A review in the British Journal of Medicine in 2013 using 24 well done studies found that the risk of death after a ruptured abdominal aortic aneurysm was approximately 81%.
-British Journal of Medicine 2013 Oct; 100(11):1405-13
Research for the best treatment or repair of aneurysms is still ongoing.
Screening for abdominal aortic aneurysms is our best defense against bad outcomes after rupture.
Screening recommendations for abdominal aortic aneurysms:
Medicare Part B (Medical Insurance) covers an abdominal aortic screening ultrasound once if you’re at risk. You’re considered at risk if you have a family history of abdominal aortic aneurysms, or you’re a man 65-75 and have smoked at least 100 cigarettes in your lifetime.
https://www.medicare.gov/coverage/abdominal-aortic-aneurysm-screenings
US preventative services Task force recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA.
https://www.aafp.org/pubs/afp/issues/2020/0515/od1.html
The American College of Cardiology and the American Heart Association, The Society for Vascular Surgery, and
The American College of Preventive Medicine all have unique but similar recommendations.
We must follow the US Government Medicaid Insurance terms.
What is an aneurysm of the aorta?
The aorta is the pipe taking blood flow from the Heart to the organs of the abdomen and legs. When the diameter of the aorta becomes wider than 3.0 cm it is defined as an aneurysm.
What are risks factors for having an aortic aneurysm?
Currently or have ever smoked tobacco
Chronic obstructive pulmonary disease (COPD)
Family history of abdominal aortic aneurysm ( AAA)
Cardiovascular disease
Hyperlipidemia
Hypertension
National Institute for Health and care excellence guidelines, published: March 19, 2020. https://www.nice.org.uk/guidance/ng156
How will we monitor a small aneurysm?
We use ultrasound when the aneurysm is very small and will be checked every 1 to 2 years depending on size. This is usually between 3.0 and 4.5 cm.
When the aneurysm is 4.5 to 5.0 cm by ultrasound, then a CT ( cat scan) will be used. It will give us a better measurement and definition of anatomy to help with treatment decisions.
When do we recommend treatment?
We will begin the discussion of treatment when a CT (cat scan) shows an abdominal aortic aneurysm is 5.0 cm. An aortic aneurysm less than 5.0 cm has almost 0% chance of rupture, by medical literature.
What is the Risk of rupture of an abdominal aortic aneurysm compared to size?
Men:
5.0-5.9 cm diameter has a 1.0% chance of rupture
6.0 cm and greater has a 14.1% chance of rupture
Women:
5.0-5.9 cm diameter has a 3.9% chance of rupture
6.0 cm and greater has a 22.3% chance of rupture
https://www.jvascsurg.org/article/S0741-5214(02)75260-9/pdf
The overall incidence of ruptured AAA in patients:
Cumulative yearly rupture rates of :
3.5% in AAAs 5.5 to 6.0 cm,
4.1% in AAAs 6.1 to 7.0 cm,
6.3% in AAAs >7.0 cm.
Overall: greater than 5.5 cm was 5.3% per year. Therefore, we begin the discussion of repair between 5.0-5.5 cm.
https://www.jvascsurg.org/article/S0741-5214(14)01905-3/fulltext
How will we choose the best treatment?
The anatomy of the aorta has many important branch vessels, including the renal arteries (arteries to the kidneys), arteries to the spine, and intestines (large and small).
The size of the aorta aneurysm can make a difference in the treatment which is recommended.
The use of endovascular techniques instead of open surgery has given vascular surgeons the ability to improve the mortality of an unruptured AAA. The most recent review from the Cochrane Database for the treatment of ruptured abdominal Aortic Aneurysms showed that:
The conclusions of this review are currently limited by the paucity of data. From the data available we found moderate quality evidence of no difference between endovascular aortic repair and open repair for the primary outcome evaluated in this review, 30 days or in the hospital mortality.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481849/pdf/CD005261.pdf
More than 90% of elective unruptured abdominal aortic aneurysms today are repaired by an endovascular stent graft.
What are the risks for treatment of an abdominal aortic aneurysm?
We will show you pictures of your anatomy, and CT (cat scan) results then discuss and explain the procedure recommendations for treatment.
Risks are the same for endovascular and traditional open repair. They are rare and will be explained. These can be listed, but using diagrams and pictures will explain these much better during your appointment. We want you to fully understand and be satisfied with your decision. Come see us for your abdominal aortic aneurysm treatment Idaho Falls, at Snake River Vascular Surgery we are here to help!