Advances in the Diagnosis and Treatment of Aneurysms Lead to Better Outcomes
While you don't hear much about it, the incidence of aortic aneurysms has tripled in the United States in the past 30 years, due in large part to the fact that people are living longer. An aneurysm is a bulge in a section of the aorta, the main artery of the body. It is a health risk because it can burst or rupture, leading to shock or even death.
Aneurysms tend to grow slowly over time and individuals with them usually have no obvious symptoms. Because they do not produce clear symptoms, there is a high rate of sudden rupture. Unfortunately, approximately 90 percent of people with a ruptured aneurysm die, many before reaching the hospital.That’s why an aortic aneurysm is often called the “silent killer."
“Aneurysms can form anywhere in the aorta, but are most common in the belly area, which is called an abdominal aortic aneurysm. There are also aneurysms that can occur in the chest as well as the belly known as thoracoabdominal aneurysms, but they are much rarer,” says Raghuveer Vallabhaneni, MD, FACS, who is director of Vascular Surgery, Baltimore region for MedStar Heart & Vascular Institute and practices at MedStar Union Memorial Hospital.
“Most aortic aneurysms are undiagnosed and are rarely detected through a physical exam. In fact, because they usually start small and enlarge slowly, they are often found when a doctor is doing a screening for something else,” he explains.
That’s what happened with Deanna Green, a 73-year-old patient with multiple health concerns, who was referred to Dr. Vallabhaneni earlier this year.
“Deanna was diagnosed with an aneurysm during a CT scan for another condition,“ says Dr. Vallabhaneni. “But, her aneurysm was not large enough to warrant surgery until recently, when it grew to a size that placed it at risk for rupture. Because of her other medical conditions, she was not a candidate for open surgery. She also had a thoracoabdominal aneurysm, which is more complex and difficult to treat than an abdominal aneurysm. So her doctor referred her to me.”
The traditional treatment for repairing an aneurysm used to be an open surgical repair, an invasive surgery involving a large incision and a lengthy recovery time. At MedStar Union Memorial, greater than 95 percent of patients are now being treated using a minimally invasive technique called endovascular repair, a procedure Dr. Vallabhaneni has performed extensively.
"During an endovascular repair, a catheter, or small tube, is inserted into the blood vessels through a small incision in the groin. Under X-ray guidance, a vascular graft is delivered through the catheter and placed inside the aneurysm.
In Deanna’s case, multiple grafts extending into the chest and vital organs were needed," Dr. Vallabhaneni says.
Because it is a minimally invasive procedure, endovascular surgery generally requires a shorter hospital stay, compared to a week or more for major surgery, has a high success rate and results in a quicker recovery.
“With endovascular repair, we can treat patients who would not have been able to have surgery or an open repair,” he adds.
After a couple of days in the hospital, Deanna spent some time in inpatient rehabilitation, then went home. She is doing great and her aneurysm is shrinking.
Abdominal aortic aneurysms occur most frequently in people over the age of 65, and men are four times more likely to have the condition. Smoking is a significant risk factor and people who have a family history of aneurysms are also at higher risk. Other risk factors include atherosclerosis, a history of heart disease and high blood pressure.
“If you are in a risk category for an abdominal aortic aneurysm, you should talk to your physician about being screened. A painless ultrasound scan can detect an abdominal aortic aneurysm and most found are treatable. That is why screening is crucial,” notes Dr. Vallabhaneni.