Often referred to as the “silent killer”, abdominal aortic aneurysms (AAA) represent a major health risk for our aging Americans. Here are the facts:

• AAA’s affect 10% of men over age 70. This translates into 1 million new AAA’s discovered each year.The number of diagnosed cases has increased 300% over the past 30 years but less than 100,000 repairs are being performed annually. This translates into 15,000 to 20,000 deaths per year in the US due to AAA rupture (fewer than 20% of patients survive AAA rupture). While death rates have decreased for patients suffering from heart disease, mortality rates for AAA have increased twenty-fold, mainly due to lack of diagnosis. The societal impact is staggering with an estimated $50 million spent annually just on the management of ruptured aneurysms in the US.

• What do we know about AAA?
The aorta is a large artery located in the abdomen that branches to supply blood to the legs. The causes of AAA include increasing age, high blood pressure, diabetes mellitus, use of tobacco products, high cholesterol and high fat diet, and a family history. As the AAA grows larger, the wall weakens causing the AAA to grow larger, increasing the risk of rupture. Most patients experience no symptoms at all until rupture.

• How do we diagnose AAA?
Diagnosis can often be made by physical exam simply with palpation of the belly wall. Ultrasound, considered the first-line test, is then used to confirm the diagnosis. Screening is recommended in persons at risk such as with advanced age, arteriosclerosis elsewhere in the body, or a family history of aneurysms.

• What is unique about the use of ultrasound?
Ultrasound is painless, can be used in all patients without risks, and takes about 30 minutes to complete. This method can be performed repeatedly over months or years with little error, making it ‘the tool of choice’ for the detection and surveillance of AAA. Because this procedure is performed in the office, results can be discussed with the patient immediately.

• When do we treat AAA?
Not all aneurysms need repair; AAA’s too small for repair are followed with ultrasound to detect growth. Generally, AAA’s greater than 5 cm are recommended for repair.

• How are AAA’s treated?

Two methods currently exist for treatment and are referred to as either the open or endograft technique. The newer technique, the endograft method, employs two small incisions in the groin and placement of the graft under x-ray guidance. Recovery from the procedure has been cut in half and complication rates as well as mortality rates are significantly reduced with the endograft technique as compared to the open technique.

The following represents some differences between two methods:

• What does this mean for the patient?

The number of patients with AAA in the US will continue to increase over the next several decades due the aging of the Baby Boomers, associated medical problems, and the use of tobacco products. AAA usually cause no symptoms until rupture, which usually results in loss of life. Through increased awareness and screening in persons at risk for the development of AAA, hopefully the number of ruptures and ultimately deaths in the US will begin to decrease. The endograft technique emerging as the treatment of choice for AAA allows for repair of AAA yielding a remarkable shorter recovery and fewer complications.