Improving Survival with AAA

Question: What do Albert Einstein, Lucille Ball, Conway Twitty and my high school physics teacher have in common?

Answer: They all lost their lives as a result of a ruptured (or dissecting) abdominal aortic aneurysm (AAA).

Unlike many fatal illnesses that are preceded by warning signs, a ruptured AAA tends to happen suddenly and spontaneously. Usually described as either a searing, ripping or tearing pain it’s generally the worst pain the patient has ever experienced.

There are no early signs. It just happens. It presents as sudden severe chest pain, oftentimes between the shoulder blades,” says John Eidt MD, head of vascular surgery at the University of Arkansas Medical Sciences Medical Center.

An AAA is a bulge in the large blood vessel that supplies blood to the abdomen. The bulge typically develops slowly over many years. The larger the aneurysm, the more likely it is to rupture and cause massive bleeding.

Dissection occurs when the aorta tears due to high blood pressure or a trauma and blood leaks out of the wall of the aorta eventually stopping the blood supply to the kidneys, brain, bowels and other extremities.

A burst AAA causes massive internal bleeding that few survive. My physics teacher was playing squash when his ruptured and never even made it off the court.  Of the 15,000 or so Americans who suffer AAA ruptures each year, about 80% die before they get to the hospital. Among patients who make it to the hospital in time, only about 50% survive traditional open surgery, during which a surgeon makes a large incision in the abdomen and replaces the damaged portion of the aorta with a Dacron tube.

However a new minimally invasive endoscopic procedure is changing all that.

Loyola University Medical Center vascular surgeon Dr. Richard Hershberger and his vascular colleagues are pioneering a technique known as endovascular surgery. In the last four years, they have performed endovascular surgery on 12 patients with ruptured AAAs, and they all survived.  The endovascular technique involves inserting a catheter into a groin artery, guiding it through blood vessels to the site of the burst aneurysm and inserting a GoreTex® stent graft that allows blood to flow safely through the stent, rather than gushing into the abdominal cavity.

Despite the improved odds of survival, SRxA’s  Word on Health should point out that it is much easier and safer to repair an aneurysm before it bursts. Risk factors for AAAs include smoking, high blood pressure, high cholesterol, male gender, emphysema, and obesity. As such, all  men 65 and older who have smoked more than 100 cigarettes in their lifetime should be screened for AAA’s.

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