Every year, 190,000 Americans develop abdominal aortic aneurysms. The resulting 15,000 deaths make it the 10th leading cause of death in the U.S., Dr. Alfonso Munoz, M.D., told listeners at a recent Lunch & Learn program at the Senior Circle.
“Vascular surgery is my specialty and my passion,” Munoz said.
The ballooning of a blood vessel that causes an aneurysm can come in many forms, including abdominal, thoracic and intracranial. Untreated, an aneurysm can rupture and without immediate attention, kill.
Munoz said the problem always starts with some contributory disease or lifestyle that impacts the health of the arteries and veins. These conditions include high blood pressure, diabetes, arteriosclerosis, smoking and genetics. Men are twice as likely to develop an aneurysm as women, he said.
The long, unprotected abdominal aorta stretches from the heart to the gut and runs along the spine, which means back pain can signal a developing aneurysm, he said. Usually, the body forms a protective layer of calcium around a developing aneurysm, which means X-rays can provide a warning. Other symptoms include abdominal pain, a palpable mass and gastrointestinal symptoms. However, most aneurysms give no warning at all, Munoz said.
Diagnosis, following an initial X-ray, will include an ultrasound. If doctors recommend surgery, they will do a CT scan to create a surgical plan.
The blood vessels like the abdominal aorta tends to expand about 10 percent per year as we age, Munoz said. The normal width is 2.25 centimeters. A portion that expands to 4 or 5 centimeters has a 1 to 2 percent chance of rupture, with the odds rising steeply as the vessel expands.
Doctors and patients must determine whether the risk of a surgery to repair the stretched blood vessel poses a greater risk than just watching and waiting.
Munoz said two types of surgery can treat the condition. One is an open or intravascular surgery. Once the patient is anesthetized, doctors expose the vessel, stop the blood flow through it, sew in an artery graft, then let the blood flow return.
“Open is a good surgery with good results,” Munoz said. Its advantages include: it is relatively permanent, has few complications and produces excellent long-term results. However, the four-hour surgery comes with a 2 to 8 percent chance of mortality.
The alternative “endoluminal repair” involves a small incision in the femoral artery and then use of a delivery system to move the compressed graft materials to the site of the aneurysm before expanding the stent or patch in place.
Munoz said most doctors will recommend this type of repair, which takes just one hour under local anesthetic.
“It is easier on the patient and the physician because it is a shorter time and the patient can usually go home in 48 hours,” he said. It also has a much lower mortality rate, ranging from .4 to 2 percent.
However, side effects include possible leakage at the graft site because of blood pressure, movement of the graft, and failure of the graft. The patient will need regular follow-ups the rest of their life.
Doctors can reduce problems like leaking and migration of the graft by using the same method to put stabilizing material to the graft site or even putting in additional grafts to hold the original repair in place. Usually, doctors rely on such added grafts for sites close to the renal arteries or where the aorta branches into the femoral arteries.
Preventing the problem always works better than surgery, said Munoz. He urged patients to not smoke and keep blood pressure under control. For those 65 and older, he urged regular screening.