November 26, 2021 by John Fernandez
At the Heart of Abdominal Aortic Aneurysms
If you’ve been diagnosed with an abdominal aortic aneurysm (AAA), you understandably may be alarmed. When an AAA ruptures, it is nearly always fatal. There is good news, however; if detected early, it is very treatable, say experts at Miami Cardiac & Vascular Institute, who as early pioneers of less invasive treatments for aneurysms also are among the most experienced.
The Institute continues to be involved in clinical trials on next generation devices for treating aneurysms. It’s also in the process of creating the first National Center for Aneurysm Therapy in the world, where physicians of all different disciplines will work together to provide the most advanced care for those with an aneurysm in the aorta, brain, kidney, liver or anywhere else in the body.
“Unfortunately, it is sometimes communicated to abdominal aortic aneurysm patients that they have a ticking time-bomb in their abdomen and they get really scared,” says interventional radiologist Barry T. Katzen, M.D., founder and chief medical executive of Miami Cardiac & Vascular Institute. “It’s important to follow up to see if treatment is necessary or if the aneurysm is small enough that it can be monitored. We follow many more patients than we have to treat with a minimally invasive procedure or surgery.”
An aneurysm is a bulging and weakening area in a blood vessel. In the aorta, it can occur anywhere from the heart to the point where the blood supply branches into the legs. Some 200,000 Americans are diagnosed with an abdominal aortic aneurysm each year, according to the Society for Vascular Surgery, and a ruptured AAA is the tenth leading cause of death in males over the age of 55.
Although AAA is referred to as a silent disease because few people have symptoms, there are risk factors everyone should understand, Dr. Katzen says. Risk factors include high blood pressure and cholesterol; diabetes; atherosclerosis or other heart disease; being overweight; being male and smoking. The link to smoking is strong enough that the U.S. Preventive Services Task Force recommends an ultrasound screening for men ages 65 to 75 who have been smokers, even if they have no symptoms. The test is covered by Medicare. In addition, there is a genetic component, increasing your risk if someone else in your family has had an AAA.
If an AAA is found, doctors look at numerous factors to determine the best treatment. “We consider the size and location of the aneurysm, and whether the patient has any serious health issues to determine if the risk of rupture is greater than the risk of treatment,” Dr. Katzen says.
In general, most patients whose aneurysms are 5.5 cm or smaller will be watched over a period of years to ensure the aneurysm doesn’t enlarge. To reduce the risk of rupture, patients may be prescribed blood pressure medication and statins as inflammation caused by cholesterol can lead to plaque build-up in an artery and weaken the blood vessel further. Smokers are advised to quit.
In the past, those who required AAA repair had a major surgical procedure that involved opening the abdomen to insert a graft device. Today, the majority of patients can undergo endovascular aneurysm repair (EVAR), a minimally invasive treatment that is also ideal for those who are not good candidates for open surgery. Miami Cardiac & Vascular Institute was among the first five research centers in the United States to use abdominal aortic stent-grafts in 1994.
During EVAR, physicians thread a catheter through an artery in the groin to the location of the aneurysm and then deploy a stent-graft device, made of a combination of metal mesh and fabric. Left in place, it safely channels the blood through the weakened section of the artery, relieving pressure and preventing the aneurysm from bursting. Patients usually stay in the hospital a night or two.
Physicians are often able to tackle very complex aneurysms and those with multiple branches using the endovascular approach as well. “We will customize or create a device for a patient,” Dr. Katzen said. “These procedures at Miami Cardiac & Vascular Institute involve teams of interventionalists and vascular surgeons bringing maximum expertise to our patients. We may be coming at aneurysms from the arm and the groin at the same time to manage difficult anatomy. While these are complex, they are still minimally invasive, making recovery easier than with open surgery.”
To learn more about the Institute’s abdominal aortic aneurysm program, click here.