Health Secrets	UPDATED: Tuesday, August 26, 2008
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A different heart problem

Posted on Tuesday, August 26, 2008

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

Every year 200,000 people in the U.S. are diagnosed with an enlargement of the body’s largest artery, the aorta. The aorta runs from the chest to your legs, where it branches into two smaller arteries. When the enlargement is within your abdomen (the area from the breastbone to the navel housing most of your internal organs), it’s called an abdominal aortic aneurysm (AAA).

“An AAA’s greatest danger is that it can rupture. Then chances of survival are poor,” says Tom Morris, D.O., Erickson Health physician at Monarch Landing, an Erickson-built and -managed community in Naperville, Ill. The good news— especially for older adults in whom AAA tends to surface most often—is the advances in both AAA diagnosis and treatment.

Getting a heads up
“Usually an AAA is discovered while someone is having an ultrasound or a CT scan for something else, like a gall bladder, back, or abdominal pain,” says Vivienne Halpern, M.D., vascular surgeon, North Shore-LIJ Health Systems, Manhasset, N.Y. “Advances in imaging are helping us discover an AAA earlier. Sometimes even a simple X-ray now shows an outline.”

To enhance the chance of detection, people at risk should be tested regularly. “After age 60 both men and women can develop an AAA, but it’s five times more likely in men. Other risk factors include family history, high blood pressure, and smoking,” Morris says. “I encourage people at risk to have an ultrasound whether or not their insurance covers it.”

That may be especially important for women. “Once women develop an AAA they’re four times more at risk for rupture,” Halpern says.

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Controlling the aneurysm
If the abdominal aneurysm expands to 3 cm in diameter, it is considered to be an AAA. “Our job is to keep it from growing and to decrease the risk of heart attack and stroke,” says Elizabeth Ratchford, M.D., director of the Johns Hopkins Center for Vascular Medicine in Baltimore, Md. She is a vascular medicine specialist (someone who cares for arteries, veins, and other areas of the circulatory system, but not the heart itself).

“I’d consider using the same steps in someone with an AAA as for someone with heart problems: stop smoking, weight loss, and exercise. “I might also choose among many drugs for thinning blood, lowering cholesterol, or improving blood pressure function,” Ratchford says. You should have an aneurysm checked every six months to a year (depending on its size and your risk factors) either by a specialist, a vascular surgeon, or your primary care doctor.

When surgery is needed
“When an AAA increases to 5 or 5 ½ cm it’s generally time to consider surgery,” Halpern says. “An AAA is like a balloon, the larger it expands the more likely the chance of rupture. Over a five-year period the rupture risk increases 50% at 5 cm, 60% at 6 cm, and so on.”

“Your age isn’t as important as your physical condition in determining whether you qualify for surgery,” says Bruce Perler, M.D., chief of the division of vascular surgery at Johns Hopkins.

There are now two different surgical options. “The traditional method is where we open the abdomen, bypass the aneurysm, and sew in a bypass graft,” Perler says. “Opening the abdomen means it takes a fair amount of time to heal—about a week in the hospital and you feel wiped out for about three months,” Halpern says. That makes it more stressful for an older patient; but once it’s fixed there’s no additional monitoring, as in the next procedure.

“Since the late 1990s we have another option called an endovascular procedure: We make small incisions in the groin, insert catheters, and slide in a bypass device called a stent graft,” Perler says. “This surgery is less invasive, so it generally offers fewer complications and risks. People can be out in a day or two and back to normal function within a week,” Halpern says. That makes it easier on someone older. “But this procedure requires constant monitoring, first for several months and then at least every year.”