Abdominal Aortic Aneurysm

Written by David Kasti M.D., FACS
Cardiac, Thoracic & Vascular Surgeon

n abdominal aortic aneurysm (AAA) is an isolated enlargement of the major artery in the abdomen that has a high propensity to rupture. If it ruptures it carries a >80% mortality rate associated with massive internal bleeding. AAAs are more common in men (85%) than women (15%). They are more common with increase in age and are found in 5% of individuals of over 60 years of age. If there is a blood relative with an AAA, the incidence increases to 20%. AAAs are the tenth leading cause of death in males and fifteenth leading cause of death overall.

Factors associated with high incidence of developing an AAA are age (>55), white race, male gender, family history, smoking and hypertension. The majority of AAAs cause no symptoms. Most are found incidentally by an ultrasound or CT scan of the abdomen performed for other complaints. If the aneurysm is large enough, it may be felt as a pulsating mass in the abdomen by the patient or an examining physician.

The vast majority of AAAs are asymptomatic until they rupture. On rare occasions AAAs may cause back or abdominal pain. Pieces of the aneurysm wall may actually break off and travel downstream to the lower extremities and cause arterial blockage problems. The rupture of an AAA often mimics other abdominal catastrophes with complaints of a sudden onset of excruciating abdominal and or back pain usually associated with shock and fainting in 70% of the cases.

The risk of rupture increases with size of the aneurysm, smoking and history of hypertension. If the aneurysm measures 4 cm, the chance of rupture in five years is 15%. If the aneurysm increases in size to 8 cm, the five-year rupture rate is 75%. Since the death rate of AAA rupture exceeds 80%, repair is recommended once they enlarge to 5 cm in diameter (two inches or greater). If the aneurysm measures less than 5 cm, the rupture rate is fairly low and the risk of surgery outweighs the risk of observation. The mortality risk of an open repair is 2-4 % when the aneurysm is not ruptured and less with the new endoluminal repair technique.

Elective open repair of an AAA involves an abdominal incision to replace the damaged aorta with a Dacron tube graft. A new technique under development and approved by the FDA involves incisions in the groins to place a stent graft via the groin arteries to the inside of the aneurysm thereby excluding the aneurysm from blood flow.

The high mortality risk associated with AAAs is, for the most part, preventable. The first step is awareness of the existence of this silent killer. The second step is to participate in a screening program or insist on a complete abdominal exam by your physician. Anyone who has an AAA or possess factors associated with a high incidence of AAA should have frequent screenings for an AAA. Again, the high risk factors for AAA are age (>55), white race, male gender, family history, smoking and hypertension.

For more information or questions about AAA, please call David Kastl M.D., FACS, Cardiac, Thoracic & Vascular Surgeon at (843) 689-8224.

Dr. Kastl earned his medical degree from the University of Oklahoma and completed residency in general surgery at University of Oklahoma Health Sciences Center. He completed a cardiac surgery and research fellowship at the National Heart, Lung and Blood Institute, National Institutes of Health and additional residency training in cardiothoracic surgery at The Milton S. Hershey Medical Center a part of the Pennsylvania State University. He has also earned a Masters of Business Administration. Dr. Kastl is board certified by the American Board of Thoracic Surgery and the American Board of Surgery and is a Fellow of the American College of Chest Physicians and American College of Surgeons.

As an accomplished surgeon, Dr. Kastl treats a variety of conditions relating to the heart, chest, and blood vessels. This includes surgical management of the heart circulation and valves plus the great vessels in the chest. He also focuses on surgical treatments for cancers of the lung, esophagus, and chest wall and has special interests in beating heart surgery, mitral valve repair and ablation of the heart arrhythmia atrial fibrillation.

Hospice Care of the Lowcountry holds 5th Annual Camp TLCYouth Bereavement Day Camp

Hospice Care of the Lowcountry will hold its fourth annual Camp TLC Youth Bereavement Day Camp for young people ages 6 to 16 from 8 a.m. to 3 p.m. Saturday, Oct. 27, at Sgt. Jasper Park in Hardeeville.

The camp is free and open to any child or teen in Beaufort or Jasper County who has experienced the loss of a family member or other significant person in his or her life.

The purpose of the camp is to help children express the feelings they have that are related to their loss and to decrease their sense of isolation by letting them know that other children have losses, too. Activities during the camp will also help them remember their loved one through art, music, conversation and play.

The day will begin with a family breakfast at the Bluffton office of Hospice Care. Transportation will be provided for campers to Sgt. Jasper Park. At the end of the day, a special Remembrance Ceremony will be held for the camp attendees. Parents are encouraged to attend this closing session.

The camp is led by professional counselors and trained volunteers. Thanks to the generosity of the Hilton Head Celebrity Golf Tournament and other sponsors, there is never a charge to attend the camp.

Deadline for registration is Oct. 19. For more information about the day camp, transportation, directions, or to register, please contact Renee Woodruff, Bereavement Services Coordinator at Hospice Care of the Lowcountry, at 843.342.8919 or via email at rwoodruff@hospicecarelc.org.

For 25 years, Hospice Care of the Lowcountry has provided care, comfort and dignity unconditionally to end-of-life patients and their families. For more information, call 843.706.2296.