It affectstwo millionpeoplenationallyand cankill in aminute.Ninetypercent ofpeople whohave onedon’t evenknow it.Silent BombDEF<strong>US</strong>INGTHE AORTICANEURYSM“It’s a hidden time bomb,” says Lars Svensson, M.D., Directorof the Center for Aortic Surgery and Marfan and ConnectiveTissue Disorder. “When a patient is told they have an aorticaneurysm, their fi rst reaction is usually one of shock.”
An aortic aneurysm is a bubble or bulgein the aorta, the body’s main artery,which extends from the heart throughthe chest and stomach and splits intothe iliac arteries that feed the pelvis andlegs. The aorta is roughly the thicknessof a garden hose and resembles a largehorseradish or ginger root. Aneurysmsform where the three-layer artery wallhas weakened from a breakdown inelastin or collagen (see images, lower right).This weakening may be caused by smoking,arteriosclerosis, hypertension (highblood pressure) or various genetic diseasessuch as Marfan’s Syndrome.If detected, aneurysms typically aretreated when they expand to twicethe thickness of the aorta, about 2inches. Smaller aneurysms are simplymonitored. Over a period of years, bloodpressure gradually inflates the aneurysm -like blowing air slowly into a balloon -until it bursts or dissects, separating thelayers of the aorta, and usually causingfatal internal bleeding.“In patients who rupture the abdominalaorta, between 50 and 75 percentdie immediately,” says Dr. Svensson. “Ifpatients rupture the aorta in the chest, 95percent die immediately. That’s why it’svery important that these aneurysms arepicked up and treated electively before itbecomes an emergency situation.”Because aneurysms rarely exhibitsymptoms before erupting, most peoplefeel they can’t protect themselves againstthe disease. But experts believe thatmany lives can be saved with a simpleultrasound screening.In February 2005, the U.S. PreventiveServices Task Force advised all males overage 65 who have ever smoked to havean ultrasound. Kenneth Ouriel, M.D.,Chair of the Division of Surgery, says hewould expand the recommendation. “Iwouldn’t say just males over 65 who’vesmoked. I would include other people- women, younger people.”Roy Greenberg, M.D., Director ofEndovascular Research, also believes theindication should be expanded. “I thinkanyone over age 60 with a history ofsmoking, a history of peripheral vasculardisease or a family history of aneurysmsshould be screened.” He adds that, “therisk of rupture in people who smoke ismuch higher than the risk of rupture inpeople who don’t smoke.”Dr. Greenberg cautions that an ultrasoundonly detects aneurysms belowthe renal or kidney arteries, whichconstitute about 50 percent of the cases.It takes a computed tomography (CT)scan, magnetic resonance image (MRI)or echocardiogram to detect chest orthoracic aneurysms.The number of aortic aneurysmcases in the United States has tripledover the past 20 years. Part of theincrease is due to improved early detection.“We see many more patients withchest aneurysms now because they getCT scans, MRIs or echocardiograms forother reasons, and so these aneurysmsare being picked up incidentally,” notesDr. Svensson.According to Dr. Svensson, if a patienthas an operation before an aneurysmbursts, the risk of death with surgeryis only 1 to 3 percent. “However, if apatient develops aneurysm dissection,which is different from rupture, 40percent of those patients will die immediately,and between 1 to 2 percent willdie every hour that surgery is delayed.”Long-term survival also is much betterfor patients who have surgery before ananeurysm ruptures, rather than after.Thanks to recent research, much ofit done at The Cleveland Clinic, manyaneurysm patients now can be treatedwith less risk, less invasive surgery, andbetter long-term results. One of theadvances, a sensor that measures bloodpressure in the vicinity of an aneurysm,is currently in trials at the Clinic.Like a modern-day wizard, Dr. Ourielwaves a tennis-racket shaped wand overthe abdomen of Gene Zeppernick ofSalem, Ohio, the first person in theUnited States to have a wireless sensorimplanted inside his aneurysm.Dr. Ouriel treated the 70-year-oldZeppernick’s aortic abdominal aneurysmwith a stent - also known as anendograft - in July 2004. The coiled,tube-like Dacron stent was threadedthrough Zeppernick’s groin and insertedinto his aorta where it expandedinto a section of tightly woven clothpipe only slightly smaller than the aorta,channeling blood past the aneurysm.Aortic Aneurysms in theUnited States• Approximately onein 1,500 people hasan aortic aneurysm.• 5 to 7 percent ofpeople over age 60have abdominal aorticaneurysms.• Aortic aneurysmdisease is the 13 thdeadliest disease,killing 25,000 peryear – more thanAIDS or brain tumors.CT IMAGE OF A NORMAL AORTA,THE KIDNEYS AND SPLEEN.CT IMAGE OF AN ABDOMINALAORTIC ANEURYSM.www.clevelandclinic.org 29
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