DEAR DR. GOTT: It is my fervent prayer that this letter reaches your hand. One cannot imagine the plethora of mail you receive daily. Therefore, I have attempted to keep my letter as short as possible.
Three words — abdominal aortic aneurysm — spoken to a patient conjures up one word: fear. Please address AAA in your daily column for the sake and benefit of the multitude of those aware and unaware of potential ramifications of this nefarious disease. I have read that 1,500 Americans lose their lives to this condition every year.
Our doctor has failed to satisfactorily address my questions about my husband’s condition during the past four years. The only medication he takes is Lovostatin daily for slightly elevated cholesterol. What causes AAA? What causes fat in the liver?
We look forward with great anticipation reading your learned knowledge of the disease, treatment options and advice.
DEAR READER: I’m not sure I can begin to measure up to your perceived inflated interpretation of my knowledge, but perhaps I can shed some light on your unanswered questions.
An AAA occurs when a portion of the aorta, the large blood vessel that supplies oxygen-rich blood to the abdomen, pelvis and legs becomes abnormally large or bulges outward. The aorta runs from the heart through the chest and abdomen. An aneurysm can develop anywhere along the aorta. When they occur in the upper portion of the aorta, they are known as thoracic aortic aneurysms. Similarly, when they occur in the lower portion of the aorta, they are called abdominal aortic aneurysms. While an unusual occurrence, when one develops between the upper and lower portion, they are known as thoracoabdominal aneurysms. Most small and slow-growing aneurysms will not rupture, and there will be few, if any, symptoms. The larger the aneurysm, the more likely it will rupture. Anyone can develop an aneurysm, but they are most commonly seen in males over the age of 60 who have at least one risk factor, such as high blood pressure, obesity, high cholesterol levels, a history of smoking, atherosclerosis, or specific genetic factors such as Marfan Syndrome, Ehlers-Danlos Syndrome, heart-valve problems, and injury.
Symptoms of a rupturing AAA can include nausea, vomiting, low blood pressure, loss of consciousness, abdominal or back pain that presents rather suddenly but persistently, clammy skin and a rapid heart rate. Examination by a physician might reveal a rigid abdomen, a pulsating sensation near the navel or a mass. While a physician might be able to palpate a mass, he or she may choose to do nothing for a non-rupturing one but monitor its size to determine whether it enlarges. If it is extremely slow growing, the aneurysm may not require any intervention other than monitoring; however, should blood from the aneurysm leak into the abdominal cavity or if it grows rapidly, surgical repair will likely be necessary unless the risks outweigh the benefits.
If a physician determines surgery can be avoided, at least temporarily, he or she may prescribe a beta blocker to slow the rate of growth of the aneurysm. In your husband’s case, he was prescribed medication to lower his cholesterol level. High levels are associated with plaque, fat deposits (from dietary choices or genetics) and a buildup of atherosclerosis and pressure on arteries. If surgery is agreed upon, there are two possibilities for repair. The first and most common is grafting the abnormal vessel with manmade material, such as Dacron. This procedure requires that a large incision be made into the abdomen. The second, known as endovascular stent grafting, doesn’t require the large incision of open repair. It has fewer risks than grafting. It is accomplished by inserting a needle in the area of the groin and advancing a catheter to the site of the aneurysm. Dye is then injected to help guide the placement of a stent graft device. Once in place, the device prevents blood flow through the aneurysm, greatly reducing the risk of rupture. Because long-term effects of this latter procedure haven’t been fully investigated, stent grafts are generally performed in patients thought to be at too high a risk for conventional repair. The prognosis is quite good for either procedure as long as the aneurysm is repaired prior to rupture. Without complications, patients are generally discharged home in four to seven days following the procedure and can resume normal activity within a month.
Prevention of an aneurysm can be accomplished through exercise, eating a healthful, low-cholesterol diet, avoiding stress and treating hypertension.
Most people diagnosed with an AAA live symptom-free, healthy lives. Guidelines for surgery are dependent on medical history, the size of an aneurysm and the rate at which it enlarges. The decision is best left to your husband’s physician.
To give you related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a $2 check or money order payable to Newsletter and forwarded to PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print out an order form from my website www.AskDrGottMD.com.
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