Did you know Abdominal Aortic Aneurysm ranks among the most significant and deadly cardiovascular diseases? In the US over 1.1 million people ages 50-84 are living with a significant sized aneurysm. Of these, only 15 percent are diagnosed and only 6 percent treated. There are 15,000 deaths in the US each year — mostly from rupture. It is the 13th leading cause of death in the US each year. Prevalence is men over women 5:1. However, death rates are higher in women.
Risk factors for Abdominal Aortic Aneurysm include: male sex; over age 65; family history of smoking; hypertension; Caucasian; and other aneurysms elsewhere in the body.
Most patients have no symptoms until an impending rupture causes abdominal and back or flank pain. Free ruptures are almost all fatal… contained ruptures have a mortality of 50 percent. This is a true surgical emergency.
Abdominal ultrasound is a rapid screening test but contrasted CT scan is the gold standard for diagnosis.
The natural history of abdominal aneurysm is to expand and rupture. Once an aneurysm exceeds five cm or twice the size of the patient’s normal sized aorta around the kidney arteries, risk of rupture rapidly accelerates. The bigger the aneurysm, the greater the risk of it rupturing. It is much like blowing a bubble with bubble gum. The larger the bubble, the greater risk of it bursting.
Treatment for Abdominal Aortic Aneurysm includes open surgery with graft replacement and endovascular stent graft replacement.
Open surgery requires a 2-3 hour operation through a long abdominal incision with a 24 to 48 hour intensive care stay and a 5 to 10 day hospital stay.
Nowadays, most aneurysms can be treated with an endograft stent placed through small incisions in the groin. This requires only about an hour of operative time and patients are usually discharged within 24 hours. The endograft technique does require yearly CT scans of the abdomen. In the near future yearly ultrasounds done in the surgeon’s office may replace CT scans.
Screening saves lives! Men and women with family histories of aneurysms and men age 65 or over who have smoked at least 100 cigarettes in their life can benefit from a free screening paid for by Medicare. This is a one time free ultrasound screening that Medicare covers the cost of in your welcome to Medicare exam.
Get screened! Risk of death with elective EVAR (endovascular) repair is less than one percent. Risk of death with repair after the aneurysm starts rupturing remains at 50 percent with either open or EVAR repair.