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October 5 2016
 

An abdominal aortic aneurysm can be a dangerous emergency in the making

No matter how much you may know about abdominal aortic aneurysms, you still may not know that you have one – even if you experience the debilitating pain that can occur with a rupture.

Ask Ed Lovas. He manages cath lab and interventional radiology services at ProHealth Waukesha Memorial Hospital. Lovas had to leave a meeting at work because of severe pain. Despite his clinical experience, he did not realize that he had a ruptured aneurysm.

An abdominal aortic aneurysm, or AAA, is an abnormal enlargement and weakening of the main artery in the abdomen. When the aneurysm is larger than 5 centimeters, there is an escalated risk for leaking or rupture. If an abdominal aortic aneurysm is not identified through a health screening and is not repaired, it may rupture, typically resulting in severe abdominal and back pain. The situation is life threatening.

Lovas, 58, said that his medical journey began on a day when he was experiencing pain while at work. “When I told my boss I was going home, she said, no, you need to go to the emergency department,” he said.

The emergency medicine professionals at Waukesha Memorial performed a scan on Lovas for a kidney stone, and the scan revealed a leaking aneurysm. A CT angiogram, a test that uses X-rays to provide detailed pictures of the heart and the blood vessels that go to the heart, was performed immediately to assess the anatomy in preparation for emergency surgery.

“Pain in the belly and chest are taken very seriously,” said Alan Johnson, director of emergency services for ProHealth Care. When patients have symptoms like Lovas had, emergency medicine professionals often elect to perform an EKG to check for a heart attack, as well as blood tests and diagnostic imaging as soon as possible, Johnson said.

"A leaking abdominal aortic aneurysm makes everybody stand up and take notice,” Johnson said. “Once we identify a leaking or ruptured aneurysm, it’s all hands on deck. We get that individual to the operating room immediately. There’s already a break in the integrity of the vessel, so it’s just a question of time until that tear becomes bigger, which is potentially fatal.”

Lovas remembers the moment the medical team sprang into action: “All of a sudden there were half a dozen people from the ER in the scanning room. I was transferred to a gurney and we went flying from there.”

Lovas underwent a minimally invasive endovascular aneurysm repair. In the procedure, a vascular and interventional radiologist and vascular surgeon work as a team to treat the ruptured aneurysm with a fabric-covered stent. The entire operation is performed through tiny incisions in the groin area. The physician uses a catheter to insert the stent into the aorta to bridge the tear and seal the leak.

Since the 60- to -90-minute procedure is less invasive than open surgery, it allows a patient to return home more quickly and resume normal activities faster.

“An endovascular repair is the standard of care for treating abdominal aortic aneurysm,” said Scott Koss, MD, an interventional radiologist at ProHealth Care. “The determination is based on the patient anatomy, but the vast majority of these procedures performed at ProHealth Care are hybrid minimally invasive surgeries performed by an advanced team of vascular interventional radiologists and vascular surgeons,” he said. “Our team of cardiovascular professionals has extensive experience in the endovascular treatment of simple and complex aortic aneurysms in the chest and abdomen.”

Dr. Koss explained that the procedure is performed when the aneurysm is 5 to 5.5 centimeters in size.

“We prefer to do a repair electively, and thankfully most aneurysms that we treat are non-ruptured,” he said. “It’s best to discover an aneurysm clinically or through vascular screening programs. When that happens we typically watch the aneurysm until it is at least 5 centimeters in size and then we start planning for an elective repair.”

Had Lovas been evaluated earlier for signs that he might have an aneurysm before it began to bleed, the situation would have been serious but his life would not have been in imminent danger.

Aneurysms can develop slowly over many years and often produce no symptoms. They are difficult for a physician to feel on physical examination. In fact, abdominal aortic aneurysms often are called a “silent killer.”

 For people with certain risk factors, a simple ultrasound screening can identify an AAA. Lovas is a believer. He has urged his family members to get screened.

“The screening is remarkably easy and non-invasive,” Dr. Koss said. “If someone has a family history of aneurysm, or a history of smoking and is 55 years old or older, it’s a good thing to do.”

Lovas’ repair was performed on a Thursday this past spring, and by Saturday evening he was home recuperating. He was back at work in less than six weeks. He said he experienced very little pain from the repair, but recovering from an abdominal aortic aneurysm takes time and can be painful because of the trauma the body experiences from the rupture. Lovas received physical therapy to help with reconditioning his muscles from the back pain associated with the AAA.

“I am so blessed and so lucky to work in a place where we have the technology to do this procedure,” Lovas said.

Technology isn’t the only thing that was instrumental in Lovas’ care. His wife, Ruth, an RN at ProHealth Waukesha Memorial, was at his side before and after the procedure and for his recovery. And he also can’t say enough about how compassionate the hospital staff and his colleagues were throughout his “adventure.”

“I tell my staff — who see people in difficult situations all the time — that they make a tremendous impact on people’s lives,” Lovas said. “And they’ve told me that it’s nice to see a former patient resume daily life. They don’t necessarily see patients after they leave the hospital.”

Abdominal aortic aneurysms are the 17th leading cause of death in the United States, according to the Society of Interventional Radiology. Approximately one in every 250 people over the age of 50 will die of an AAA, and men are four times more likely to have an aneurysm than women. Half of patients with an abdominal aortic aneurysm who do not undergo treatment die of a rupture.

Lovas urges anyone experiencing severe pain to get help right away.

“Listen to your body and seek medical treatment sooner than later,” Lovas said. “Even with my experience, I didn’t know I had an abdominal aortic aneurysm. If I had not pursued medical help, the outcome would not have been what it was.”

For more information about vascular screening, please visit ProHealthCare.org/VascularScreening.

 

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For more than a century, ProHealth Care has been the health care leader in Waukesha County and surrounding areas, providing outstanding care across a full spectrum of services. The people of ProHealth Care strive to continuously improve the health and well-being of the community by combining skill, compassion and innovation. The ProHealth family includes ProHealth Waukesha Memorial Hospital, ProHealth Oconomowoc Memorial Hospital, ProHealth Rehabilitation Hospital of Wisconsin, ProHealth Medical Group, the UW Cancer Center at ProHealth Care, Moreland Surgery Center, ProHealth AngelsGrace Hospice, ProHealth Home Care, ProHealth West Wood Health & Fitness Center and ProHealth Regency Senior Communities. Learn more at ProHealthCare.org.