An aneurysm of an artery is one of the most common blood vessel diseases causing disability and death. Aneurysms are defined as a permanent and focal widening of an artery at least 50 percent greater in width than the normal size of the vessel. More than 70 percent of all aneurysms involve the aorta (the largest artery in the body) located in the abdomen. In the United States, ruptured abdominal aortic aneurysms, or AAA, are the tenth leading cause of death in men older than age 55 and the fifteenth leading cause of death overall. The median age for a rupture to occur is 76 years old for men and 81 for women. The overall death rate associated with a rupture is 78 percent, most of which occur outside of a hospital setting.
In addition to being male, risk factors which may cause an abdominal aneurysm include being of advanced age, being of the white race, having a family history of aneurysms, smoking, high blood pressure, high cholesterol, and having other blocked arteries and diseases of the heart’s arteries. Smoking is the single most important factor which causes aneurysms to form. Thus, stopping smoking is critically important for the prevention of aneurysm formation.
Although aneurysms are less common in women, women with aneurysms are more likely to have affected relatives. For a given patient with an aneurysm (male or female), however, brothers are at least twice as likely as sisters to have aneurysms.
Because aneurysms cause no symptoms, they are often not discovered until they rupture. Ultrasound screening for aneurysms is recommended for people at risk. Medicare reimburses ultrasound screening for aneurysms for men at risk as a part of the “Welcome to Medicare” physical examination.
There is no proven drug for aneurysms; surgery is the only effective treatment. Risk of rupture increases substantially once the diameter of an aneurysm increases to greater than 5 centimeter. Therefore, repair should be considered for any AAA that is at least 5 centimeter in diameter. Traditional open surgery is a “mature” technology having been performed for many decades. This involves an incision in the abdomen, a stay in intensive care, a hospital stay of nearly a week and a three month period before reaching complete recovery.
Another approach, known as “Endovascular aneurysm repair” uses only a needle puncture in the groin, x-rays, and stent grafts to treat an aneurysm. This technique significantly reduces time spent in the hospital as well as operative death rates. A patient’s hospital stay is typically just one to two days, with complete recovery occurring within a week. This technique also requires regular follow-up with CT or ultrasound images, however, to ensure the graft remains in good position and that the aneurysm has not changed in size. In some centers this technique has all but replaced open surgery for treatment of aneurysms.
The imaging department at Brattleboro Memorial Hospital has the ability to perform abdominal ultrasounds, which can evaluate the size and extent of aneurysms. If an AAA is located in the head or chest, a CT scan would be performed. In addition, the hospital recently partnered with Dartmouth Hitchcock Medical Center and the healthcare technology provider, M2S, to perform CT scans for AAA which can then be used for surgical planning. After BMH performs the CT, M2S takes the image and custom builds stents for aortic repair. The insertion of the stent and other, more invasive surgeries would be performed at DHMC or another tertiary care center. The patient would then return to the BMH Center for Cardiovascular Health for their follow-up care and post-operative imaging as needed.
Daniel Walsh, MD is a member of the medical staff at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. He sees patients at the BMH Center for Cardiovascular Health two afternoons a month. He can be reached at 802-275-3699.