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October 5 2016

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

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.

“Pain in the belly and chest are taken very seriously,” said Alan Johnson, director of emergency services for ProHealth Care.

When patients have these symptoms, 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. When a AAA is identified, a CT angiogram is performed. The angiogram uses X-rays to provide detailed pictures of the heart and the blood vessels that go to the heart.

"Once we identify a leaking or ruptured aneurysm, it’s all hands on deck," Johnson said. "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.”

The next step is an endovascular aneurysm repair, a minimally invasive procedure in which 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. “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.”

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.

“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.”

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.

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.