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All About AAA

Learning about this condition can save your life

Most of us think of the emergency auto service when we see "AAA," but these letters also stand for a health issue that could result in a surgical emergency or sudden death: an abdominal aortic aneurysm.

The aorta, the body's largest artery, carries blood from the heart to the rest of the body. It runs through your chest and abdomen - where it supplies blood to vital organs - and then splits into two branches, called femoral arteries, that carry blood into each leg.

An abdominal aortic aneurysm occurs when the aortic wall weakens and balloons, growing larger over time until it ruptures if not diagnosed and treated. These ruptures are often deadly and lead to 9,000 deaths in the United States annually.

Immediate attention required

Marc Schermerhorn, MD

"AAAs are stealthy, growing slowly and without symptoms until a rupture occurs," said Marc Schermerhorn, MD, Chief of Vascular and Endovascular Surgery at Beth Israel Deaconess Medical Center's CardioVascular Institute. "Symptoms of a rupture can include a severe pain in the lower back or abdomen, nausea, clammy skin and muscle stiffness. These symptoms require immediate attention in an emergency room, since this is a life-threatening condition."

Traditional AAA surgery to prevent rupture involves an abdominal incision and the insertion of a synthetic graft to replace the weakened walls of the aneurysm. This surgery requires a hospital stay of five to seven days and four to six weeks of recovery.

In recent years, a minimally invasive procedure has been developed to repair abdominal aortic aneurysms. Called endovascular repair, this approach originally involved making two one-inch incisions on each side of the groin to insert catheters in the two arteries that branch off from the abdominal aorta. A graft is placed in the aneurysm, and a balloon within inflates the graft to the size that is needed.

The latest therapy

Today, vascular surgeons at BIDMC are repairing AAAs using an even newer technique that not only avoids the need for an abdominal incision, but also eliminates the need for incisions into the groin. This new type of endovascular repair, called total percutaneous AAA repair, allows access through two tiny punctures in the groin.

"We do this less invasively than most surgeons," said Schermerhorn. "There are no incisions at all, just punctures. We use ultrasound technology to guide us in placing the graft. Our AAA procedures without incisions have incredibly low rates of complications and the highest success rate in the country. We are able to use the procedure without incisions for 97 percent of our patients requiring AAA intervention."

The new endovascular approach reduces the mortality rate from as high as 7 to 10 percent for traditional open surgery, to less than one percent for the newest procedure, according to Schermerhorn. It also allows patients to return home in one to two days with a substantially shorter recovery period of two weeks.

Schermerhorn was the first researcher to demonstrate, in a large nationwide analysis of Medicare-aged patients, that endovascular repair has resulted in a reduction in deaths and complications due to AAAs when compared to open repair.

Who is at risk?

Factors that increase your risk for an AAA include:

  • Smoking - You are eight times more likely to develop an aneurysm if you smoke.
  • Age - AAAs are more likely to happen in people between the ages of 60 and 80.
  • Sex - Men are four times more likely than women to have an AAA.
  • High blood pressure
  • High cholesterol
  • Excess weight
  • Emphysema
  • Family history of aortic aneurysm or heart disease

Early intervention starts with a test

The normal size for an abdominal aorta is one to two centimeters wide. If a small aneurysm (less than 5 cm) is found, a physician may recommend "watchful waiting," with ultrasounds conducted on an annual or semi-annual basis. If the AAA is growing rapidly (for example, an increase of 0.5 cm in six months) or has reached a certain size (generally 5 cm or greater), intervention is needed before rupture occurs.

The good news is that a simple ultrasound test can reveal whether an AAA is present. This test should be conducted starting at age 65. Your physician may require an earlier test if you have multiple risk factors for AAAs.

It's important to note that qualified Medicare recipients are entitled to a free, one-time screening to detect abdominal aortic aneurysms. You may be eligible within the first 12 months of your enrollment in Medicare. To qualify, if you are a man, you must have smoked at least 100 cigarettes during your life. Men and women with a family history of AAA may also be eligible.

A better future for AAA patients

People who are at risk for AAAs can improve their risk factors by losing excess weight, quitting smoking, engaging in regular exercise and controlling high blood pressure or cholesterol. And thanks to early intervention with testing and this new procedure, most patients with high-risk AAAs can expect smooth sailing by addressing their aneurysms before they spell trouble.

Posted October 2011

Contact Information

CardioVascular Institute at
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215