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Aortic Aneurysm is a Silent and Instant Killer

NEW YORK May 13, 2004

Weakening and rupture of the aorta, the largest artery in the body, usually occurs along the abdominal part of the artery and kills 80-90 percent of those affected; even when a patient with an abdominal aortic aneurysm reaches the hospital alive, only half will survive, according to K. Craig Kent, M.D., chief, Division of Vascular Surgery, New York Presbyterian Hospital, Cornell and Columbia campuses and Professor of Surgery at Weill Medical College of Cornell University and College of Physicians and Surgeons, Columbia University, New York City.

"The biggest shame about people lost to aortic aneurysms, Dr. Kent added, "is that the disorder is easily discovered in a l0-minute screening test and if detected, can be surgically corrected successfully in 95-99% of people." Dr. Kent spoke today at an American Medical Association media briefing on cardiovascular disease in New York City. "We know that about 15,000 people die annually of ruptured aneurysms," Dr. Kent said. "Five to 10 percent of people (200,000 annually) who die of sudden death are also victims of this. That adds up to at least 30,000 deaths each year-- approximately the same number that die every year of breast or prostate cancer.

One of the reasons why most people are not aware of the disorder is the nature of the disease and the population affected. "Aneurysms affect older people and it is usually the young who are advocates for diseases," Dr. Kent explained. "Also, it is a silent and sudden killer; when someone dies of an aneurysm, it is a quick process, but when people have breast or prostate cancer, the course is usually protracted and consequently awareness is increased."

The aorta is a tubular structure that originates in the heart and runs through the chest and abdomen, providing blood to arteries that feed the organs. In certain individuals, the aortic wall weakens and dilates, becoming thin and subject to rupture. The rupture usually occurs in the abdominal portion of the great artery, leading to profuse bleeding, shock and death. It occurs more frequently in the elderly and in men (at a ratio of 5:1). Risk factors for aortic aneurysm are similar to those for cardiac disease: smoking, diabetes, high blood pressure and cholesterol, other events such as stroke and heart attack, and family history.

The medical community has known about abdominal aortic aneurysm for many years, Dr. Kent stated. The condition has been treatable with surgery since the 1950s. "One might suspect that our ability to treat and detect aneurysms would have improved over the past several years; however, this is not the case." fn a recent study, Dr. Kent and colleagues compared database information on aortic aneurysm for thousands of patients from 1980 through 2000 in terms of treatment, detection and prevention. "What we found over the 20-year span,” Dr. Kent said, "is that there was no improvement at all-the same number of people were being treated, the number of ruptured aneurysms was the same and mortality from aneurysm, repair was approximately the same.”

A new minimally invasive approach has been developed that allows treating aneurysm to be treated through two small incisions in the groin, requiring only a 1 to 2 day stay versus the 7 to 10 day stay that was the norm. In a study conducted by Dr. Kent, this new procedure is associated with a mortality rate of only 1 percent, compared to the previous rate of 2-4 percent using traditional surgery. The rate of complications was also lower with the newer technique.

Thus, one of the ways to solve this problem is to introduce wide-scale screening for aneurysms. In a follow-up study, Dr. Kent and his collaborators found that screening for aortic aneurysm is cost effective.

"In terms of saving money for society, in terms of making people live longer, screening for aneurysms is more effective than mammography is for breast cancer, or screening for prostate cancer." He added that screening should be recommended for all men over 60 years of age and for similarly-aged women with risk factors. The condition can be screened for using a basic, non-invasive ultrasound imaging test of the abdomen, yet many health insurance plans, including Medicare and Medicaid, do not cover the procedure.

A bill is on its 'way to Congress that will mandate coverage of screening. "The bill is a really exciting development," Dr. Kent said. "With this, we will be able to identify those people [with aneurysms] before they rupture." The American Vascular Association has designated May 13th as National Screening Day for abdominal aortic aneurysm.

To contact K. Craig Kent, M.D., call Annie Bayne at 212/305-9746 or email: As862@columbia.edu.

Editor's Note: Dr. Kent has no financial interests, arrangements, nor affiliations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation to disclose. Dr. Kent has received an honorarium from the American Medical Association to speak at today's briefing.