This month I have asked my colleague, interventional cardiologist Zvonimir Krajcer, MD, to write about abdominal aortic aneurysms, a lethal cardiac problem for women as well as men. Through his research at Texas Heart Institute, he has pioneered a repair technique for these potentially deadly aneurysms that does not require major surgery as in the past. His groundbreaking catheter-based technique reduces both risk and cost and improves outcomes for patients.
Dr. Krajcer is the Program Director of Peripheral Vascular Interventions at St. Luke’s Episcopal Hospital and Texas Heart Institute and a founding member of the Texas Heart Institute Cardiac Society.
Until next time!
Stephanie Coulter, MD
An overview of Abdominal Aortic Aneurysms
The abdominal aorta delivers blood from the heart to the lower half of the body. If the abdominal aorta becomes weak, it can balloon or enlarge, forming an abdominal aortic aneurysm (AAA).
Pressure from blood flowing through an AAA can cause the abdominal aorta to burst. Rupture of an AAA is almost always fatal. As many as 30,000 Americans die each year from AAAs, and studies have shown that they occur in up to 13% of men and 6% of women over the age of 65.
Symptoms
Aneurysms develop slowly over many years and usually have no symptoms. AAAs that are large (> 5.5 cm) or those that expand rapidly (≥ 0.5 cm over six months) are at high risk of rupture and can result in the following symptoms:
- A pulsing feeling in the abdomen, similar to the heartbeat
- Severe, sudden pain in abdomen or lower back (a sign of potential rupture)
- Pain, discoloration, or sores on the toes or feet from material shed from the aneurysm
- Sudden death
Smokers are at great risk
Risk factors for developing an AAA include:
- Age
- Smoking
- High blood pressure
- Obesity
- Genetic factors / family history
Studies have shown that women over 65 with a combination of the above risk factors have a six-fold increased risk of AAA. Studies have also shown that females with AAA are three times more likely to rupture, making death far more likely.
Furthermore, women who smoke are eight times more likely to develop AAA than women who have never smoked.
Screening
Abdominal ultrasonography is the most common screening test to determine if AAA is present. There are no current recommendations to screen women, however, the following tests are conducted to confirm a suspicion of AAA:
- Abdominal ultrasound
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
Treatment
Treatment to prevent a rupture of AAA traditionally requires a major 4-6 hour surgery to remove the enlarged section of the aorta and replace it with an artificial tube or graft. The good news is that new techniques have been developed that are far less invasive and can be carried out with small incisions and catheters.
The best treatment for AAA is prevention. The best way to prevent an aneurysm is to control blood pressure and to not smoke.
If you quit smoking, your risk of having an AAA decreases by half.
Medications that slow the heart rate, such as beta blockers, may help prevent aneurysm expansion. The most important aspect of care is to identify aneurysms early and monitor them closely.
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