NEW YORK CITY -- Abdominal aortic aneurysm scared former U.S. Senate majority leader Bob Dole more than his previous bout with cancer did. Yet when diagnosed with it in 1998, he felt lucky because he found it in time. Most patients aren’t so lucky. Because screening is uncommon, over 15,000 people in the United States, mostly men, die from a ruptured abdominal aortic aneurysm (AAA) every year.
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What is abdominal aortic aneurysm?
AAA is an enlargement of the lower portion of the aorta, the largest artery in the body and the one that serves as the main route for distributing blood to organs and other tissues.
The condition begins with a weakened area in the aorta’s wall that swells over time from the pressure of circulating blood.
If the aorta stretches to 1.5 times its normal size, it is considered an aneurysm.
As the size increases and the wall becomes thinner, the risk of rupture and sudden death increase.
Because surgery is risky, doctors generally won’t operate until the aorta has stretched to approximately 5 cm in diameter.
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It is the 13th leading cause of death of men in this country, although women are affected too. More doctors should be screening their patients, Dole told a group of vascular specialists in November at the 30th annual VEITH Symposium, an international congress on vascular surgery and treatments that is sponsored by Montefiore Medical Center, Bronx, NY. And he urged the vascular specialists to spread the word among general practitioners. He said non-specialists may not know enough about AAA or when to order a screening. "You know how little some doctors know about aneurysms, and it’s scary," Dole said. "How do you get the message out?"
The sudden death of actor John Ritter on Sept. 11 brought screening for aortic dysfunction into the spotlight for a short time, Dole said.
Ritter, who was 54, died suddenly of a related condition, aortic dissection, the separation of the outer layers of the aorta. Like AAA, it is extremely difficult to detect without screening. "That certainly got people’s attention, but we forget pretty easily," Dole said.
Dole’s father died of a ruptured AAA without warning in 1975. After his own diagnosis, Dole is now speaking about the importance of screening and about the non-invasive procedure that saved his own life.
Most AAAs are found by accident. In Dole’s case his doctors discovered it while he was getting screened for a colectomy (the removal of part of the colon). After the AAA diagnosis, his doctors monitored the size of it before doing the procedure.
"Studies have shown that if it gets up near 5.5 cm, which is a little bit less than two inches, the risk of rupture outweighs the risk of the operation," said Kenneth Ouriel, MD, who performed the procedure on Dole. Ouriel is professor of surgery at Cleveland Clinic Lerner College of Medicine at Case Western Reserve University and chair of the department of vascular surgery at the Cleveland Clinic.
Dole elected to undergo a relatively new, minimally invasive procedure called endovascular aneurysm repair.
"We used to have to make a long incision," Ouriel told Heart1.com. "Instead of making a big incision in the abdomen you can make a little incision at the top of a thigh."
A catheter is used to push a stent with an attached tubular graft through the artery to the location of the aneurysm. After the catheter is pulled back out, the endograft remains behind and expands, strengthening the aorta and preventing rupture, Ouriel said.
If an AAA ruptures, a patient will die unless he is able to get to an emergency room in time. Even then the risk of death is 75%, Ouriel said.
"I was lucky. I was used to going to doctors," Dole said. "I’m 80 years old and probably shouldn’t even be around, but I’ve had a lot of good medical care."
