Important Information About Abdominal Aortic Aneurysms
Many people are not familiar with the term
"abdominal aneurysm," or its full name. An abdominal aortic aneurysm
(AAA) is a pathological expansion in the abdominal aorta. The condition
is usually asymptomatic and can be thought of as a "silent killer."
According to Dr. Frank Levi, a senior vascular surgeon, the prevalence
of this condition in people over 65 is between 2-12%. It is estimated
that about a thousand people develop a life-threatening abdominal
aneurysm every year. Still, only 60% of them receive preventive surgery
when their aneurysm is diagnosed before it ruptures. If it does rupture,
the risk of mortality is incredibly high, over 90%. Men over 65,
current or former smokers, and those with first-degree relatives who
have aortic aneurysms are all at risk.
Before the 1950s, Dr. Levi explains, there
was no reliable way to manage the illness. Today, the test is
recommended to those aged 64 and up who have smoked in the past and/or
currently, even if it was only in small amounts and for a short period,
as well as to those with a close relative with the condition. Tobacco
use and arteriosclerosis weaken the aorta wall, initiating an
asymptomatic process where the artery, which usually measures 2-2.5 cm,
starts to expand like a balloon, resulting in an aneurysm more than 3 cm
in diameter. This process has been developing for years, "below the
surface." One of the problems is that there are usually no symptoms.
The aorta expands slowly over many years.
When it reaches a life-threatening diameter, a rupture may occur and
then there is an immediate danger to life. "When the aneurysm ruptures,
it leads to massive bleeding inside the body, and the person experiences
abdominal pain and/or severe back pain accompanied by hemodynamic
collapse (a state of shock/shaking, i.e. very low blood pressure) and
usually loss of consciousness."
After that, there are two possibilities:
the person succumbs to the bleeding in a few minutes, or the bleeding is
contained, and they manage to get to a hospital. In fact, the only way
to save their life is to perform emergency surgery to repair the
aneurysm and stop the bleeding. "As long as the aneurysm is not
repaired, the patient is in immediate danger throughout their life,"
said Dr. Levi. "It is important to note that even organizing this type
of surgery and completing it is a complex matter and may take several
hours." It is often the case that an abdominal aneurysm does not produce
any symptoms.
This is why it is recommended to perform a screening if you're in a
high-risk group. The test is non-invasive, quick, and painless, and it's
done through abdominal ultrasound. If the test result reveals the
diameter of the abdominal aorta to be over 3 cm, then it is considered
an aneurysm, though mostly a small one that is not a major danger to the
patient's life. Alternatively, a CT scan of the prostate or abdomen may
be done.
The treatment is effective. When an aneurysm is identified via
ultrasound or any other scan, the patient must be referred to a vascular
surgeon for further review and to determine if treatment is needed.
This is because many of the aneurysms are too small, do not require
treatment, and only need a monitoring plan.
For men, an aneurysm with a size of 5.5 cm
or more is an indication for treatment, while for women, the size must
be 5 cm or greater as they usually have a slimmer aorta. A growth rate
of 1 cm per year is another factor that might warrant treatment. If the
aneurysm is smaller than that, the danger of it bursting is relatively
low. Therefore, surgery may not be the best option due to the risks
involved.
Nevertheless, these patients still need to
have a follow-up plan for the aneurysm. Presently, when there is a
requirement for an aneurysm to be treated, most operations are done with
a minimally invasive approach as compared to the past when the surgery
had higher chances of risks and complications. The procedure currently
used is catheterization, wherein surgeons enter the vascular system
through the arteries situated in the groin, navigate through the
vascular system from the groin to the blood vessels in the abdomen and
pelvis, and place a cloth-covered stent inside the blood vessels. This
technique covers the entire aneurysmal area, and the blood flows beyond
the stent, achieving a success rate of more than 95% with very low
levels of complications, only a few percent.
In conclusion, the best course of action is to abstain from smoking or
get regularly checked. The ultrasound test is quick, straightforward,
non-intrusive, and poses no discomfort. The elective surgery to fix the
aneurysm includes hospitalization, but generally, it goes well, and the
patient can come back to their home and life after a brief period of
time.