Abdominal Aortic Aneurysm: A two-specialist approach can improve patient outcomes
By Kristy Bleizeffer Oct 9, 2015
Like most patients with an abdominal aortic aneurysm (AAA), Larry didn’t know he had one. His primary care doctor found the bulge during an CT scan as Larry underwent other tests.
Larry, of Lander, is a typical AAA patient in other ways: He’s a man in his late 60s and he has a family history. Since his aneurysm measured more than 5 centimeters, it needed treatment or it risked rupture or dissection – a medical emergency that could have killed him.
His primary care physician referred him to Wyoming Medical Center for an endovascular stent graft, a minimally invasive surgery performed here by two specialists working together: both a general surgeon and an interventional radiologist.
“As physicians, we are both thinking of the procedure in a different way and this covers all bases,” said Dr. Jim Anderson, a general and vascular surgeon who fixed Larry’s aneurysm with interventional radiologist Dr. Michael Sloan. “Our outcomes are excellent.”
What is AAA?
An abdominal aortic aneurysm is a balloon-like bulge in the body’s largest artery. The aorta is about the circumference of a garden hose and carries oxygenated blood directly from the heart to the kidneys, abdomen and the lower body. High blood pressure and atherosclerosis (a disease in which plaque builds up inside your arteries) contribute to its formation.
Aortic aneurysms kill about 13,000 Americans each year, most of them caused by tears in the aortic walls (dissection) or sudden rupture. This can cause fatal internal bleeding if not treated with immediate emergency surgery.
The national survival rate for ruptured aortic aneurysms is about 50 percent, said Dr. Anderson. He sees 8 to 10 such cases a year. When patients get to our emergency room with a blood pressure, Wyoming Medical Center surgeons save about 95 percent of them, he said.
Physicians can often repair aortic aneurysms with minimal downtime for the patient when detected early. At Wyoming Medical Center, an interventional radiologist and a general surgeon team up to repair AAA with endovascular stent grafts on patients who are good candidates. The minimally invasive surgery requires only two small incisions in a patient’s groin.
“We’re trying to repair them before they rupture,” said Dr. Sloan.
Who’s at risk?
AAA is often called a “silent” problem because it rarely causes symptoms, and is usually found when doctors order tests for other conditions. The aneurysm may create a pulsating abdominal mass – a strong pulse in your stomach – but this typically cannot be felt in people who are overweight. Anyone can develop this type of aneurysm, but certain factors increase the risk:
- Being male (two-thirds of AAA deaths are men)
- Having a family history, especially on your mother’s side
- Having high blood pressure
- Having a blood vessel disease in another part of the body
- Being over age 55 for men and 65 for women
Men with a family history should be screened in their mid-40s as should male smokers over 50, Dr. Anderson said. Ultrasound and CT scans evaluate aneurysms. Often, a patient's aneurysm is discovered on a CT or ultrasound exam being performed for other reasons. Medicare pays for one AAA screening, said Dr. Sloan, so ask your primary care provider if you think you may be at risk.
How's it treated?
Minor bulging of an aortic aneurysm may be managed with medication and close monitoring. Larger bulges often require surgery. There are two types of surgical treatments:
- Open surgery: A general surgeon accesses the aneurysm through a 10- to 12-inch incision in your abdomen.
- Endovascular stent graft: Endovascular means the repair is made from inside the blood vessels. It requires only two small incisions in the patient’s groin. Catheters threaded through the patient’s arteries guide the stent graft to the aneurysm. This technique results in less trauma than an open surgery, less blood loss and a shorter hospital stay. Patients typically leave the hospital within a couple of days and are significantly less likely to suffer a rupture or dissection.
Whenever appropriate, Wyoming Medical Center uses the endovascular approach with two specialists.
“When you figure that two physicians are here for each case, the institutional experience for this procedure is very robust. Despite the fact that we are out here in the middle of Wyoming, we have done hundreds of AAA repairs and we’ve had great results,” said Dr. Sloan.
Benefits of 2-specialist approach
At some hospitals, a general surgeon does endovascular stent grafts. At others, they might be done by an interventional radiologist. Wyoming Medical Center uses both specialists to ensure the best results.
The interventional and diagnostic radiologists from Casper Medical Imaging and Outpatient Radiology, like Dr. Sloan, create the high-resolution, 3D imaging used to map out the procedure. Interventional radiologists are also the experts in endovascular procedures using catheters.
The general surgeons, like Dr. Anderson, are the experts in incising tissue. If complications develop, which is rare, they have the expertise to operate and fix the problem.
“Both individuals bring their experience in their particular areas. You’ve got the maximum amount of knowledge for the case and it produces better outcomes,” Dr. Sloan said.
In Larry’s case, doctors Sloan and Anderson planned out the procedure step-by-step with radiology’s high-resolution 3D imaging days before the patient arrived at the hospital. They mapped out each incision and the catheter pathway through the blood vessels.
Larry spent two days in the hospital and will undergo a follow-up CT scan after 2 or 3 months and yearly for 3 to 4 years. He’ll then have ultrasounds under the supervision of his primary care physician.
And how is he doing so far?
“He’s doing great,” Dr. Anderson said.
Symptoms of a ruptured aneurysm
A ruptured Abdominal Aortic Aneurysm is a medical emergency that requires immediate treatment. Call 911 if you:
- Have severe abdominal or back pain
- Your blood pressure drops noticeably
Dr. Anderson is board certified in general surgery and vascular surgery. He has worked in Casper for almost 35 years, 25 of which he was the only board-certified vascular surgeon in Wyoming. He practices at Wyoming Surgical Associates, PC, 419 S. Washington St., Suite 200, in Casper. Call (307) 577-4220 for a referral.
Medical school: University of Colorado School of Medicine, Denver
Internship: University of Washington School of Medicine, Seattle, General Surgery
Residency: University of Washington School of Medicine, Seattle, General Surgery
Dr. Sloan is board certified in general and interventional radiology. He practices at Casper Medical Imaging and Outpatient Radiology, 419 S. Washington St., Suite 101, in Casper. Call (307) 265-1620 for a referral.
Medical school: The University of Tennessee, Knoxville
Internship: Baylor College of Medicine, Houston, Texas; Transitional
Residency: Baylor College of Medicine; Diagnostic Radiology
Fellowship: Interventional Radiology, Yale University School of Medicine, New Haven, CT