by Andy C. Chiou, M.D., M.P.H., F.A.C.S.
Originally Appeared in The Peoria Woman, July 2004

With the recent publicity surrounding the Race For The Cure, the important topic of breast cancer has been brought to the forefront once again. And while breast cancer kills thousands of women a year, there is another deadly condition that women need to be aware of – not just for themselves, but also for their loved ones.

It’s called an Abdominal Aortic Aneurysm (AAA). And it can be a silent killer. Look at these startling statistics: About half of the people with ruptured aneurysms never make it to the hospital. Of the half that do make it, many die before or immediately after emergency surgery. In all, 75-85% of people that rupture an aneurysm outside of the hospital will die. Most didn’t even know they had an aneurysm.

In fact, 15,000-30,000 people die each year from ruptured aneurysms – compare this to approximately 32,000 people that die annually from prostate cancer and about 42,000 women who die each year of breast cancer.

What is an abdominal aortic aneurysm?

It is a weakening of the aorta, the largest blood vessel leading out of the heart. Most of these aneurysms occur in the abdomen rather than the chest because of the differences in the chemical and tissue matrix that makes up the blood vessels in the different locations. Compared to the aorta in the abdomen, the aorta in the chest has a lot more of a substance called “elastin.” We think that aneurysms in the abdomen are caused by an imbalance of enzymes in the blood vessel wall that essentially causes a “self-digestion” and weakening of the wall. This eventually results in a ballooning out of the blood vessel, and like a helium balloon, the wall gets thinner as the balloon enlarges. Unfortunately, this ends a lot times in the rupture of the blood vessel and severe internal bleeding that leads to death.What are the symptoms?A lot of times, there are no symptoms. Occasionally, people may experience severe, tearing back pain or abdominal pain. Other times, this disease can shoot clots down into the legs and cause a blue toe or foot. You may also notice a throbbing or pulsing in your abdomen.What are the risk factors?
The biggest risk factor is having a close family member who has been diagnosed with an aneurysm. Other risk factors include age over 55, high blood pressure, heart disease, smoking and a history of blood vessel hardening or atherosclerosis.

What can I do?

Early recognition and diagnosis is the key. If you have any risk factor, get screened with an ultrasound. It is painless, harmless and very accurate.

What are the treatments?

If you have a very small aneurysm, you may not need treatment, but just close and careful watching by your primary care doctor or internist. If you have a larger aneurysm – usually over 4.5 centimeters or a little over 2 inches in width – you should be seen by a vascular surgeon. Vascular surgeons are specially trained surgeons in the treatment of blood vessel diseases. They will confirm the actual size of your aneurysm with another study, and, if it is over 2.5 inches or over 5 centimeters, you will likely be recommended for repair of the blood vessel. This can be done two ways:

One way is to repair the blood vessel from the inside out, with only small cuts in the groins to access the major blood vessels. This technique is called endovascular repair of the aorta. There is usually less pain with this procedure and you typically go home from the hospital within a day or two. This way of fixing aneurysms is limited to the types of devices that are currently manufactured and also limited by your own anatomy. It is certainly not “one size fits all” and many people will not qualify for this technique of repair because of the shape of their aneurysm.

Another way to fix this problem is by opening up the abdomen and fixing the blood vessel by replacing it with an artificial tube. This is the traditional approach for repair. It is more involved and the recovery time is longer, but the results have been proven over four decades, while the new endovascular technique has only been approved by the Food and Drug Administration since October of 1999. Both ways are effective and relatively safe if performed electively or scheduled in advance by an experienced vascular surgeon. Emergency surgery always carries a much higher risk.

Who do I talk to about getting screened for this disease?

Ask your family doctor or internist to look at your risk factors. The doctor may then send you for an ultrasound screening. Otherwise, there are several vascular labs in the area that would perform this screen for you at low cost or for free and prepare a brief screening report for you to discuss with your doctor.