Aortic Aneurysm
What is an Aneurysm?
An aneurysm is an abnormal
ballooning of an artery wall to 1 ½ times the normal
diameter. This most commonly occurs in the
abdominal aorta, the largest vessel in the body, which
carries blood from the heart to all the abdominal organs
as well as the legs. Abdominal aortic aneurysm (AAA)
affects between 3 and 9% of the population being much
more prevalent in males and especially if you have
a close relative who had a AAA. It is
estimated that 1.5 million Americans have a AAA but
only about 50% of those have been
diagnosed.
Normal
aorta
Dangerous ballooning of the artery
If
this is such a large problem, why isn’t routine testing
performed? Aortic aneurysms develop
slowly and are often asymptomatic, leaving the problem
largely undetected and untreated. Few doctors routinely
inquire about aneurysm histories in patients, making this
one of the most neglected diseases.
Aneurysms occasionally cause pain or
discomfort by the pressure put on surrounding
structures (like back pain if it irritates the nearby
backbone) or small blood clots from inside lining of the
aneurysm may break off and block the circulation to the
legs or feet. Unfortunately, most aneurysms cause
NO SYMPTOMS until
they rupture. Rupture results in massive internal
bleeding usually causing severe pain with shock and loss
of consciousness. Unfortunately, the majority
of people with AAA rupture will die so it is
important to know if AAA is present. An AAA is usually
discovered on physical exam by the physician, or during
an x-ray examination done for other reasons. If you or
your physician are worried that you might have an AAA, an
ultrasound can easily detect this
problem.
We know that aneurysms below a certain
size are unlikely to rupture so if an aneurysm is
discovered, regular follow-up is required to determine if
the aneurysm is enlarging.
Figure
1
Figure 2
Fig. 1 A duplex ultrasound
of a noraml aorta - note the smooth uniform walls
Fig. 2 Note the variable
dimensions of this aorta - called "aortic ectasia". While
not quite large enough to be classified as an aneurysm, this
should be watched with regular duplex scanning.
Figure
3 Figure
4
Figure 3 A small saccular
aneurysm of the abdominal aorta
Figure 4 A large abdominal aortic
aneurysm that would be considered for intervention
Aortic
aneurysms can be successfully treated - If
identified early enough!
Aneurysms
have been studied for many years so we know a good deal
about them. For instance, aneurysms below 5 centimeters are
very unlikely to rupture. So aneurysms less than this need
regular follow-up with duplex ultrasound every 6 - 12 months
to check for enlargement. For aneurysms larger than 5
centimeters, repair is usually recommended unless the person
has other conditions that would make the procedure more
risky, such as bad heart disease for example. Repair is
traditionally done surgically through an incision in the
abdomen. A synthetic graft is sewn in above and below the
aneurysm, excluding it. This procedure has been performed for
over 40 year and is highly successful. More recently, endovascular repair is being
performed. In this operation, a synthetic graft is the graft
is inserted inside the aneurysm through a small incision in
the groin. Special stents hook the graft in place above and
below the aneurysm, effectively excluding it. This procedure
does carry its own set of risks and complications and can
not be performed in all patients but is an exciting
development in the treatment of this life threatening
disease.
Screening can save
lives! Due to insurance regulations,
physicians generally cannot order tests unless there are
specific signs and symptoms of disease - a problem for
detection of aortic aneurysm and much peripheral vascular
disease. However, according to a study published in
The Lancet, a British medical journal in November
2002, thousands of the elderly individuals with abdominal
aortic aneurysms could be saved each year with regular
screening programs. Today, most aortic aneurysms can
be detected with a simple, painless and effective
ultrasound-screening test. Find out today if you have the
“silent killer!”
These tests can be performed at the request of
the patient and do not require a physician order! Simply
contact us for an appointment.
Click here for
mor information of QVI's Screenings
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