Are You At Risk For AAA?
Learn About the Test that Can Save Your Life
At first glance, Lucille Ball and Albert Einstein did not have much in common. They did share a serious and very preventable health risk, however - both died of an abdominal aortic aneurysm (AAA). AAA, a potentially life-threatening disorder, is caused by a weak spot in the aorta, the body's largest artery, which can bulge like a balloon and potentially burst if left untreated.
"The trouble with AAA is that many people have no idea they are at risk until it's too late," says
Dr. Mark Wyers, a vascular surgeon in the
CardioVascular Institute at
Beth Israel Deaconess Medical Center.
In some cases, Wyers says, an aortic rupture causes severe pain in the lower back or abdomen -symptoms that require immediate emergency room attention. But most individuals don't experience any symptoms until the aneurysm is near rupture or ruptures. Unfortunately, AAA ruptures cause about 15,000 deaths every year in the United States.
AAA can be diagnosed with an abdominal ultrasound, a simple 30 to 60 minute test recommended by the
Society for Vascular Surgery for patients beginning at age 65, or earlier when there is a family history of AAA. At the
CardioVascular Institute at BIDMC, vascular surgeons work with patients to diagnose and treat AAA before a potential rupture.
When diagnosed, AAA can be closely monitored and repaired before the risk of rupture gets too high. At the CVI, more than half of AAAs are repaired with a minimally invasive procedure. The surgeon repairs the aorta through a catheter inserted via small punctures in the groin and effectively re-lines the AAA with a specially designed stent. This procedure is referred to as Endovascular Aneurysm Repair, or EVAR. Otherwise, traditional surgery can be performed to remove the AAA and replace the segment with a man-made graft that is sewn in place.
Patients at high risk for AAA include:
Smokers - You are eight times more likely to develop an aneurysm if you smoke.
Older adults - AAA is more likely to occur in people between the ages of 60 and 80.
Men - Males are four times more likely than women to have an AAA.
- Those with
high blood pressure.
- Those with
- Those with a
family history of AAA - Some 15 to 20 percent of individuals with AAA have a genetic history of the disorder.
Even with no other risk factors, a family history of AAA or heart disease warrants AAA screening starting at age 50, according to Wyers.
"The baseline risk for people without a family history of AAA is about 3 percent," he says, "but that risk is roughly 3 to 4 times greater if you have a first-degree family member, such as a parent or sibling, who suffered an aneurysm."
Siblings of an individual with AAA, aged 60 or older, had an 18 percent increase in the likelihood of having AAA,
according to a study published by the American College of Physicians-American Society of Internal Medicine in the Annals of Internal Medicine. The study reviewed 238 living first-degree relatives of patients who underwent surgery to treat AAA.
Gender is also equally significant in indicating risk; men are five times more likely to develop aneurysms than women.
"Although AAA is less common in women, there is a stronger trend of inheritance if your mother had AAA," said Wyers. "
Knowing your family history is important. Family history, along with male gender and a history of smoking are the strongest indicators for screening, which can catch an aneurysm before it puts a patient at risk of rupture."
If you have a history of AAA in your family, an ultrasound screening should be completed around age 50 to check for signs of aneurysm. (Note: Medicare covers AAA screenings for qualified individuals within the first year of coverage.)
"Screening can prove beneficial in slowing down the incidence of rupture and death," said Wyers. "Catching the beginning of an aneurysm affords us the ability to monitor its growth and work with patients on their surgical or medicinal options should the aneurysm grow to reach a size requiring further action."
While you may not be able to do anything about genetic predisposition, there are ways you can take charge to reduce some of the other risk factors. Some research has shown that controlling blood pressure and cholesterol levels with medication may help slow growth.
"If you're a smoker, the best way to reduce your risk of AAA is to quit," said Wyers. "People that continue to smoke with an aneurysm have a much faster rate of growth and a higher risk of rupture."
Aneurysms rank number 15 on the list of most common deaths in the United States.
"A lot of people don't realize just how common aneurysms are as a cause of death," said Wyers. "The good news is that aneurysm screening is effective and it works - one study has shown a 50 percent decrease in rupture rate among those who underwent screening."
Screening is easy and the potential health benefits are great. So no excuses: if you are 65 or older or have a family history of AAA, talk to your doctor about an ultrasound.
Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted June 2012