Last time, in Part 1, we discussed Abdominal Aortic Aneurysm (AAA)—what it is and why it is a serious condition, being the 13th leading cause of death in this country. The question is what to do if you have the risk factors we discussed. How does one diagnose a problem that has no symptoms and is silent until it is too late?
Options for Detecting an Abdominal Aortic Aneurysm
Sometimes this condition can be picked up on careful physical exam. But often the body conceals it, making it hard or impossible to detect. An AAA is usually found by accident. It can be picked up on abdominal x-ray. In fact when a physician orders x-rays for an abdominal or low back problem this dangerous condition can be seen.
However, it doesn’t make sense to routinely subject all patients with risk factors to abdominal x-ray examination. Furthermore, what about the people who just want piece of mind?
Using Ultrasound to Find an AAA
The answer lies in the ultrasound examination. Even if the aneurysm can’t be felt on physical exam, the ultrasound can visualize the aorta and identify the condition. The problem is that a standard, detailed abdominal ultrasound can cost $200+ and is therefore relatively expensive. However, screening exams, done preferably by an ultrasound technician with experience working with (preferably) a Vascular Surgeon can be very cost effective.
It is recommended that older individuals, who have risk factors or who want peace of mind, contact the office of a Vascular Surgeon and inquire about screening exams for AAA. There have been several recent papers in the literature that support the benefits of screening exams for AAA. The Vascular Surgeon can recommend a plan that can be applied to your situation.
Abdominal Aortic Aneurysm Treatment Suggestions
If you have an AAA that is less than 5cm in diameter, it is generally recommended that this condition be followed with serial ultrasounds every 6 months. Recalling the table from the last article, we know that the chance of rupture of a 4cm AAA is close to nil. The chance of rupture of an AAA that is 4-5cm approaches 5% in some series. The mortality of resection and open repair of an AAA runs about 5-6% in most series. Therefore, it is usually recommended that conservative therapy be applied with an AAA of 5cm or less. This includes every 6 month ultrasounds as well as cessation of nicotine use and control of high blood pressure.
Once the aneurysm grows to greater than 5cm, surgical intervention is recommended since the risk of rupture and death go up significantly in aneurysms of this size. At this point it is safer to operate since the risk would be too high if conservative therapy were applied. In fact, an AAA of greater than 8cm in diameter has a rupture rate that approaches 50% over the next year.
In part 3 of our series, we will address what to do if we have an AAA that if greater than 5cm.
Five Star Vein Institute offers a free vein screening. Contact Dr. Robert Ruess and his staff to find out more about your risk of venous diseases and how you can effectively treat any issues.