clinical update publication

Deborah Offers Nonsurgical Treatment for Abdominal Aortic Aneurysm

Accounting for more than 15,000 deaths each year and affecting as much as eight percent of the population over 65, abdominal aortic aneurysms (AAA) threaten thousands of lives annually. Current data suggests that the occurrence of AAA has increased threefold in the past 30 years. Aneurysms over 5 to 5.5 cm diameter are especially at risk for rupture, and merit treatment. The diagnosis and treatment is unquestionably essential, since fewer than 20 percent of patients ever survive AAA rupture.

“Accurate, timely diagnosis and treatment of abdominal aortic aneurysms are the only ways to ensure survival of this condition,” stated Manu Rajachandran, MD, Chair, Department of Endovascular Medicine, Deborah Heart and Lung Center. “The disease is often called a ‘silent killer’ because of the absence of obvious symptoms; in fact, three out of four patients will have no symptoms at the time of diagnosis. Careful examination of the patient and evaluation of family history and risk factors are essential for swift diagnosis and treatment.”

Diagnosis
When present, symptoms of an aneurysm can include abdominal pain, the feeling of a heartbeat-like pulse in the abdomen, and, in the case of an aneurysm that is nearing rupture, sudden and severe pain in the abdomen or lower back. In the event of a rupture, symptoms, in addition to sudden and severe abdominal or lower back pain, can include paleness, dry mouth and skin, excessive thirst, nausea and vomiting, and symptoms of shock, such as fainting, sweating, dizziness and weakness.

In the likely event that patients visit their physicians and report no symptoms that would generate suspicion of AAA, physicians should be keenly aware of risk factors related to the condition in order to identify at-risk patients. These risk factors include family history, high blood pressure, smoking, and, though AAA can occur at any age, being a male over the age of 60. If AAA is suspected, the patient should be quickly referred for diagnostic testing; the most common diagnostic methods include MRI, CT scan and abdominal ultrasound.

Repair
Traditionally, the only treatment for AAA has been surgical repair, a lengthy procedure involving an open abdomen and sewing of a man-made graft into the aorta at the bulge, alleviating pressure on the aneurysm to prevent rupture. While the procedure is reliable and has been proven effective in both the short- and long-term, it requires a long hospital stay and recovery, and offers no solution to those at high risk for surgical repair. These patients are left to choose between very risky surgery or the chance of rupture on medical therapy alone.

With the recent advent of interventional endovascular AAA repair, however, this patient population now has hope. “Interventional repair of abdominal aortic aneurysms is relatively new, and has generated much excitement in the vascular community,” stated Dr. Rajachandran. “The potential to repair this condition in someone who might otherwise have no option is remarkable.”

At Deborah, Dr. Rajachandran, Vascular Surgeon Seyed-Mojtaba Gashti, DO, and Radiologist Robert Altin, MD, collaborate to perform this procedure in one of Deborah’s five operating suites, using Cook Medical’s Zenith® Stent Graft System. This particular graft was selected because of its ability to fix above the renal arteries without cutting blood supply to the kidneys, and because of its significantly lower risk of graft migration and endoleaks.

The first patient to receive this stent graft at Deborah underwent the procedure in September 2004. Due to prior abdominal surgery, a hostile abdomen and the existence of multiple comorbidities, the patient was considered to be of prohibitive surgical risk. Prior to graft implantation, the aneurysm measured more than 5 cm diameter and required prompt repair. The interventional procedure proceeded smoothly and was considered a roaring success.

“This particular patient was able to go home in two days, and enjoyed a swift, less painful recovery,” explained Dr. Rajachandran. “Without this interventional procedure, the patient faced a grim choice: high-risk surgery, or risk of rupture. Now, he is able to live his years without fear.”

Though interventional repair of abdominal aortic aneurysms clearly offers a less painful and quicker recovery than open surgical repair, its relative novelty still prevents it from being the ideal option for every AAA patient. Currently, it is recommended only for patients for whom open surgical repair presents a greater mortality risk than leaving the aneurysm untreated; patients in otherwise satisfactory health with minimal surgical risk are still encouraged to receive surgical repair, as long-term effects of interventional repair are still unknown. It is expected, however, to become a more viable option for all patients as results are examined in the long term.

“Thanks to the development of interventional repair, we are now able to offer a viable option to abdominal aortic aneurysm patients who otherwise face a dismal choice: undergoing high-risk surgery, or leaving a dangerous problem untreated,” stated Dr. Rajachandran. “Nothing gives our team more satisfaction than to offer such an optimistic alternative to Deborah’s patients.”™

Return to Home l Cardiac Services l Pulmonary Services l Patient Information l Support Groups l Directions

Are You Interested in Being Contacted for an Appointment?
Questions? send your e-mail to
askaquestion@deborah.org