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Vascular News
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Screening for AAA in Male Smokers Aged 65-75 Recommended by the "U.S. Preventive Services Task Force"
Abdominal aortic aneurysm (AAA) develops when the abdominal aorta (large artery carrying blood from the heart through the abdomen to the legs) becomes enlarged and "ballooned out" and weakened. The artery wall expands as a result of loss of connective tissue and the deposit of fatty plaque in the arterial wall. Like a balloon, the aortic wall becomes thinner and thinner as it expands. As the pressure inside the arterial system continues to dilate the artery wall, the aneurysm may eventually rupture without warning.
The U.S. Preventive Services Task Force recommends that men between the ages of 65 and 75 years, who are or have ever been smokers, have a ultrasound screening for abdominal aortic aneurysm. (AAA). Evidence now exists that screening high-risk men for abdominal aortic aneurysms can reduce deaths from aneurysm. Screening and surgery to repair large abdominal aortic aneurysms (AAA) have been proven effective at reducing the number of deaths in men as a result of this condition. Between 59% and 83% of patients with a ruptured AAA die before reaching the hospital and undergoing surgery, according to estimates. The task force noted that there is evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 cm is effective in reducing the number of deaths caused by AAA. There are approximately 9,000 deaths a year in this country caused by AAA. (Ann. Intern. Med. 2005; 142:198-202)
Feature Article: Simple, but little-known screenings can help prevent strokes
Nancy Suddath Galyon, a Y-12 employee, recently took advantage of a free carotid screening at a Safety/Health Expo. There was a problem discovered with her right carotid artery. She was immediately encouraged to see her primary care physician. Mrs. Galyon said "the screening took only a few minutes of my time, but it may have saved my life or at least saved me from becoming disabled." She says, "you never know what may be found during a screening or when your health may be saved because of it! I was not aware that I had a problem, and didn't think that I had shown any classic symptoms. I had the screening done for my own peace of mind...since there was something found, I am so very thankful that my problem was taken care of before it turned into either a stroke or a heart attack." Only cancer and heart attacks cause more deaths than strokes. Stroke deaths in America are up to 164,000 deaths in 2001 compared to 144,000 in 1990. Many Americans, seemingly in excellent health, suffer sudden massive strokes daily in America. This dismal failure of medical care in the United States to prevent strokes could be avoided by two inexpensive, accurate diagnostic tests. Neither of these tests is well known to the general public. The first diagnostic test is a screening Carotid Ultrasound. Ultrasound waves from an instrument placed on the neck can spot fatty plaque accumulating in carotid arteries, which transport vital blood to the brain. Stroke occurs when plaque or clots block blood flow resulting in death of vital brain tissue. Vascular specialists estimate that carotid plaques account for up to 50% of all strokes. If a plaque, hidden in the artery is found early, it may be controlled with drugs, diet, and other medical measures. Advanced, unstable plaques, threatening sudden stroke, can be removed by Vascular Surgeons. Carotid surgery is an excellent, proven operation. Patients are in the hospital for less than 24 hours, and the mortality is less than 1% when done by experienced surgeons. Vascular specialists, such as William Flynn, chief of surgery at the University of Maryland, believe one half of stroke deaths and disabilities can be prevented by early diagnosis with ultrasound screenings. Oak Ridge is ahead of the curve in carotid artery screening. Several local citizens, including Mrs. Nancy Suddath Galyon, have attributed local Health Fairs and other screening carotid studies for personally preventing a disastrous stroke. Nancy Suddath Galyon had a carotid screening at a local Health Fair last year. She said "The Carotid screening test saved my life!" The Second Screening Test is the ankle-brachial index (ABI), which indicates the risk of plaque blocking arteries to the heart, legs, kidneys and other vital organs. Because Medicare and other private insurance will not pay for screening tests, millions of Americans risk fatal complications from blocked arteries. Although most experts agree it wouldn't be worth billions of dollars screening every American adult for stroke risk, people with high cholesterol, hypertension family history of strokes and over 60 years old can benefit greatly from screening tests. The Cleveland Clinic has been particularly prominent in recommending screening for stroke prevention. Eric J. Topal, chairman of Cardiovascular Medicine states that he is actually amazed at how slowly the medical community has been adopting these tests. "There is no risk, there is little cost, and there are hardly any false positive or false negatives." Americans are flooded with messages to get screenings for cholesterol, mammograms, and cancer prevention tests, but hear little about carotid artery or ABI screenings. Stepping into the vacuum, Vascular Surgeons are at the forefront of evaluating who should be screened. Short questionnaires available in doctors offices allow patients to take tests to see if they are at risk of stroke or other vascular disease and if a screening test would be cost effective for them. An American Vascular Association study of 8,000 patients, found 7% with over 50% carotid artery blockage, and 10% with abnormal ABI scores. As more active Americans become aware of the simplicity of short questionnaires in ascertaining their risk of vascular disease and take advantage of appropriate inexpensive vascular ultrasound screenings, we can hope that stroke deaths will decrease over the next decade.
