QUESTION: What can we do about a medical issue that 1) involves the largest, most important blood vessel in the body, 2) has few, if any, symptoms and 3) has a 90% risk of death if it ruptures?
ANSWER: If you are a man, a smoker and are age 65-75, the U.S. Preventive Services Task Force recommends an immediate ultrasound screening by your physician or a vascular specialist for an aortic aneurysm.
“The aorta (ay-OAR-tuh) is the main artery coming directly from your heart, delivering blood to your organs and throughout the body,” explains McLeod Vascular Surgeon Dr. Christopher Cunningham. “A number of factors can lead to a bulge or ballooning in a section. A normal aorta is about the size of a garden hose. If the bulge gets too large, the wall of the artery bursts, causing massive internal bleeding, leading to a 90% death rate. That is why it’s important to catch the aneurysm before it ruptures.”
Aortic Aneurysms (bulges) can be found in the chest or stomach area. Thoracic (chest) aneurysms occur equally in men and women and are sometimes associated with inherited connective tissue conditions. The Abdominal (stomach) Aortic Aneurysm (AAA) is more likely to affect men over age 65. Smokers are 8 times more likely to have an AAA than non-smokers.
More than 75% of the Abdominal Aortic Aneurysms are discovered coincidentally as part of a routine exam or evaluation for another condition. The bulging blood vessel may first appear in a chest X-ray. Ultrasounds, CTs or MRIs are used to further pinpoint the size and location of the aorta’s weakened section.
If the bulge in the aorta is small enough or growing slowly, your physician may take a “wait and see” approach. One recent study suggests two servings of fruit a day can lower your risk of a lethal aneurysm.
Once the aneurysm has tripled in size (to as large as a lemon), the chance of a rupture rises to 50% and surgery will likely be the recommended.
Open Abdomen or Open Chest Surgery
For more than 50 years, vascular surgeons have successfully entered the chest or stomach through an incision. The weakened portion of the artery is removed replaced with a graft of man-made material that should last the remainder of the patient’s life. Patients are in the hospital about a week and are fully recovered in 4-8 weeks.
Using a small tube (catheter) inserted near the groin, the surgeon uses an x-ray to guide the tube inside the aorta to the weak point. A graft of man-made material is expanded from the inside and fastened in place. Patients are out of the hospital in one or two days and back to their daily activities in about a week.
Final Thought. The endovascular technique is not possible in every case. Your vascular surgeon will help determine whether this or standard surgery is the best approach. But it’s your responsibility to make an appointment and start the screening process.
Sources include: McLeod Health, US Agency for Healthcare Research & Quality, National Library of Medicine, National Institutes of Health, Centers for Disease Control & Prevention, Society of Thoracic Surgeons, US Department of Health & Human Services, American Heart Association, Vascular Disease Foundation.