Fixing the Aorta

aaaThe aorta is the body's biggest blood vessel. It arises from the heart, curves upward, then descends through the chest cavity, crossing the diaphragm into the abdomen, where it is referred to as the 'abdominal aorta.' And it is here that this giant and vital pipeline is most likely to develop a weakening or ballooning in its wall called an aneurysm. This condition is known as 'abdominal aortic aneurysm' or 'AAA' for those in the know.

AAA is an increasing problem, especially for older men. We could think of it as a success story since the majority of people have to live long enough to develop the condition, but the big danger is that the aneurysm will rupture, most likely resulting in sudden death. The US Surgeon General has recently mounted a public education campaign to focus awareness on AAA since cases are increasing in that fastest-growing segment of our population: those aged 80 and older.

What can be done about AAA? A study in this week's NEJM takes a look at two interventions: so-called open surgery, where a traditional operation to repair the ballooning part of the aorta is performed, and so-called endovascular repair, where an instrument is snaked up through the vessel and a graft is placed over the area that is weakened. The study concludes that while endovascular repair is less of a problem up front, it offers no benefits in terms of survival over the long haul compared with open surgery, and is more likely to require another operation down the road. It's also more expensive because the grafts are quite pricey. Rick and I both conclude in the podcast that if we were in the unenviable position of having to choose, we would pick the open repair.

Things can be done to minimize your chances of developing AAA. Don't smoke, keep your blood pressure under control, and watch both weight and diet. Just about the same advice for a long and healthy life in all ways. In the case of AAA though, you should also ask your physician about an ultrasound examination of your abdomen. If a ballooning area is found on your aorta, size matters. It's not necessary to intervene until and unless the area reaches a certain size. So don't be too concerned if you're told you have AAA but your physician chooses to simply watch it for a while.

Other topics this week include appropriate control of heart rate in a heart condition known as atrial fibrillation, also in NEJM, and two studies from JAMA: the impact of financial considerations in people seeking treatment for heart attack, and screening infants for a viral infection known as CMV. Until next week, y'all live well.

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John Carsten August 19, 2011 at 9:27 am

Having had my first endo repair of my AAA in 2002 with subsequent "modifications" in 2004 and 2011 I am still a believer that the endo is the way to go.
With an open procedure there is significantly higher risk for a problem during the procedure that doesn't exist with the endo. The recovery time (full recovery) can be as long as 90 days for the open procedure while that for the endo is 2 weeks.
Outcomes, including possible problems during procedures indicate clearly that the endo procedure is far more positive not withstanding the eventual need for further surgery for either procedure.
I will take the endo over open surgery any time.

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