Abdominal aortic aneurysm (AAA) is an abnormal expansion in the abdominal portion of the aorta, the largest artery in the body. It develops when the aortic wall weakens and eventually starts to bulge. AAA develops slowly and most often does not cause symptoms. If the aneurysm gets too big, then it can rupture, or tear, resulting in massive internal bleeding and death. Most people do not survive a rupture. Ruptured abdominal aortic aneurysms are one of the leading causes of death in the elderly in the United States - killing approximately 15,000 Americans each year. The aneurysms are highly treatable and curable in 95 percent of men and women when detected before rupture occurs.
Dr. Richard DeMasi, a vascular surgeon in Norfolk, Va., talked with us about how people can protect themselves from a ruptured abdominal aortic aneurysm.
Q: What causes abdominal aortic aneurysms?
A: No one knows exactly what causes them. It was once thought that hardening of the arteries was involved, but that is not the case now. It seems that genetics, smoking and abnormal enzymes may erode the aortic wall, causing it to weaken and bulge.
Q: Who is most at risk for abdominal aortic aneurysm?
A: Men, smokers, anyone 65 and older and anyone with a family history among their first degree relatives - that's mom, dad, brother or sister. People most at risk should ask their doctors for an ultrasound test. They generally cost about $100. Aneurysms can also be detected without an ultrasound, provided that the patient is reasonably thin.
Q: Do children ever get abdominal aortic aneurysms?
A: It almost never happens in young people or children. There are some inflammatory diseases as well as traumatic injuries that could cause it, but it's rare.
Q: How are abdominal aortic aneurysms treated?
A: It depends on their size to some degree. An aneurysm whose diameter is less than 4 centimeters, which is about the size of a small orange, is generally left alone, but monitored every 6 to 12 months to see if it's changed.
Aneurysms larger than 5 centimeters - or the size of the average fist - should be repaired surgically. But a patient's treatment also depends on how risk surgery could be for them.
Q: How do you surgically repair an abdominal aortic aneurysm?
A: For a long time, we opened the abdomen and replaced the aorta with a prosthetic tube made of a material like GoreTex. It's flexible and lasts for a long time. Now, we are also able to put a stent in the aorta. The stent fits like a sleeve inside the vessel, channeling the blood flow. Over time, the aneurysm collapses around the stent, which shrinks the aneurysm and reduces the risk of rupture.
Q: Are there free screening programs available?
A: Yes. As of January 2007, Medicare is offering a free, one-time, ultrasound screening benefit to check for abdominal aortic aneurysm in men who have smoked at least 100 cigarettes during their life, and people with a family history of abdominal aortic aneurysm as part of their Welcome to Medicare Physical Exam. The exam must be completed within the first six months of Medicare eligibility.
The Medicare program is a major step forward, but it falls a little short. It's limited to people who meet the criteria upon entry into the Medicare system. The benefit does not apply to people covered by Medicare already.
Published On: November 12, 2007