Disarming the Ticking Time Bomb: AAA Awareness and EVAR

Older men are at risk for Abdominal Aortic Aneursyms. To learn how to detect early, and treat successfully, read on…

Such are the advances of medicine that life can now begin whenever you want it to – fifty, it seems, is just the starting point. The ‘golden years’, once considered a time to slow down and reflect, can often be among the most active years in a person’s life. Running a marathon at eighty is no longer headline news, nor receiving one’s first degree at ninety. Thanks in large part to new therapies, medications and medical advances, society as a whole is living longer, healthier lives.

However, maintaining this level of vitality does require extra watchfulness in terms of one’s health. Most men are now aware of the dangers of prostate cancerdefinedefine, but perhaps among the lesser-known age-related health risks for men is that of an aneurysm. Those over sixty, especially those who smoke, have high blood pressure, angina or other heart related diseases, or who have a family history of the disease, are at a higher than average risk of an aneurysm, the most common of which is an abdominal aortic aneurysm or AAA. It’s not purely a male disease - women may also suffer - but men are five times more likely to have it.

So what exactly is it? AAA is a disease that occurs when the walls of the aortadefine, the body’s largest blood vessel, weaken and expand. The larger the aneurysm, the more apt it is to rupture, creating a potentially fatal situation – only two in ten survive, with most dying before they reach a hospital. Whilst one in 10 men over 65 may have some enlargement of the abdominal aorta, about 1 in 100 are at risk of rupture – and so require surgery. In England and Wales, between 6,000 and 10,000 people each year suffer from rupture (bursting) of an abdominal aortic aneurysm. The vast majority of these patients are men over the age of 65 years.

The exact cause of AAAs is unknown, and in its early stages, the aneurysm often is virtually pain-free and may present few recognizable symptoms. Occasionally, a patient may become aware of a feeling of pulsation in the abdomendefine. On rare occasions, a lump can be visible. A doctor is the best person to diagnose one, so those with specific AAA questions or concerns should contact their GP. The good news is that, when diagnosed early, AAA often can be treated, or even cured, with highly effective and proven treatments.

The second piece of good news is that AAAs are currently reasonably high up on the NHS’s agenda. The UK’s National Screening Committee has recently decided that AAA screening could be offered to men aged 65. In tandem with this, it has issued a number of provisos to ensure that clear information is given to those invited to screening, and correct support provided to vasculardefine surgeons, allowing them to specialize in the area.

The preferred method of screening is by a painless ultrasound scan or CAT scan. These are simple exams - they are non-invasive and can be done on an outpatient basis. The scan will tell doctors how big the aneurysm is – the key element in determining whether or not treatment is needed.

EVAR – an alternative to AAA
Until recently, open surgery had been the most common form of repairing AAAs. Whilst this is successful, it does carry certain risks. Open surgery involves a major operation, with a long recovery time that the elderly may often struggle to tolerate. The alternative, Endovascular Aortic Repair (EVAR), provides a less-invasive alternative to open surgery, and was first introduced to vascular surgeons in 1999. Use of this minimally invasive procedure has since increased dramatically, helping patients with severe aneurysms have a better chance to live a longer, fuller life.

EVAR is performed by making two small incisions in the groin and threading two catheters through the patient’s arteries. Once in place, the catheters are used by the physician to release a tubular device comprising of large z-shaped metal stents sewn to surgical graft material that expands to channel blood through the aorta and reduce the pressure on the aneurismal sac. The recovery time for endovascular repair is usually much shorter than with open surgery, cutting hospital stays down to two to three days.

There have been many recent studies on EVAR. In the UK, a study published in The Lancet in August 2005, which investigated a thousand AAA patients at 41 hospitals, showed that EVAR boosted the odds for short–term patient survival (ie. within 30 days) by two-thirds when compared to standard surgery.

From the US, a study by the Journal of Vascular Surgery released in March, 2006 compared the survival rates of AAA patients who were treated with EVAR, as opposed to the more conventional, open surgical method. The three-year, 28,000-person study, which was conducted at the University of Pittsburgh, revealed that the risk of in-hospital death was significantly lower with EVAR.

Another recently released study of almost 400 patients in 15 health centers throughout the United States showed a compelling 98.9 percent rate of survival at 30 days following surgery for endovascular patients following EVAR and 97.5 percent for patients who underwent open surgery.

It’s clear that AAA is a serious disease, which, if undetected and untreated, could prove to be life-threatening. Today, the growing use of EVAR is helping spur a rising survival rate of AAA patients and a dramatic reduction in the trauma and lengthy recovery times associated with open surgery. With an ever-increasing elderly population, those who feel they may be at risk should consult their GPs.

Regular screenings and an awareness of all the many resources available for the detection and treatment of this disease could help just a few of those 10,000 patients each year who face debilitating surgery. To those for whom surgery is no option, EVAR offers a less invasive alternative.

Phil Nowell is Global Director of the Aortic Intervention Strategic Business Unit for Cook Medical
Italics - text , a world leader in devices to treat aortic aneurysms. He can be reached at info@cookmedical.com.