Published: July 08, 2009 11:33 am      

Abdominal Aortic Aneurysm (AAA): The Key is Screening

By: Rebecca Barton Kraftick, PA-C

Steve Marcum considered himself a pretty healthy guy. Like many in southeast Kentucky, he had a history of smoking but quit a few years ago. He took blood pressure and cholesterol pills, and something for his thyroid. Not a lot of medicine for a young guy of 75 years. He lived by himself and enjoyed visiting with people and spreading the gospel. Little did he know he was walking around with a potential life-threatening disease.

It was September of 2008 when Marcum went to his family physician, Dr. Ashu Joshi, for a simple sinus infection. He was not having abdominal or back pain. He denied any chest pain, shortness of breath, or weakness. Other than his usual seasonal sinus infection, he was feeling good. But he did have history of tobacco abuse, hypertension and chronic obstructive pulmonary disease (COPD). All of which are risk factors for abdominal aortic aneurysm (AAA) and Dr. Joshi recognized it.

“He had all the risk factors and I was able to do the screening in my office,” Joshi says.

A noninvasive ultrasound of his abdomen confirmed the suspicion and Marcum was referred to Dr. James Shoptaw, a cardiovascular surgeon in London.

“I had never even heard of this kind of aneurysm before they said I had it,” Marcum explains.

Abdominal aortic aneurysm (AAA) is a relatively common medical problem. The aorta is a large blood vessel that arises from the heart and carries oxygenated blood to the body. An aneurysm is defined as a dilation or enlargement of the artery more than 50 percent of what is expected. Most abdominal aortas measuring over three centimeters would classify as an aneurysm.

Marcum had a CT scan with contrast shortly after the ultrasound to evaluate the exact size and location of his aneurysm. A scan showed the aneurysm to be 6.1 centimeters in diameter and located below the renal arteries. Dr. Shoptaw was then able to offer Steve a less invasive procedure known as endovascular stent repair as opposed to an open aneurysm repair.

“Steve wanted a procedure with less mortality risk and fewer hospital days,” Dr. Shoptaw says. Surgical intervention is recommended based on the size, growth rate and anatomy of the aneurysm along with the patient’s functional state and life-expectancy.

Marcum underwent endovascular repair of an abdominal aortic aneurysm on Sept. 30, 2008 without any complications. He was discharged home in just two days. He now receives follow up ultrasounds to monitor the aneurysm and stent. On his last scan, it measured 3.5 centimeters. When asked if he was glad he agreed to the procedure, Marcum responds, “If I was the emperor of China, I wouldn’t have been treated any better. Yes.”

Ruptured AAA is the 13th leading cause of death in the U.S., attributing to approximately 15,000 deaths per year. As many as two out of three patients with a ruptured AAA die before arriving at the hospital. Of those who make it to surgery, the mortality rate is still 50 percent.

Because patients often do not display any symptoms until rupturing occurs, the key to increasing survival with an AAA is screening.

“An ultrasound only takes 10 minutes and results are available in 30 seconds. There’s no reason not to screen,” explains Dr. Joshi.

A simple, cost-effective abdominal ultrasound may have saved Steve Marcum’s life.

AAA RISK FACTORS

• Hypertension
• Smoking
• Male (white males are higher risk)
• Advanced Age (usually over age 60)
• Chronic Obstructive Pulmonary Disease (COPD)
• First Degree Relative with AAA
• History of Popliteal Artery Aneurysm
• History of Cerebral Artery Aneurysm
• Marfan Disease
• Type IV Ehlers-Danlos Syndrome