Detecting an Aneurysm

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As the largest artery, the aorta carries oxygen-rich blood throughout the body from the heart. When it reaches the abdomen, this artery is known as the abdominal aorta, which supplies blood to the lower areas of the body. In the abdomen, the aorta splits into two branches (the iliac arteries) carrying blood into each leg. When an area of the abdominal aorta becomes weak and expands or bulges, it is called an abdominal aortic aneurysm (AAA).

"Over time, pressure from blood flowing through the abdominal aorta can cause the aorta to bulge if the area is weak," says Christopher J. Kwolek, MD, Chief of Vascular Surgery at Newton-Wellesley Hospital and Director of Endovascular Training at Massachusetts General Hospital. "These bulges, called aneurysms, can burst or rupture causing severe internal bleeding, which can lead to shock and even death. If a patient has an aneurysm in one part of the body such as behind the knee, in the groin or in the chest, they have a higher chance of having an abdominal aortic aneurysm as well."

Clots can also form inside the aneurysm and travel to other blood vessels in the body, a condition called embolization. This condition is less common; however, if one of the blood vessels becomes blocked, it can cause severe pain and even lead to the loss of a limb.

Collaboration with MGH
Through a collaboration with Massachusetts General Hospital (MGH), Newton-Wellesley provides access to highly regarded vascular surgeons and state-of-the-art surgical facilities to offer world-class vascular surgery. The dedicated vascular team, including David Brewster, MD, Tom Biuckians, MD, Thomas Grady, MD, Joanna Sentissi, MD and Jacqueline Machain, Nurse Practitioner, is able to offer patients the most up-todate technology.

"In conjunction with the MGH Vascular Center, we now have access to the newest devices available to treat abdominal aortic aneurysms," says Dr. Kwolek. "We are constantly evaluating the latest options and working to make these advanced tools available to patients here at Newton-Wellesley. Patients have access to an outstanding anesthesia team, specialized nursing care and advanced operating room facilities."

Causes
Abdominal aortic aneurysms may be caused by an inflammation in the aorta that causes the wall to weaken. This inflammation can be associated with atherosclerosis (hardening of the arteries) or risk factors that contribute to atherosclerosis such as high blood pressure. When a patient has atherosclerosis, fatty deposits, called plaque, build up in the artery. Over time, this buildup causes the artery to narrow, stiffen and eventually weaken.

Diagnosis
Patients with abdominal aortic aneurysms often do not experience any symptoms. According to Dr. Kwolek, most aneurysms are diagnosed by accident when a patient is undergoing tests for another condition.

“Patients will come in for radiology exams such as a CT scan or an ultrasound for other conditions such as kidney, back or gallbladder problems. When the physician reads their diagnostic exam, an AAA will sometimes be detected,” says Dr. Kwolek.

Physicians may recommend one of the following tests to confirm the AAA and determine the size:

  • Abdominal ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)

"If your tests show that you have a small AAA, your physician may monitor you for changes in aneurysm size through regular CT scans or ultrasounds," says Dr. Kwolek.

Patients with high blood pressure may be prescribed medication to lower the pressure on the weakened area of the blood vessel wall.

"If a patient with an aneurysm is being watched by their physician, it is very important that they continue with followup care,” says Dr. Kwolek. “Aneurysms may grow over time and could eventually burst.”
 
If the aneurysm bursts, patients may experience severe pain in the abdomen radiating to the back, feel sudden, intense weakness and dizziness and may lose consciousness.

A less frequently discovered sign of an aneurysm can be a prominent pulse in the abdomen that can be felt on palpation,” adds Dr. Kwolek. “ Having an aneurysm rupture is a life-threatening situation. It is very important for patients experiencing these symptoms to seek medical treatment immediately.”

Treatment
When patients come to Newton-Wellesley Hospital, they receive a thorough evaluation to determine the best method of treatment. Once a patient has been diagnosed, treatment options will depend on the size of the aneurysm. Physicians also help patients make lifestyle changes to improve their condition. “Larger aneurysms require a procedure to replace the artery wall and prevent it from rupturing,” says Dr. Kwolek. “At Newton-Wellesley, we offer minimally invasive aortic endograft procedures – advanced treatment for abdominal aortic aneurysms.”

Endovascular aneurysm repair (EVAR) is a relatively new procedure that was developed as a less-invasive alternative to open surgery for patients with abdominal aortic aneurysms. Surgeons insert a catheter (a thin, flexible tube) through small incisions in the groin and into the blood vessel to navigate to the weakened area. A man-made fabric tube called a stent graft is then inserted into the artery and positioned inside the aorta. Newton-Wellesley recently completed a study using a new device inside the blood vessel to secure the stent graft in position. The Hospital in collaboration with MGH was one of only 30 sites in the United States and the only center in Boston to be able to offer this advanced technology to patients.

"This graft seals off the aneurysm, relines the blood vessel and creates a new path for the blood to follow,” says Dr. Kwolek. “Because we use smaller incisions, patients typically have a shorter recovery time, remaining in the Hospital for two days instead of a week to 10 days. They are also able to return to their everyday activities more quickly, usually within two to four weeks instead of three to six months.” Those who are not candidates for the minimally invasive technique also have the option of an open surgical aneurysm repair. During an open repair, a larger incision is made in the abdomen and the weakened area of the aorta is replaced with a graft.

"We are currently able to perform minimally invasive surgery in about seven out of every 10 patients,” says Dr. Kwolek. “ During the procedure, we use live X-ray images to guide the tube to the aneurysm to strengthen the artery. Both surgical methods are effective in preventing a life-threatening ruptured aneurysm.”

After surgery, patients return for frequent follow-up visits to ensure that their graft is functioning properly. With the proper diagnosis and treatment, patients with abdominal aortic aneurysms can return to active and healthy lifestyles.

Know Your Risk
The risk of developing an AAA increases with age and is more common in men than women. Some risk factors that can increase the chance of an abdominal aneurysm include:

  • Being a male older than 60 years
  • Having an immediate relative with an AAA
  • High blood pressure
  • Smoking
  • High-fat diet
  • Presence of other aneurysms (behind the knee, in the chest)
  • Obesity
  • Heart disease
  • Hyperlipidemia (high levels of certain fats in the blood)
  • Pulmonary disease

"It is important that we create awareness about abdominal aneurysms since many patients do not present with symptoms,” says Dr. Kwolek. “At Newton-Wellesley, we have an outstanding vascular team and the technology available to diagnose and treat this condition and allow patients to quickly return to their everyday activities.”

More Information
For more information about physicians or services at Newton-Wellesley Hospital, please contact CareFinder at 1-866-NWH-DOCS (694-3627).

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