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ABDOMINAL AORTIC ANEURYSM CLINIC
The Abdominal Aortic Aneurysm Clinic (AAA Clinic) of the IRC was formed to care for and follow-up patients with abdominal aortic aneurysms, to educate patients about their aneurysms and to evaluate for minimally invasive treatment options, as needed, using the latest imaging techniques.
Abdominal aortic aneurysms (AAA) affect 1.5 million individuals in the U.S. and each year 190,000 new diagnoses are made. Ruptured abdominal aortic aneurysms have a high risk of mortality (>90%) and each year 10,000 individuals die from this disease, making it the 10th leading cause of death in the Western world. Some familiar names of people who have died from ruptured AAAs include physicist Albert Einstein and actors Lucille Ball and George C. Scott.
Rupture risk from small aneurysms measuring 4-5cm is low
(1-5 % / year) but the risk increases substantially as the aneurysm grows (25-40%/year for an aneurysm 7-8 cm. Risk factors for development of an AAA include heredity, male gender, smoking, hypertension, among others.
Aneurysms may grow about .2-.5 cm per year. Current guidelines (J Vasc Surgery 37(5) 1106-1117) recommend 5.5 cm as the "best threshold" for repair of an AAA. There may be subsets of younger, good-risk patients who might be repaired earlier whereas older poorer-risk patients may be best served by watchful waiting if they are not candidates for minimally invasive therapy known as endovascular aneurysm repair (EVAR) using a stent-graft. Decision making regarding AAA treatment requires careful assessment of rupture risk, co-morbities, risks of intervention, and life expectancies and individualized assessment is essential, especially considering newer less invasive forms of therapy and the importance of patient preference. Newer techniques of endovascular repair offer additional options for older, higher risk patients with multiple medical problems.
Abdominal aortic aneurysm detection is sometimes clinically difficult and many are discovered incidentally. Most go unnoticed by the patient. Ultrasound is a very accurate means of detection and is readily available, cost-efficient, and reliable. Newer multislice CT scans give excellent quality images which allow characterization of morphology of the aneurysm, detection of other coexisting vascular abnormalities such as narrowing of arteries to bowel, other abdominal organs, or legs, and unsuspected aneurysms of arteries in the pelvis or legs. These studies may also detect other abnormalities, such as a cancer that may be caught when it is small and can be removed.
These multislice CT scans can produce exquisite angiograms, appearing similar to catheter-based angiograms without requiring a needle puncture of the artery and catheter placement through the groin. These CT scans are essential to evaluating a patient for EVAR.
Recent screening guidelines (J Vasc Surg 2004:39(1):267-269) suggest the following groups of people undergo screening:
- All males age 60-85 years
- All females aged 60-85 years with a cardiovascular history
- All males and females 50 years and older with a family history of AAA.
Endovascular aneurysm repair (EVAR) is a newer minimally invasive technique involving insertion of a self expanding graft into the aneurysm via groin incisions to seal the aneurysm off, preventing expansion and rupture. It has distinct advantages over open surgery, including decreased recovery time, blood loss, complications, and death.
Radiologists of the IRC have been involved in EVAR since it was approved by the FDA in 1999 and have treated over 100 patients in conjunction with the vascular surgery service.
All or our patients have been managed by our team approach with vascular surgery resulting in a perioperative mortality rate of less than one percent. In our series there have been no ruptures following EVAR and approximately 89% of patients had shrinkage or stabilization of the AAA post treatment. None have required conversion to open repair. Our team has demonstrated, over the course of a 56 month study, a low incidence of mortality and complications and excellent outcomes similar to published studies.
The IRC AAA clinic will provide to our patients:
- Safe and efficient monitoring of patients with small diameter aneurysms that do not yet require treatment.
- patient education
- Coordination of communication between physician specialists.
- State-of-the-art imaging and interpretation of those studies
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Follow this link to read more about our experience in treating patients with aneurysms via this minimally invasive route. It was written by IRC physician Steve Wegert, M.D. more »
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