Answers to FAQs about abdominal aortic aneurysms

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    Answers to Frequently Asked Questions about Abdominal
    Aortic Aneurysms, prepared by:
    M. David Tilson, MD
    Professor of Surgery
    Columbia University
    New York City
    *Please see Section 11 for the most recent update, May 2004,
    regarding Endovascular Repair*
    1. What is an aneurysm?
         An aneurysm is a dilation of a blood vessel (similar
    to a balloon) that poses a risk to health from the
    potential for rupture, clotting, or dissecting.  Rupture
    of an aneurysm in the brain causes stroke, and rupture of
    an aneurysm in the abdomen causes shock.  The abdominal
    aortic aneurysm (AAA) is the most common, and the rest of
    this discussion will focus on the AAA.
    2. What causes aneurysms?
         Several new theories have developed over the last 15
    years.  It appears that the disease probably requires a
    basic genetic susceptibility that may be traceable to a
    single major locus, probably an autosomal dominant
    gene.  The disease unequivocally runs in families.  In
    addition, there are probably other contributing causes,
    such as smoking and high blood pressure.  
    3. Who is at greatest risk?
         White men over age 55 are at the greatest risk.  In
    fact, aneurysms are among the top ten causes of death
    among this group. By about age 80, over 5% of white males will have
    developed an aneurysm.  AAA's occur less frequently in
    white women, and they are relatively uncommon in African
    Americans of both sexes.
    4. Why are aneurysms so dangerous?
         AAA's cause many deaths because they are usually
    silent until a medical emergency occurs.  One author has
    referred to an AAA as a "U-boat" in the belly, because
    they are silent, deep, deadly, and detectable by sound waves.  
    5. How can I find out if I have one?
         If you are thin and have a moderately large-sized
    AAA, you or your doctor may be able to feel it below your
    rib cage.  Many are incidentally discovered as a result
    of medical imaging for other conditions, by ultrasound
    exams, CAT scans, MRI's, or even plain X©rays of the
    abdomen.  If you are over 55 and other members of your
    family have had one or more AAA's, you should advise your
    doctor and have an ultrasound.  It is safe, fast and
    6. If I have an aneurysm, what is the risk of death from 
         If rupture occurs, few survive.  Among celebrities, 
    Roy Rogers survived a rupture, but he was the exception 
    and not the rule.  Albert Einstein, Lucille Ball, and Conway 
    Twitty were not so fortunate.  The best predictor of risk of 
    rupture is the size of the aneurysm. The diameter of a normal
    aorta is about 2 centimeters (a little less than an inch).   
    Once a AAA has reached 5-6 centimeters in diameter, about the 
    size of an orange, the risk of rupture is very substantial, probably 
    about 50/50 over the next few years.  Most vascular surgeons 
    would agree that a 5-6 cm aneurysm should be repaired, unless other 
    medical factors in a patient make the operation too risky.  There 
    is less unanimity of opinion about smaller AAA's, since the risk of 
    rupture is much lower.  Some surgeons are now recommending repair of 
    aneurysms over 3 centimeters, but others would advise watchful 
    waiting for AAA's that small. There is presently a controlled, 
    randomized, multi-center trial being carried out in the Veterans 
    Administration Hospitals to try to answer the question as to when 
    the size of the aneurysm indicates that the surgical risk for the 
    patient has become less than the risk from rupture.   
    7. What is "watchful waiting?"
         Most vascular surgeons feel comfortable following
    patients with small AAA's every six months with an
    ultrasound examination.  The average rate of growth of an
    aneurysm is less than one-half of a centimeter per year,
    and some grow much slower, remaining relatively stable
    for fairly long periods of time.  Others may enlarge
    rapidly, and a "growth spurt" is a serious warning sign.
    8. Is there anything one can do while "waiting"?
         Giving up tobacco, making sure of reasonable blood
    pressure control, and improving physical fitness with a
    mild exercise program are all prudent.  So far, no
    medication has been proven in a prospective scientific
    experiment to reduce the growth rate of AAA's in people,
    although propranolol (a beta-blocker) has been shown to
    reduce the incidence of ruptured aneurysms in turkeys and to 
    delay the growth of aneurysms in mice.  Retrospective studies 
    at Yale and at the University of Vermont have suggested thatp
    ropranolol might be beneficial in people, but proof will await a
    prospective trial.  Such a trial is now being planned by
    surgeons at the University of Vermont.
    9. What are the risks of surgical repair?
         The risk of death from surgery is related to
    hospital expertise and experience, the skill of the
    surgeon, and the basic underlying health of the patient. 
    Mortality rates are frequently reported to be as low as
    0 to 2% in academic medical centers with vascular
    specialists and superior intensive care.  Rates may be
    higher in small community hospitals without dedicated
    vascular specialists.  Patients without any history
    or signs of heart disease generally do very well,
    because heart attack postoperatively is the leading cause
    of surgical mortality.  Patients with known coronary
    artery disease should have a thorough cardiological
    evaluation prior to surgery.  
    10. How long does it take to recover, and what is the likelihood of
    returning to a normal life?
         The average hospital stay is 7-10 days, and most
    patients take about 6 weeks off before returning to work. 
    By that time, they have usually regained their sense of
    well being, although some bounce back much faster.  The 
    vast majority of patients are back on a normal survival 
    curve for life expectancy, consistent with their cohort 
    of persons of similar age and with similar underlying 
    health (e.g., heart condition, renal function, etc.).  One
    unfortunate complication, about which male patients should
    be forewarned, is the possibility of sexual dysfunction.
    If this occurs, it usually takes the form of "retrograde
    ejaculation", not impotence.  For more information, please
    consult with your doctor.
    11. I've heard of "minimally invasive surgery".  Does
    this work for AAA?
         There has been recent progress toward this goal.  An
    "endovascular" repair (e.g., using tubes, stents, and
    wires threaded up into the aneurysm from leg arteries)
    was developed by a surgeon in Argentina and is presently
    coming into use in the United States.  This procedure is
    presently considered to be in its developmental stages, 
    and it is offered only in selected centers.
    [Addendum to this FAQ, April 30, 1995: Dr. Juan Perodi has
    just published an account of the first 50 of these aneurysm
    procedures, reviewed by mdt in the April Papers of the Month
    section in the Aneurysm Information Project Home Page.]
    [Addendum, May 2004: In the past decade, it is fair to say
    that the endovascular approach has matured to the point
    where many specialists presently consider it to be the
    procedure "of choice".  Please click on Aneurysm Surgery
    back at the homepage for a link to Dr. Todd's website,
    where there is a very informative discussion of the present
    state of endovascular versus open repair.]
    >For a quick link to this comparison,  click 
    12. What can I do to help the Aneurysm Information Project
    reach more people?
    	Good question.  It's absolutely amazing that almost
    as many people die from aneurysms as from diseases that get
    tremendous amounts of public attention and awareness (like 
    AIDS and breast cancer).  I guess because its primary
    victims are aging Caucasian males, it doesn't have much sex
    appeal.  But just as early detection of breast cancer with
    mammography can save life, so can early detection of AAA by
    ultrasound.  Advising family members over age 50-55 to have
    an ultrasound (and letting your older friends know that
    about 5% of men over 70 will be positive) should certainly
    prevent unnecessary loss of life.  
    13. Is there anything I can do to help advance knowledge of
    the causes and prevention of aneurysms through research?
    	Thanks for asking.  While the NIH is spending almost
    two billion $ / year on AIDS and hundreds of millions / year on
    breast cancer, AAA's only got a few hundred thousand $.  I am
    presently keeping my research program alive thanks to the
    generosity of friends of the Aneurysm Information Project.  On
    an average, it costs about $50-75,000 to do an experiment; and
    my students and I hope to finish about 4 this year.  That gives
    you an idea about the scale of fund-raising I need to 
    accomplish to stay in the chase for the aneurysm susceptibility
    	One of my parent organizations, the St.Luke's/Roosevelt
    Hospital Center is non-profit and tax-exempt, so that you may
    make a fully tax-deductible gift to it, earmarked for the 
    Special Fund for Resident Research on Aneurysms (which is under
    my authority).  Friends of the Special Fund will get periodic
    reports from me on the status of the research program; and
    especially generous contributions will be acknowledged with
    appreciation in the footnotes to our scientific papers. 
    	Make check to SLR Hospital Center
    	Mail to M. D. Tilson, MD
                    SLR Hospital Center
    		1000 Tenth Avenue
    		New York, NY  10019