Aneurysms and high-risk anesthesia

I’m looking for some advice—experience, insight, anything at all. My father is 74 and dealing with three aneurysms: one femoral (pelvic area) and two peripheral ones in his legs. The first one is actually growing; you can see it as a lump just below the groin, about 4-5 cm wide. His surgeon has already scheduled him for surgery because of the rupture risk. However, the anesthesiologist is flagging him as high-risk—an ASA IV case—given his history of severe heart disease, two prior bypasses, a stroke, and generally weak cardiac function. Honestly, even the medical team isn't entirely sure if they should proceed with the operation, but we won't know for certain until he goes into the hospital on December 7th for more testing. I’m feeling a bit lost. It feels like the "easier" path might be to skip the surgery, but I have no idea what the actual likelihood of a rupture is, or if there are any medications that might mitigate that risk.
If anyone has any insight on this, please help.

...look, there isn't some magic pill to shrink an aneurysm... the only way you're indirectly protecting those blood vessels is by keeping your cholesterol and LDL levels in check—think Lipitor or whatever similar meds they prescribe, plus actually sticking to a decent diet...

...since we're talking about surgery on the femoral artery, there might be a chance they could just go with spinal anesthesia—basically local—but I can't give you a definitive answer on that... just try to have a real conversation with the anesthesiologist about whether local is an option...

The anesthesiologist claims a spinal is just as risky for him—arguing that with general anesthesia, they at least maintain some level of control. Her verdict? "It’s either general or nothing."

Looking at the ASA IV classification, it’s pretty clear that the biggest threat to this patient isn't actually the surgery itself, but rather the physical toll of undergoing anesthesia.
It’s always tough to give a solid opinion when you're only seeing half the picture, but I’d say some form of regional anesthesia is definitely worth exploring here—besides a spinal block, which seems doable, a peripheral block might work, or even RIVA (regional intravenous anesthesia) could be a great way to go.
That whole "it's either general anesthesia or nothing" argument feels a bit too black and white to me, though at the end of the day, the anesthesiologist is the one who really knows what they're dealing with, so maybe grab a second opinion from someone who specializes in vascular or cardiac cases just to be safe.
Either way, the risk factor is undeniably high.
What would be a smart move is to check in with the vascular surgeon planning the procedure... (I'm assuming it's a vascular specialist, please tell me it's not someone else)... to see if there's any chance of stenting that upper aneurysm instead. You know, some of those advanced imaging centers out there, when they pair up with a really skilled interventional radiologist, can pull off all sorts of "intravascular repairs" by threading endovascular stents through catheters, all while just using local numbing agents.

I believe it would be wise to consult with an interventional radiologist, if they haven't already, to see if a graft stent is a viable option... After that, you might want to discuss the possibility of regional anesthesia paired with basal sedation with the anesthesiologist. It could be a reasonable approach, though of course, the attending anesthesiologist has the best grasp on the specifics of the case and may determine otherwise. It is certainly worth asking.

Honestly, thank you all so much—it’s been rough, and every bit of advice or scrap of hope regarding other options really helps me through.
My dad has an appointment on December 7th for some vascular tests at General Hospital; once those results are in, we'll finally be able to sit down and discuss what our actual moves are. In the meantime, does anyone have a recommendation for a specialist—maybe an anesthesiologist or a vascular surgeon—or perhaps a different hospital or private practice worth looking into?

I've already been digging through some articles on stent grafts—apparently, they're seeing fantastic results over in San Francisco. It might be something they're offering at General Hospital too, but if not, we'll head to San Francisco or wherever else we need to go. As long as it's an option for my dad...

Professor Dr. Josip Mašković does excellent work over in San Francisco... I'm not entirely sure who is leading the way up in Washington, D.C.

I reached out to Dr. Mašković—he’s absolutely wonderful. He asked me to send over my test results to see if we can move forward with stent grafts. Fingers crossed, everyone. And honestly, thank you all so much; I never would have found him without this group.

You're very welcome, it was truly my pleasure 😁 best of luck with your dad