Aortic Intervention, Coronary Intervention, Interventional Radiology, Peripheral Intervention, Vascular Surgery

Abdominal aortic aneurysm claims thousands of lives a year: can they be saved?

When an aneurysm of the abdominal aorta ruptures, the probability of survival reaches only 50 percent. Prevention can help stop this insidious disease, but few know that having noticed the enlarged aorta on time, adversities can be easily avoided.

An abdominal aorta aneurysm is extremely life-threatening since a person does not feel the aorta expanding. Most often, for a long time, a patient is not aware of the risk. A looming disease that prowls silently strikes hard – the first symptom can only be felt by a person when the aorta is ruptured. Only an early diagnosis can save a patient’s life, which is why people should take personal care of themselves and undergo annual preventive screening to detect aortic anomalies in time.

Abdominal ultrasound can save lives

The family doctor should refer patients at higher risk for a free examination and if a person has no complaints and wants to be examined – issue a referral for an abdominal ultrasound. Unfortunately, the numbers of people being treated for enlarged aorta show that such practices are still difficult to achieve. Only part of the family doctors encourage their patients for self‑examination, and most of the people know little about this disease and for this reason, do not register for an examination. Most often, the disease is diagnosed during the examinations of other diseases. It is, therefore, necessary to ensure greater awareness of disease prevention and to increase access to this testing.

A rapid and not uncomfortable examination is of particular importance since when the aortic diameter is determined, the risk of rupture can be assessed, while in case of the suspected enlarged aorta – the patient’s life can be saved.

The vascular surgeon emphasizes that the referral should state that when a patient is referred for an abdominal aorta examination, the aorta may remain not examined during the ultrasound examination of other organs. During such an examination, the echoscopist calculates and evaluates the diameter of the aorta, reviews the entire length of the aorta, checks the arteries. The disease can affect not only the aorta but also the iliac arteries – as many as 85 % of patients have lesions in both the abdominal aorta and the iliac arteries.

According to the vascular surgeon Mackevičius, it is recommended to start screening in men aged 65 and over. In women, this disease occurs 5 or 10 years later, but an aortic aneurysm can also occur at an earlier age. High blood pressure, heredity, and smoking are also important risk factors for abdominal aortic aneurysms.

“If a suspicious expansion of the aorta is found, the family doctor will continue to refer the patient for consultations with a vascular surgeon. A surgeon, depending on the diameter of the aorta, informs about the next steps. For example, he continues to monitor the patient, sends a computed tomography‑angiography test, or prescribes open surgical or endovascular therapy,” says the doctor. Mr. Mackevičius adds that the examination and treatment are reimbursed by the National Health Insurance Fund.

Lower intervention create better chances to get through the disease

An abdominal aortic aneurysm is treated in two ways – by open surgery or endovascular treatment. Open surgery is an invasive treatment in which the aorta is clamped having cut open the abdomen, half the blood flow of the body is stopped and an artificial blood vessel is stitched. Such a method of treatment of the abdominal aortic aneurysm causes significant trauma for the patient, while during the endovascular treatment, minimal intervention is applied. Through the groin, endovascularly is inserted a stent graft, through which blood flows and thus the blood flow is restored.

As the vascular surgeon Mackevičius explains, both methods are recommended by American and European societies of vascular surgery. “In each individual case, account shall be taken of the patient’s age, anatomy, and other circumstances. If the patient is younger, healthy, and free from any other co‑morbidities, open treatment is usually offered. In all other cases, endovascular therapy is recommended, as less intervention gives a higher chance of survival. For example, in Germany, when the aorta is ruptured, the mortality rate of patients undergoing open surgery is about 35 %, while in the case of endovascular treatment, the mortality rate is only 15 %,” says Mackevičius.

After the surgery, it is necessary to continue examinations

After endovascular (closed) surgery, the aneurysm of the aorta remains “disconnected” from the bloodstream, therefore it is necessary to monitor the patient even after the surgery. Often, patients who come for examination after the surgery, do not come back after having heard the good news. The doctor instructs that after implantation it is necessary to perform monitoring and come for examination after a month, half a year, a year, and later once a year.

“The situation should be monitored for leaks and disease progression. Presumably, some pressure accumulates and the disease continues to progress, which can complicate the healing process, but as technology advances, the progression might be slowed down; as a result, re-intervention is less likely to be needed,” says Artūras Mackevičius.

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