Did you know what caused Albert Einstein’s death? A ruptured abdominal artery. This condition, known as abdominal aortic aneurysm, is not only difficult to pronounce but also largely unknown. Yet, it affects around 5% of men and 2% of women over 65.
The silent threat
The dangerous aspect of this potentially fatal condition is that it causes no symptoms in 90% of cases. Most people don’t even know they’re affected. In England, it’s officially called “the silent killer,” explains Herribert Lösel-Sadée, Chief of Vascular Surgery at Sana Hospital Gerresheim.
He estimates that out of 500,000 affected individuals in Germany, about 100,000 have an abdominal aortic aneurysm requiring treatment. In these cases, the main artery in the abdomen has swollen to a diameter of more than five centimeters and is at risk of rupturing. Surgery is urgently needed, but only 15% of all patients are treated early enough.
Early detection
Doctors can detect an enlarged abdominal aorta through an ultrasound examination. Since 2018, men over 65 with statutory health insurance in Germany are entitled to an ultrasound screening for early detection of abdominal aortic aneurysms, with costs covered by health insurance.
This regulation aims to prevent doctors from discovering the condition by chance, as was often the case in the past. Although the disease is more common in men, Lösel-Sadée recommends regular abdominal ultrasounds for everyone over 65.
Risk factors
Doctors should be particularly alert with patients who:
- Are overweight
- Have diabetes
- Smoke regularly
- Recently complained of back pain radiating to the abdomen
Such a patient fits the risk profile for an abdominal aortic aneurysm and may be experiencing pain caused by the enlarged aorta pressing on the peritoneum.
Risk factors for abdominal aortic aneurysm include:
- Obesity
- Diabetes
- Smoking
- High blood pressure
These factors damage blood vessels, leading to increased deposits that narrow the vessels. The walls widen, become thinner, and less stable. If they rupture, it results in life-threatening internal bleeding.
Lösel-Sadée suggests the condition may also be genetically predisposed. He attributes the higher prevalence in men to their generally less healthy lifestyle.
Treatment options
If an ultrasound reveals an enlarged abdominal aorta, the next step is a computed tomography scan to get a detailed image of the altered shape.
In traditional surgery, the surgeon opens the abdominal cavity and replaces the abdominal aorta with a synthetic graft. They clamp the vessels above and below the widened area, open the aneurysm, and sew in the graft.
However, treatment is now possible without fully opening the abdominal cavity. Using an endovascular stent graft, only a small wound remains after the procedure, explains Lösel-Sadée. This method combines a stabilizing wire mesh with a synthetic blood vessel. Patients typically recover within two to seven days after surgery.
Lösel-Sadée documented the progress of 144 patients after stent graft surgery in a study published in 2015 in “The Italian Journal of Vascular and Endovascular Surgery.” The study confirmed the benefits of this surgical method. During the five-year follow-up period, there were no ruptures of the aortic aneurysm, and no second operations were necessary.
