A Life-Saving Gift - Valentine Screening Uncovers Abdominal Aortic Aneurysm    (Posted 3/23/06) 

Beth Kelsey of Bettendorf thought she was doing her husband a favor when she bought him a Valentine's Day gift card from Genesis for an abdominal aortic aneurysm screening.  

"My husband turns 55 this year and his father hand an abdominal aortic aneurysm, so I thought, 'Let's do that,' says Kelsey.  She's the family's self-appointed health advocate and often drags her husband to screenings.  "To make sure he'd go, I made an appointment for both of us.  I told him 'Here's your Valentine's Day present.  I don't want any baloney about it.  We're going.' "

She never suspected that the Valentine's Day present for her husband would become a life-saving gift for herself.  

Her husband, Steven, passed the screening with flying colors.  However, her ultrasound exam uncovered a silent killer called an abdominal aortic aneurysm, or AAA - a balloon-like swelling of the aorta, the largest blood vessel in the body. 

AAA's grow quietly in the abdomen and generally have no symptoms.  Allowed to grow undetected, the artery that runs from the heart to the legs can rupture, causing sudden, catastrophic bleeding and cardiovascular collapse.  When it does rupture, more than 75 percent of people die. 

Beth Kelsey is familiar with abdominal aortic aneurysms; she has a family history.  "When I saw the bulge in my aorta on the ultrasound screen, I knew it wasn't good," she says. 

Kelsey's aneurysm measured just over 5 centimeters, the size when surgeons begin to recommend surgery to prevent a future rupture.  This week, she underwent elective surgery at Genesis Medical Center, Davenport. 

Her surgeon Afzal Abdullah, M.D., of Vascular and Thoracic Associates, Ltd., opened her abdominal cavity and placed a Dacron tube that imitates the shape of a normal aorta inside the aneurysm.  It's similar to putting a good pipe inside a bad one. 

"When we fix an abdominal aortic aneurysm before it ruptures, the success rate is 95 percent," Dr. Abdullah says. 

It's quite a different story for a ruptured aneurysm, however: Only a small fraction of patients with a ruptured aneurysm will live along enough to undergo an emergency operation.  Only 50 percent will survive an emergency operation to repair a ruptured AAA. 

Luck of the Irish
After a successful surgery, Beth Kelsey is still stunned that the Genesis screening meant to protect her husband from abdominal aortic aneurysm ultimately protected her.  

About 400 Quad Citians signed up for reduced-cost screenings, which were a cooperative effort of the Genesis Heart Institute, radiologists and vascular surgeons during National Heart Month in February. 

"It never would have occurred to me to go in for a screening myself," says Kelsey, who eats healthy and exercises regularly to keep her cholesterol under control.  "I had planned to do it when I was around 60 because of my family history.  but I'm only 52!  I had absolutely no symptoms whatsoever!"  

A lack of symptoms is the reason screenings are so important, Dr. Abdullah says.  The aorta is the body's largest artery - larger than the width of a garden hose - and is well protected.  As a result, abdominal aortic aneurysms are not easily detected.  

Studies suggest that between 5-7 percent of adults over age 60 have an AAA, but they are usually not aware of it until the aneurysm bursts.  As a result, AAA kills more than 9,000 Americans each year. 

Early Detection is Key
"The important message is that if AAAs are detected early when they are smaller, the outcomes are far better," Dr. Abdullah says.  "Rarely do aneurysms shrink.  Most of the time, they grow slowly or stay stable.  When an aneurysm measures about 5 centimeters, we consider operating because the risk of it rupturing on its own grows about 5 percent per year."

A majority of aortic aneurysms occur in the abdominal aorta, mainly from atherosclerosis, or fatty deposits in the walls of the arteries that cause them to become less elastic and weaker.  People who smoke have a much greater chance of forming an AAA than a non-smoker.  Other risk factors include being age 55 or older; being male; and having a family history of AAA.  

Many people can have an aortic aneurysm for years before any symptoms develop.  When they do become evident, symptoms of an AAA can include: a pulsating feeling in the abdomen, abdominal pain or back pain. 

Each year, physicians diagnose 200,000 people in the U.S. with AAA.  Of those 200,000, nearly 15,000 may have AAA's threatening enough to cause death from a ruptured aneurysm if not treated, says the  Society for Vascular Surgery. 

"Usually, abdominal aortic aneurysms are detected during a radiological study for another reason," Dr. Abdullah says.  "For example, the patient has a CT scan or an ultrasound for gallstones and we get a look at the aorta and see that it's generous.  Or they're having abdominal pain, and we feel an aneurysm on a physical exam.  Sometimes, we can actually feel them, but you can't count on that." 

Dr. Abdullah says it's unusual to find an abdominal aneurysm in an otherwise healthy, 52-year-old woman like Kelsey.  "Abdominal aortic aneurysms are predominantly found in males and usually present a little later than this age," he says.  "There is a hereditary risk for some." 

He adds, "There's still not a great consensus as to who should have a screening.  But if you're over 55, you're male, you have high blood pressure, you smoke or you have a family history of aneurysms, it may be beneficial to get a screening." 

Kelsey required open surgery because of the geometry of her aneurysm.  But today, nearly half of all abdominal aortic aneurysms can be fixed less invasively with an endovascular procedure, he says. 

During endovascular surgery, a synthetic graft is attached to a stent that is inserted into the bloodstream, usually through an artery in the leg.  The surgeon threads the stent-graft to the weak part of the aorta, where the aneurysm is located.  Once the stent-graft is expanded, it reinforces the weakened section of the aorta to prevent rupture. 

A Family History
Beth Kelsey's mother had an AAA discovered during an ultrasound she had before intestinal surgery.  Her uncle had an AAA burst in the E.R.  "My uncle's heart stopped three times before he made it to the O.R.; no one thought he would make it through surgery," she says.  

Since her screening, her three brothers and two sisters have received AAA screenings.  They were O.K. 

"The Genesis screening was a wonderful thing, and because they were at the Scott County YMCA's it made them easily accessible to a lot of people," Beth Kelsey says.  "I'm really thankful that I got my screening."  

RISK FACTORS
Factors that can contribute to abdominal aortic aneurysm include: 

• Family history of abdominal aortic aneurysms
• Smoking
• High blood pressure 
• Male gender
• Age 55 or older 
• Diabetes