What You Need to Know About Abdominal Aortic Aneurysms (AAA)
Christopher Healey, MD
Abdominal Aortic Aneurysms (AAA) are a common condition, especially among older adults.
Men who ever smoked are at especially high risk. But without any symptoms, this potentially lethal condition can progress undetected.
Screening and treatment have vastly improved in recent years.
As adults enroll in Medicare, the screening test –an ultrasound - is offered at no charge.
Dr. Christopher Healey (Guest): An abdominal aortic aneurysm is actually just a weakness of the aorta in the abdomen, and that weakness turns into an enlargement, which subsequent to that can lead to a rupture of your aorta.
Melanie: Who would be at risk for this rupture of the aorta or possible?
Dr. Healey: The people at the highest risk are men in their 60s, 70s, and 80s, particularly men who have smoked, and also women of that age bracket also are at some degree of risk, but not as high as the males.
Melanie: Are there any symptoms that might signal to send somebody to see a doctor such as yourself to let them know this is a possibility?
Dr. Healey: No, and that’s the most challenging part of treating abdominal aortic aneurysms. They cause no symptoms whatsoever. Therefore, it’s very important that we identify them before they develop symptoms. When they develop symptoms, it means that they are ruptured or there is impending rupture, and people formally don’t do well with that condition versus how well they do if we can find them before they have symptoms.
Melanie: Now, what about if it’s progressed and it has gone towards the bursting stage? What would they notice? Is it like a heart attack? What kind of symptoms would they experience?
Dr. Healey: If someone had the misfortune of having symptoms, it would usually present with significant abdominal pain or pain in the back. Oftentimes, when we have to take care of a rupture, the emergency room thinks that the patient has a kidney stone. It feels very much like a kidney stone, and they end up getting a CAT scan to look for a kidney stone and they find that the patient has a ruptured aneurysm.
Melanie: Then what? What is the treatment for an aneurysm if you -- well, first, actually, let’s discuss diagnosis and screening. How do we find it if there are no symptoms?
Dr. Healey: The way you find it is typically with ultrasound. It can be found on a variety of different x-ray tests, CAT scans, MRI. But ultrasound is the key screening test. And the way to screen people is to look at the population who are at risk, and what is typically recommended is any men over 65 who has ever smoked should have an ultrasound to look for an aneurysm, and any woman with risk factors or family history should also have an ultrasound.
Melanie: Should this be something, Dr. Healey, that patients ask their internist when they’re having their physical if they’re over 65 and they had smoked? Do they say, “I’d like an abdominal ultrasound to see if I’m at risk for aortic aneurysm”?
Dr. Healey: Absolutely. That would be a great idea, and the hope would be when someone enters into Medicare, as part of their Medicare initiation physical, they’re entitled to get one. So the hope would be that at the primary care doctors are offering it to people on their entry into the Medicare system.
Melanie: How often should they have this ultrasound? Does it come every year with your physical or just once?
Dr. Healey: If they have an ultrasound and they don’t have an aneurysm at that age, then they don’t need to have another one. If they have an ultrasound and they have a small aneurysm, then they will need to be checked annually. If they have a large one, then they may need to be repaired right away.
Melanie: After the age of 65, if they didn’t have any evidence of aneurysm, it’s not going to develop then, most likely.
Dr. Healey: It would be unlikely to have a normal aorta at 65 and to then develop one later. If they have a strong history, I might say five or 10 years later you could be checked again. But most people, if they’re going to develop one, will have one when they’re in their 60s.
Melanie: So then, if you detect one, what are the treatment? What do you do as the first line of defense for them?
Dr. Healey: It really depends on the size. If we find them at a fairly smaller size, we watch them really until they become a risk to rupture. Once they reach that stage, there are two ways to fix them. One is with a large incision in the abdomen, where you actually replace the aorta, and two is with two small incisions in the groin, where you put a stent into the aneurysm to basically stop the flow to the aneurysm.Then, the difference is with the bigger procedure, you’re in the hospital for a week and it’s a several week to a couple of months recovery. The stent procedure is in the hospital for a night, and really minimal kind of recovery time. Not everyone is a candidate for the stent procedure, and that’s related to the anatomy of their aneurysm, and that’s why we still end up doing both procedures on a not infrequent basis.
Melanie: How long does that stent last? Is it something that now will last them for the rest of their life? Do you have to go back in and recheck it at a 10-year mark or so?
Dr. Healey: They are designed to last forever. Because you’re not actually removing the aneurysm, they do need to be monitored. Someone who has it repaired with a stent graft gets checked a couple of times in the first year. Then they usually have either an ultrasound or a CAT scan once a year indefinitely. About 85 percent of people will never need to have anything else done, but about 10 or 15 percent of people may need to have a second procedure to add another piece of stent or to do another small procedure to protect them from rupture.
Melanie: Are there any medications involved, Dr. Healey?
Dr. Healey: No, there’s really no medications involved. There are studies to try to figure out a medication that we could give people when they have small aneurysms to slow the growth, but there’s nothing really yet that I have to offer when I see someone with a small aneurysm. I basically tell them we’re going to watch it, and when it gets big enough, we’ll fix it. I think someday, I’ll probably meet a patient and say, “I’m gonna watch it, but also take this medicine and it will be less likely to grow.” But we don’t have that yet.
Melanie: Now, what about lifestyle and things that they can do at home. Give us a little tip for prevention and if they have a detected aneurysm, what you want them to do right now to help themselves.
Dr. Healey: Stopping smoking is the biggest thing that they could do to change their risk of rupture, to change the rate that the aneurysm grows, and to decrease the chance of complication when they do have to have surgery. Really, that’s my biggest piece of advice. I think they still need to follow up with their primary care doctor and try to control their blood pressure and their cholesterol, but if I could pick one thing that they could do to try to help them not suffer from a ruptured aneurysm, it would be to stop smoking.
Melanie: In just the last few minutes, Dr. Healey, your best advice for people that are at risk for an abdominal aortic aneurysm and why they should come to Maine Medical Partners and Maine Medical Center for their care.
Dr. Healey: I think my advice would be that this is a very dangerous and often lethal problem when it’s an emergency, but it’s a very easy to treat and safe procedure to undergo when it’s not an emergency, and therefore I would try to get checked to make sure it never becomes one. And I would ask their primary care doctor to get an ultrasound to make sure they don’t have an aneurysm.
Melanie: Thank you so much. You’re listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening and have a great day.