Most people with Abdominal Aortic Aneurysms (AAA) are not even aware they have the condition, resulting in more than 30,000 deaths in the United States each year. This winter alone, Apostolos K. Tassiopoulos, MD, Chief of the Division of Vascular Surgery, Stony Brook University Hospital (SBUH), has seen the greatest increase of AAA cases in his entire 15 year career.
“This winter the cold weather could indirectly lay blame on this increase,” said Tassiopoulos, “Although the exact mechanism is not known, multiple studies have pointed out a spike in AAA ruptures during the winter months. And a number of possible explanations have been entertained.”
Tassiopoulos says, lower barometric pressure, smoking and increases in blood pressure are proven factors contributing to aortic aneurysm rupture. “During the winter months periods of low barometric pressure are more common and exposure to smoking is higher as time spent indoors increases. Blood pressure also increases with exposure to cold weather."
And with the cold weather came a lot of snow this winter. “With strenuous weather-related activities, such as snow removal, and the possibilities of missing scheduled medical appointments due to outdoor conditions, patients are more vulnerable to ruptures,” said Tassiopoulos.
But there is hope. Tassiopoulos points out, with better awareness and greater screening, these potentially fatal ruptures could be prevented.
An abdominal aortic aneurysm is an enlargement of a segment of the aorta, the main blood vessel that carries blood away from the heart, associated with a significant weakness of the wall in the dilated area. A normal aorta is less than 1 inch in diameter. An aneurysm can grow significantly without warning symptoms and when its size exceeds 2 inches the risk of rupture increases substantially. The larger the aneurysms the more likely it is to burst.
Rupture presents with severe pain in the abdomen or back and results in massive internal bleeding. Unless immediately treated, it can result in sudden death. Less than 20% of all patients who have a burst aneurysm will eventually survive and this is the reason these aneurysms are considered a serious health condition.
“Abdominal aortic aneurysms seldom give warning signs,” said Tassiopoulos, “Many people don’t know they have an aneurysm until it ruptures. As the population ages, the prevalence of AAAs increases and the lack of organized screening programs coupled with the low disease awareness in patients and primary care providers can result in an increase in aortic rupture emergencies.”
Although any adult can develop AAA, the risk is higher for men, adults age 60 and older, those who have a family history of AAAs, current or former smokers, and people with obesity, diabetes, heart disease, high blood pressure or high cholesterol.
“If you have any combination of these risk factors, we suggest you talk to your primary care physician, cardiologist or vascular specialist about getting screened,” said Tassiopoulos, "Screening helps diagnose an aneurysm and treat it electively to prevent rupture.”
Abdominal ultrasound is the best tool used to screen for AAAs. This non-invasive test is painless and takes just a few minutes, and the benefits could be life-saving.
Recognizing the significant benefit and the low level of awareness, the Aortic Center of Stony Brook Medicine is organizing free screening events year round. The next scheduled screening is in the end of June. Patients considered to be at risk based on their health profile receive a duplex ultrasound and information materials about the condition, including strategies to decrease their individual risk.
“Screening is important and can save lives,” said Tassiopoulos, “This is just one more way Stony Brook is staying on the forefront of keeping our community healthy. Our goal is to make patients aware of this silent killer and help them understand their risk and how to minimize it.”
More than 80% of all aneurysms today can be treated with minimally invasive techniques, often without incisions. These procedures have a very low complication rate and are particularly well tolerated even by at risk population.
“We hope that we can identify some patients with aneurysms in early stages but also educate our patients and physician community about the condition so we can improve its detection rate.