In AAA, the wall of the aorta (the body’s main artery) weakens and bulges like a balloon. The swelling can cause pain in the chest, belly, back or scrotum, but the condition often goes unnoticed until the AAA grows large enough to burst. When that happens, blood rushes into the abdomen, causing searing pain and a sudden drop in blood pressure. Fifty percent of victims die before they even get to an operating room–and only half of those who get emergency surgery survive it.
Fortunately, doctors are getting better at predicting and detecting AAAs, and at repairing them before they rupture. The condition usually result from atherosclerosis–the leading cause of heart attacks and strokes–and it involves the same risk factors: smoking, high blood pressure, unhealthy cholesterol levels, obesity, inactivity, advancing age and genetic predisposition. Diagnosis usually involves ultrasound, a harmless imaging test that uses sound waves to form a picture of the aorta. In a recent British study involving nearly 60,000 men aged 65 to74, those who got the ultrasound test were only half as likely as untested men to die of AAAs over a four-year period. Medical authorities in the United States and Britain are now considering whether men this age, or younger, should receive routine screening. Some doctors are already scheduling ultrasounds on senior citizens who smoke, have high blood pressure or have a family history of AAA.
Not surprisingly, the larger the AAA, the greater the chance it will burst. Small, painless aneurysms are typically monitored by ultrasound every six to 12 months. But recent studies show that treatment is required when an aneu-rysm is wider than two inches or expands by more than a quarter inch in one year. Surgeons have traditionally treated the condition by cutting through the abdomen and opening the diseased aorta to insert a Dacron tube, which reinforces the arterial wall. The procedure, though usually effective, carries a 2 to 6 percent risk of death. A newer option involves threading a collapsible stent into the aorta through a catheter inserted into an artery in the leg. The stent treatment is less risky than surgery, particularly in experienced hands. But because the technique is new, no one yet knows whether its benefits last as long as those of surgery.
The bottom line? If you’re older than 60 and have risk factors for cardiovascular disease, talk to your doctor about an ultrasound test for AAA. The Society of Interventional Radiology will offer free ultrasound screening at designated clinics during the second week of September. Testing is especially important if you have a pulsating or gnawing sensation in the abdomen or midback. The test itself is painless, and it could spare you a date with death.
