Time bombs in the abdomen show few early symptoms
If you think a burst pipe in your house causes havoc, try to imagine the calamity when a critical tube in your belly erupts. A fairly common but sneaky condition known as an abdominal aortic aneurysm can produce just such a medical disaster.
Although no one knows why, men are at least four times as likely as women to have this type of aneurysm. The condition, which appears to run in families and is rare in people younger than 50, kills about 15,000 Americans a year.
An aneurysm is a widened section of a blood vessel. Aneurysms of all types are more common in people who have clogged arteries or high blood pressure, and abdominal aortic aneurysms are no exception. They occur along the portion of the aorta, the body’s major blood vessel, that passes through the abdomen.
The wider an abdominal aortic aneurysm bulges, the more likely it will rupture. Victims of the ruptures experience intense pain in the back, abdomen or groin. They may also faint, sweat profusely or become nauseated. About 50% of victims die before reaching the hospital; of those who make it to the emergency room, another half die during, or soon after, surgery.
Before they burst, such aneurysms usually cause no symptoms and therefore go unnoticed, which is why they’re sometimes called time bombs. Occasionally, however, physicians stumble on such aneurysms by chance. During a physical, a doctor may feel a pulsating sensation in a patient’s abdomen. Or a physician may notice the problem while performing an ultrasound scan for some other condition, such as kidney stones.
Small aneurysms have a low risk of rupturing, so doctors usually don’t operate on them. Instead, the patient is instructed to return every six months for monitoring. When aneurysms balloon to more than 2 inches, or about double the width of a healthy aorta, the risk of rupture rises dramatically.
For half a century, the standard treatment has been a surgical procedure in which a doctor replaces the affected section of the aorta with a synthetic tube. The surgery is effective but grueling, requiring a large incision, at least a week in the hospital and a long recovery. It’s also somewhat risky. A total of 2% to 5% of patients die of heart attacks, infections or other complications related to the surgery, says vascular surgeon William Pearce of Northwestern Memorial Hospital in Chicago.
Men need to know something else about repairing an abdominal aortic aneurysm. “Traditional surgery carries with it the risk of impotence,” says Pearce, because it may damage nerves and arteries that produce an erection. Because of this risk, one of Pearce’s aneurysm patients, a 58-year-old man, recently opted for an alternative procedure, known as endovascular repair, developed over the last decade.
In this technique, an interventional radiologist inserts a catheter into a blood vessel in the groin and threads it to the aorta. Using the catheter, the doctor guides a device known as a stent-graft -- a synthetic tube wrapped in a metal jacket -- to the aneurysm. The metal portion of the stent-graft is expanded, locking it in place and sealing off the aneurysm but allowing blood to flow through the aorta. Having a stent-graft installed is far less traumatic than traditional surgery.
These devices made headlines in June, when Indianapolis-based Guidant Corp. announced it would stop selling its popular stent-grafts after it was fined more than $92 million for failing to report problems with the device to the Food and Drug Administration.
Doctors who have used the Guidant stent-graft say it’s safe and effective. “Most of us are quite disappointed” that the device will no longer be available after Oct. 1, says interventional radiologist Barry Katzen of the Miami Cardiac & Vascular Institute. Several other companies still make stent-grafts that studies have shown to be effective in treating abdominal aortic aneurysms.
Endovascular repair isn’t necessarily the superior choice if you’re diagnosed with such an aneurysm. Stent-grafts can leak or move out of place, so patients must be willing to visit their physician every six months for a checkup. Because stent-grafts have been in use for only about 10 years, doctors can’t say whether they will develop more serious problems over the long term. That’s why many physicians feel that stent-grafts are best suited for older patients who may not be able to withstand the rigors of traditional surgery and who have a shorter life expectancy.
“We tell younger people that we don’t know what’s going to happen with this device,” says Dr. David Williams, an interventional radiologist at the University of Michigan.
If you’re older than 55 and have a family member who has been diagnosed with such an aneurysm, or if you’re older than 65 and have hypertension or smoke, talk with your doctor about getting screened for this often deadly -- but treatable -- condition.
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Massachusetts freelance writer Timothy Gower can be reached by e-mail at tgower@comcast.net. The Healthy Man runs the second Monday of the month.
