosis? This refers to a variety of metabolic conditions that affect the composition and structure of the middle layer of an aortic wall, says Dr. Gashti, by altering collagen, elastin, etc. This is seen in connective tissue disorders like Marfan’s syndrome, he points out.
He adds: “The most common consequence of this is aortic dissection; more than 90% of deaths in this group is related to aortic dissection, rupture, and sudden death.
“Aneurysms can also form in patients with this condition, but the incidence of that is low.”
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm. He received his medical degree from University of New England College of Osteopathic Medicine and has been in practice for more than 20 years.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Source: ncbi.nlm.nih.gov/pubmed/17950810
Aortic Aneurysm & Lifting Weights: Research Scarce
A vascular surgeon discusses the obscurity of research involving lifting weights with an aortic aneurysm.
The restrictions for lifting weights in people with an aortic aneurysm are, quite literally, all over the map.
It’s like a bell curve: Most doctors urge their patients with aortic aneurysm to lift no more than 25-50 pounds.
On one end of the bell curve are physicians who urge against just about ANY kind of lifting, meaning men should not lift more than 10 pounds, and women should not lift more than 5 pounds.
Think of how much these restrictions would disrupt a person’s life; being warned by their doctor to avoid carrying their own babies!
This means a woman with an aortic aneurysm should not lift her baby from a crib!
What if nobody else is there to pick the baby up? What if nobody is there to put her baby, let alone a heavier toddler, in the car seat?
The other extreme are doctors who warn against straining with heavy weights, but tell their patients with aortic aneurysm they can continue working out – just don’t bear down to the point of having to grunt and moan.
As a personal trainer with an interest in medicine, I dug very deep into this issue and came up with very little research.
“As far as hardcore data on what the weight limit should be for an individual with known thoracic aortic aneurysm or abdominal aortic aneurysm, I am not aware of any,” says Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
“It is well-documented that aerobic exercise will actually decrease the systemic blood pressure.
“However, exercise such as weight lifting, if done repeatedly in succession, actually causes significant increase in systemic BP.”
As a person progresses further into a weight set, blood pressure increases.
Pushing out those last few reps means that blood pressure is its highest, and the exercises that cause the highest blood pressure increase, when done with heavy resistance, are the deadlift, barbell squat, hack squat and leg press.
Freepik.com, pressfoto
Dr. Gasthi continues, “I believe that most of these recommendations are therefore at best conjecture and perhaps minimally common sense.”
Lifting Weights on the Job and Aortic Aneurysm
Weightlifting gyms across America are filled with people every day, yet one doesn’t hear about aortic dissections occurring left and right at gyms.
About 200,000 people every year are diagnosed with abdominal aortic aneurysms, and about 30,000 with thoracic aortic aneurysms.
So where are all the dissections that you’d think be brought on by lifting weights?
Yes, a statistically significant percentage of these diagnoses are in people under age 50, and more and more people over age 60 are hitting gyms as well.
Further, millions of people every day do heavy hoisting on the job. Where are all the dissections?
Dr. Gashti explains, “I think that 50 pounds,” including for people who lift on the job, “is not very much, but if you have a 7 cm AAA, you should probably not be lifting more than that.
“But if you have a 3.5 cm AAA, I normally tell my patients to go about their lives normally and am yet to regret these recommendations.”
Research on lifting weights with aortic aneurysm is scarce.
“I am not aware of any randomized controlled trials that have looked into these issues,” says Dr. Gashti.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm. He received his medical degree from University of New England College of Osteopathic Medicine and has been in practice for more than 20 years.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Kiselev Andrey Valerevich
Aortic Aneurysm: Are Deadlifts Safe to Do?
Dr. John Elefteriades, leading aortic disease surgeon, weighs in on the danger of deadlifts in people with an aneurysm of the aorta.
Though most aortic aneurysms affect older people, younger adults can be diagnosed with an aortic aneurysm, and older adults do lift weights for fitness and strength gains.
Thus, it is perfectly logical to wonder just how dangerous the deadlift is for a person with an aortic aneurysm.
Dr. Elefteriades is a weightlifter and also is William W.L. Glenn Professor of Surgery, and Director, Aortic Institute at Yale-New Haven, New Haven, CT.
Dr. Elefteriades refers to the deadlift as a “dangerous exercise” for a person with an aortic aneurysm.
The deadlift is especially dangerous because it requires the use of so many muscles.
Thus, at heavy weights (relative to the athlete’s strength, of course), this exercise has the potential to cause a rapid, extremely high increase in intrathoracic pressure.
Can a person, with aortic aneurysm, do deadlifts at a non-heavy weight?
After all, a deadlift refers to a type of joint motion, not to an amount of weight lifted. You can do a deadlift with a broom stick.
Dr. Elefteriades advises that an athlete with an aortic aneurysm limit a deadlift to just one-half his body weight.
As a former certified personal trainer, I’m initially thinking of the concept of half one’s body weight.
Suppose a new client of mine weighs 405 pounds: a morbidly obese person. This person has an aortic aneurysm less than 5 cm and not meeting surgical repair criteria.
According to the half body weight rule, this client gets to do deadlifts with a 200 pound barbell.
He won’t be able to at first, but according to the half body weight rule, it’s a safe goal to work towards.
Now suppose I get another client who’s been training for years and weighs 180 pounds, but is solid muscle.
He hires me to help him lose 10 pounds of body fat for a more chiseled appearance, and he’s so strong he warms up with a 200 pound deadlift.
Then he learns he has an aortic aneurysm (under 5 cm) after having a routine coronary calcium score test.
According to the half body weight rule, that 200 pound deadlift warmup is very off-limits, even though it’s easy for him to do.
Meanwhile, my 405-pound client, over time, has worked his way up to eight repetitions with 200 pounds — and he strains with every rep, barely completing the eighth one.
The 180-pound guy, because of his light body weight, gets “punished” for being only 180 pounds by the half body weight rule, being limited to just a 90-pound barbell: a total insult.
Something really doesn’t sound right here, because there would be significantly more intrathoracic strain (and hence a blood pressure spike), in the 405-pounder as he strains, struggles and grunts his way through eight reps at 200 pounds in the deadlift.
Whereas for the 180-pound man, a 200 pound deadlift would be a walk in the park, and hence, very little blood pressure increase.
So rather than a half body weight rule for aortic aneurysm, I wondered about a “no straining” rule that is based on subjective experience, rather than a numerical value.
Dr. Elefteriades explains, “The half body weight rule is for the average individual. There will be a moderate amount of strain for the amateur bench pressing half his weight.”
Though this article is about the deadlift, Dr. Elefteriades’ response applies to any major compound weightlifting exercise.
He continues, “A trained athlete can lift more to achieve a similar amount of strain.”
My 180-pound client might have to deadlift 300 pounds (1.6 times his body weight!) to experience the same degree of straining as my 405-pound client.
Dr. Elefteriades continues, “However, trained competitive bodybuilders achieve the highest aortic pressures ever recorded—up to 380 mmHg—normal is 120 mmHg.”
Even the sickest patients in hospital cardiac care don’t have blood pressures this high.
He adds, “We just advise prorating other exercises to the same perceived strain as with bench pressing 50 percent of body weight.”
The smaller the muscle group worked, continues Dr. Elefteriades, such as in triceps push-downs, the less strain even with max efforts, and hence, the less of a blood pressure rise, when compared to big compound movements like the deadlift, barbell squat and, of course, bench press.
So when it comes to the deadlift and aortic aneurysm, what’s the final verdict?
Well, suppose I get a third client; he too weighs 180 pounds but he’s not as strong as the other lightweight guy, but he’s been training for a while nonetheless and strains to deadlift 160 pounds eight times.
He’s just been diagnosed with aortic aneurysm; the 160-pound deadlift sets are over.
However, he easily knocks off a set of eight deadlifts at 115 pounds. No straining whatsoever. He whips through these quickly without a reduction in tempo.
According to the “no straining” rule, this is safe for him. For the other lightweight guy, a comparable easiness of effort is achieved at 200 pounds—making that safe for him.
Formerly the chief of cardiothoracic surgery at Yale University and Yale New-Haven Hospital, Dr. Elefteriades is working on identifying the genetic mutations responsible for thoracic aortic aneurysms. He is the author of over 400 scientific publications on a wide range of cardiac and thoracic topics.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Shutterstock/Ihor Bulyhin
Resistance Band Strength Training for Aortic Aneurysm
Here are guidelines for tension or resistance band training if you have a thoracic aortic aneurysm and are worried about a dissection from straining.
People with thoracic aortic aneurysms are typically told to avoid lifting weights or lift no more than half their bodyweight, but what about the safety of using tension tubes (resistance bands)?
Tension Bands and Tubes for a Thoracic Aortic Aneurysm
“The best guideline on this is to avoid a sensation of heavy strain in the exercise,” says Dr. John A. Elefteriades, MD, William W.L. Glenn Professor of Surgery, and Director, Aortic Institute at Yale-New Haven, New Haven, CT.
Shutterstock/aijiro
Research into specifically the safety or danger of resistance band or tension tube workouts in a patient with aortic aneurysm is non-existent. However, extrapolations can be made.
The general rule with aortic aneurysm is to avoid heavy lifting or lifting that causes you to strain, struggle or grunt.
According to Dr. Elefteriades, a workout program in a patient with aortic aneurysm can, indeed, include tension tubing or resistance bands, of which there are varying strengths.
The next question, then, is how effective are tension tubes at increasing strength, toning or building muscle?
Shutterstock/Ken stocker
I use resistance bands for a few routines only when I can’t get to the gym, but let me tell you, they can really pack a punch.
The thing about resistance bands is that you do not need to induce a sensation of strain to get a deep, searing burn.
Quite frankly, using tension bands for shoulder and chest workouts to “muscle failure” hurts to high heaven.
Shutterstock/InnerVisionPRO
And this happens without feeling the kind of straining that you’d feel if trying to lift up a super heavy barbell or carry a loaded file cabinet across a room.
But does workout pain equate to building strength and muscle?
Of course it does, but this doesn’t mean that “pain” is necessary to build strength and muscle, either.
For someone with aortic aneurysm, using tension tubes or resistance bands will create a good training effect because of several reasons.
Shutterstock/Aaron Amat
Without having to strain or struggle, the individual can harness results because tension bands force one to maintain tighter contraction levels.
This means recruitment of more muscle fiber than that from traditional weight implements.
Movement with tension bands is not affected by gravity, as it is with moving a dumbbell, barbell or a machine’s weight stack.
As a result, the movement can be done faster, for instance, with a shoulder press using resistance bands, than with a shoulder press using dumbbells.
Shutterstock/Maridav
In order to move quickly with dumbbells, you’d have to use pretty light dumbbells.
With a tension band you can use more relative resistance, yet move the band faster. Speed against resistance develops strength.
Resistance bands apply constant tension. With traditional weight implements, the tension tapers at points in the movement.
If you have a thoracic aortic aneurysm and have been lifting weights for a while and want to get a good bang for your buck without straining, get on a tension tube program.
The drawback is that resistance bands can’t do much for the hamstrings.
If you have a thoracic aortic aneurysm and have never lifted before, start lifting with tension tubes.
Formerly the chief of cardiothoracic surgery at Yale University and Yale New-Haven Hospital, Dr. Elefteriades is working on identifying the genetic mutations responsible for thoracic aortic aneurysms. He is the author of over 400 scientific publications on a wide range of cardiac and thoracic topics.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Shutterstock/Veronika Zakharova
Are Barbell Squats Safe with an Aortic Aneurysm?
Weightlifter and aortic disease repair surgeon Dr. John Elefteriades talks about squatting with a thoracic aortic aneurysm.
It’s devastating when a strength training enthusiast or bodybuilder learns he or she has a thoracic aortic aneurysm; this means that heavy weightlifting should be avoided.
A favorite with bodybuilders and other weightlifters is the barbell squat.
Jules43
Kiss Barbell Squats Goodbye?
But does the avoidance of “heavy” or “straining” weightlifting automatically rule out the barbell squat in an athlete with a thoracic aortic aneurysm?
For this article my expert source is John A. Elefteriades, MD, a weightlifter himself, and William W.L. Glenn Professor of Surgery, and Director, Aortic Institute at Yale-New Haven, New Haven, CT.
I’m a former certified personal trainer and was well aware that the general rule that doctors administer to their aortic aneurysm patients is that of avoiding lifting more than half their body weight.
I found this to be a very peculiar rule, because it doesn’t take into account an individual’s fitness level (e.g., strength, especially strength for a particular exercise).
Let’s say I have two clients (let’s make them women) with thoracic aortic aneurysm who were told by their doctors not to lift more than half their body weight. Both clients weigh 200 pounds.
One client can perform barbell squats easily with 200 pounds for 15 reps.
The other client strains and has to loudly grunt to complete eight reps at just 80 pounds—which, according to the half body weight rule, is safe for her to work with.
Though both women weigh the same, their body composition is strikingly different.
The strong client has a lot more muscle than the weak client.
Yet according to the half body weight rule, that strong client suffers with the same restriction as the weak client, even though the strong woman warms up with 200 pounds.
This one-size-fits-all restriction does not make sense.
Dr. Elefteriades tells me, “The half body weight rule is for the average individual.” That would mean my weak client. The average woman would struggle with an 80-pound barbell across her back for a squat.
“There will be a moderate amount of strain,” continues Dr. Elefteriades, “for the amateur bench pressing half his body weight.” The rules that apply to bench pressing also apply to the barbell squat.
He continues, “A trained athlete can lift more to achieve a similar amount of strain. We just advise prorating other exercises to the same perceived strain as with bench pressing 50 percent of body weight.”
This application can get tricky because for some people, benching half their body weight is a breeze, while for others, it requires straining.
So what, then, is the verdict when it comes to thoracic aortic aneurysm and doing barbell squats?
It’s simple: Don’t strain. If that means keep the barbell squat under 100 pounds, then that’s your rule. If it means keep it under 200 pounds, that’s your rule.
Just make sure that you are not straining, struggling, grunting or your face is turning red.
If the tempo of the barbell squat must be slowed down in order for you to complete the reps, it’s too heavy for a thoracic aortic aneurysm.
Formerly the chief of cardiothoracic surgery at Yale University and Yale New-Haven Hospital, Dr. Elefteriades is working on identifying the genetic mutations responsible for thoracic aortic aneurysms. He is the author of over 400 scientific publications on a wide range of cardiac and thoracic topics.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
Top image: Shutterstock/Veronika Zakharova
Aortic Aneurysm: Are Heavy Bag Workouts Safe?
See what aortic repair surgeon, Dr. John Elefteriades, has to say about heavy bag workouts and aneurysms.
When a person is diagnosed with an aortic aneurysm, he or she is warned to avoid exercise of a heavy or straining nature, because this will cause a significant rise in blood pressure—which can increase the odds of an aortic dissection.
But where do heavy bag workouts fit in?
Patients with aortic aneurysm are encouraged to do cardio exercise, but there is very little data on just what the limitations for aerobic activity should be.
Are heavy bag workouts safe (for people with an aortic aneurysm)?
“Not for patients with thoracic aortic aneurysm,” says John A. Elefteriades, MD, William W.L. Glenn Professor of Surgery, and Director, Aortic Institute at Yale-New Haven, New Haven, CT.
Thoracic aortic aneurysm. Shutterstock/Sebastian Kaulitzki
I was surprised at this answer because a heavy bag workout does not involve any lifting at all; one simply throws punching and kicking techniques at a heavy bag.
The increase in blood pressure, during cardio activity, is typically modest.
Some patients do have a hypertensive response to cardio (this can be determined with special testing), but my question applied to athletes in general who learn they have an aortic aneurysm, yet would like to kick and punch at a heavy bag.
Dr. Elefteriades elaborated: “I have a heavy bag myself. My concern stems from the fact that the impact has to be born by the body as a whole, and the torso, in some way.
“I am being cautious in my recommendation. I do not know any direct way to test this exercise, in terms of its immediate and momentary potential to raise blood pressure to dangerous levels.”
There are blood pressure monitors on the market that a person can wear on the arm or wrist that will record blood pressure during exercise.
But these will not be as accurate as a blood pressure test given in a formal, medical setting with more sophisticated equipment.
Perhaps what a person, with an aortic aneurysm, can do, is par back on fierce striking of the heavy bag.
Shutterstock/Oscar Carrascosa Martinez
Rather than focus, for example, on 10 all-out, as-hard-as-possible uppercuts, the athlete can go for duration more than speed and power—doing moderate-intensity uppercuts or crosses for several minutes. The same principle can be applied to kicking.
Though abdominal and descending aortic aneurysms are associated with older age, younger or middle-aged adults are more likely to be diagnosed with an ascending aortic aneurysm.
Because the vast majority of aortic aneurysms do not produce symptoms, many people do not know they have these, and usually, they are discovered by accident via imaging for an unrelated concern.
Thus, the prevalence of non-symptomatic aortic aneurysm is not known.
If patients wish to work out with a heavy bag, they should first consult with their cardiologist.
Formerly the chief of cardiothoracic surgery at Yale University and Yale New-Haven Hospital, Dr. Elefteriades is working on identifying the genetic mutations responsible for thoracic aortic aneurysms. He is the author of over 400 scientific publications on a wide range of cardiac and thoracic topics.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Shutterstock/Monkey Business Images
Biceps Curl Safety Guidelines for Aortic Aneurysm
Here are guidelines for safely doing biceps curls if you have a thoracic aortic aneurysm: guidelines straight from an aortic repair surgeon.
If you’ve been diagnosed with a thoracic aortic aneurysm and have been lifting weights for years, enjoying a buff physique, does this now mean you’ll lose that physique?
Well, if you’re in training for a bodybuilding competition, you’ll have to give up your dreams. But that doesn’t mean you’ll regress to flab.
For this article my expert source is John A. Elefteriades, MD, a weightlifter himself, and William W.L. Glenn Professor of Surgery, and Director, Aortic Institute at Yale-New Haven, New Haven, CT.
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Biceps Curls and Thoracic Aortic Aneurysm: Is There Hope?
I was reading an online aneurysm forum in which an older man, an avid weightlifter for years, had recently learned he had a thoracic aortic aneurysm.
He posted a message stating that he’d have to work on accepting the fact that he’d never have the biggest biceps in the retirement living community.
Here is what Dr. Elefteriades says: “Exercises on relatively small muscle groups—e.g., curls—do not easily produce as much strain and blood pressure rise as those involving large muscle groups—bench press, lat pull-downs, squats.”
This is great news for that older guy with the thoracic aortic aneurysm who thinks his biceps will shrink from ceasing weightlifting.
If you’ve been diagnosed with a thoracic aortic aneurysm, you can still train fairly hard—with isolation routines.
If you do enough biceps curls (and triceps push-downs and kickbacks with cables), you can get a pretty good pump and good muscle fiber recruitment—enough to stimulate growth.
You won’t get a body like Mr. America with only isolation routines like biceps curls, but you can still get some nice, symmetrical muscles, especially since there are so many variations of biceps curls.
Not only are there a ton of biceps curl variations, but intensity techniques can be applied even if you have a thoracic aortic aneurysm, because the biceps are such a small muscle group.
If you have a thoracic aortic aneurysm, you can safely do 21s with biceps curls.
This automatically requires a non-heavy weight, since 21 reps need to be completed.
Another safe intensity technique is the drop-set. Though the “pain” is significant when you force yourself to muscle failure with biceps curl drop-sets, the strain on the aorta isn’t sufficient enough to set off alarm bells.
You can build a round, hard biceps also with curls using tension bands.
Feel free to do biceps curls with a barbell, dumbbells, kettlebells and cables, preacher machines, spider curls, concentration curls, the whole nine yards — even if you have an aortic aneurysm.
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However, if you must break form to get the weight up, use a lighter weight. Form should always be solid, and this can be your guideline for keeping the workout as safe as possible.
If you have a thoracic aortic aneurysm, you can get very nice arms from lots of biceps curls, triceps work and even isolation shoulder work like lateral lifts, front raises and reverse flyes.
Just make sure you always exhale during the lifting phase and inhale on the release.
Formerly the chief of cardiothoracic surgery at Yale University and Yale New-Haven Hospital, Dr. Elefteriades is working on identifying the genetic mutations responsible for thoracic aortic aneurysms. He is the author of over 400 scientific publications on a wide range of cardiac and thoracic topics.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
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