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Abdominal Aortic Aneurysms: A Silent Threat

Posted Aug 24 2008 1:49pm
ANNOUNCER: An aneurysm is an abnormal enlargement or bulging of an artery, caused by damage or weakness in a blood vessel wall. If left untreated, the vessel can burst and become deadly.

THOMAS RILES, MD: Aneurysms can occur in almost any part of the body. They can occur in the aorta, in the abdomen, in the chest, in the brain. They can occur to an artery in a kidney, a liver. Virtually any vessel in the body can create an aneurysm. The most common aneurysms that we see in our population are in the aorta of the abdomen.

ANNOUNCER: Abdominal aortic aneurysms are responsible for 1 to 2 percent of all deaths in men over the age of 65 and account for 15,000 deaths annually in the United States.

THOMAS RILES, MD: The aorta is the largest blood vessel in the body. It starts at the heart, makes an arch in the chest like a candy cane, coming down through the chest and into the abdomen. It stops right at the level of the belly button, where it splits into branch arteries going on to the legs.

The normal size of an aorta is about the size of a quarter or a half -dollar, which would be 2 centimeters to 2.5 centimeters. Anything larger than 3, we use the term "aneurysm."

ANNOUNCER: The natural progression of any aneurysm is that it slowly grows and the "bulge" becomes larger over time.

THOMAS RILES, MD: After they reach a certain size, the walls become so weak that they can rupture and bleed.

Only about 25 percent of individuals survive a ruptured aneurysm. Usually the bleeding is internal; it's so rapid that most individuals can't survive.

ANNOUNCER: Aortic aneurysms are more common in men than in women and are usually seen in people over the age of fifty. Additional risk factors include a family history of aneurysms, high blood pressure, hardening of the arteries and smoking.

One of the main reasons that aortic aneurysms have such a high mortality rate is that in most cases there are no recognizable symptoms. In fact, most aneurysms are found by accident through a physical exam, such as an annual physical, or by an ultrasound or CAT scan being performed for some other reason. Once an aneurysm is detected the choice of treatment depends on its size.

THOMAS RILES, MD: Generally, aneurysms that are less than 5 centimeters, the chance of rupture is very, very small, perhaps maybe 1 in 500.

Most of us will not recommend surgery, but will recommend that the patient have serial measurements over the next year or two. The rationale here is that most of the treatments are probably at a higher risk than the risk of the rupture. Once the aneurysm is larger than 5 centimeters, then we start talking about treatment options, which is usually some sort of a surgical procedure to replace the weakened blood vessel with a new synthetic graft that will act as their new aorta.

ANNOUNCER: If surgery is recommended, there are two types currently being performed.

THOMAS RILES, MD: The classical procedure that was developed in the 1950s requires an incision in the abdomen. The aorta has to be isolated; clamps are placed on the vessels to stop the blood flow, and then the graft is inserted as an interposition between the good artery above and the good artery below.

The second type of surgery has been developed only the past decade, and it's called an endograft. Essentially it's the same type of graft, but rather than opening the abdomen to sew it in, the graft is threaded up through the artery in the leg, and then opened up, deployed to make a bridge across the aneurysm.

ANNOUNCER: The risks associated with surgery on aortic aneurysms is primarily heart attack as the procedures can be stressful on the heart. Bleeding, clotting, and infection can also occur, however, the risk of death or severe complication from surgery is low: approximately 2 percent.

Because of the high mortality from undetected aneurysms, the issue of screening has become increasingly important. And in 2005, the US Preventative Task Force released new recommendations, specifically for people at high risk.

THOMAS RILES, MD: The US Preventative Task Force has recommended that men who are smokers who are between the ages of 65 and 75 have an ultrasound to detect abdominal aortic aneurysms.

ANNOUNCER: Unfortunately, this recommendation was not carried to women but it doesn't mean that this not also a woman's disease.

THOMAS RILES, MD: If a patient has a screening test, and the aorta is less than 3 centimeters, the recommendation is that that is enough. They don't need to be followed again for perhaps up to 10 years. If the aorta is between 3 and 4 centimeters in diameter, then they should be followed every year with another ultrasound. If it is between 4 and 4.5 centimeters, the frequency of testing should be every six months. Of course, if the aorta is larger than 5 centimeters, then the patient would be advised to have treatment right away.

ANNOUNCER: It is estimated that half of the individuals that currently die from aneurysms each year could be saved by this simple, painless test.

THOMAS RILES, MD: The tragedy about aneurysms is that most individuals who have a rupture and might die from an aneurysm never knew that they had the aneurysm before. What we really would like to do is to have a program so that individuals who are at risk can have screening, and they can be told whether or not they are at risk, and if they are, that they could be advised to have appropriate treatment.

Now that this recommendation has come out from the task force, I think it will be much more likely that hospitals will be opening up screening centers for abdominal aortic aneurysms.

ANNOUNCER: For a screening center near you log on to www.vascularweb.com.

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