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Abdominal aneurysms often present even among those not at risk
Tuesday, April 10, 2001 By Virginia Linn, Post-Gazette Staff Writer
David Baltos' father and maternal grandfather died of ruptured aortic abdominal aneurysms at ages 55 and 64, respectively. His mother and maternal grandmother also had aneurysms and were treated.
Baltos, 63, of Ross would regularly convey this information to his family doctor during his annual checkups. The doctor would feel around his abdomen and listen with a stethoscope. Nothing, the doctor said. Everything looked fine.
Baltos' wife Michele wasn't convinced. Late last summer she read a "Dear Abby" column featuring a letter from a reader urging anyone with family history of these aneurysms to get checked with ultrasounds because of the strong genetic link. Michele Baltos sent a letter and a copy of the column to her husband's doctor.
"As David is now 63 years old, we would greatly appreciate if you would seriously consider having a sonogram done on David," she wrote.
Still there was no response. She called and begged for a test to be ordered. Finally, the doctor consented.
An ultrasound at Sewickley Valley Hospital revealed a bulge a whopping 8.4 centimeters in diameter in the abdominal aorta. Usually artery repair is recommended when the thinning wall balloons beyond 5 centimeters, or 2 inches in diameter. David Baltos had surgery immediately to remove the aneurysm and repair the blood vessel.
"I was livid through the whole thing, as you can imagine," said his wife. "Why wasn't he checked? That scared me to death."
The accident in South Park last month in which a man died of a ruptured aortic abdominal aneurysm while driving and lost control of his car, killing his wife and three pedestrians, has heightened local awareness about the condition. Life Line Screening, a mobile vascular screening service that offers ultrasound testing for aneurysms, has been flooded with calls since the tragedy.
But vascular specialists for years have been pushing for greater awareness among the public and primary care physicians about the growing prevalence of these potentially fatal aneurysms as more people have such risk factors as high blood pressure, hardening of the arteries and diabetes.
"This is a huge public health issue," said Dr. Peter Beatty, an interventional radiologist in Portland, Oregon.
Beatty oversees a national vascular screening program that for the first time in September will offer free tests or risk assessments at up to 600 sites across the country, including in Pittsburgh, to detect these aneurysms.
It will be part of the Legs for Life National Screening program that has offered mass screenings for peripheral vascular disease -- a narrowing or clogging of arteries in the arms or legs -- since 1998.
An aneurysm is a thinned, weakened spot in the blood vessel wall that is ballooned out by the pressure of blood flow. Most people die when the artery ruptures.
The incidence of abdominal aortic aneurysms -- the most common type of aneurysm, located in the belly just before the body's largest artery branches off into each leg -- has increased three-fold over the past 40 years. It's the 13th-leading cause of death in the United States, accounting for 15,000 deaths a year, according to the Society of Cardiovascular & Interventional Radiology, which sponsors the Legs for Life program.
These aneurysms occur in 5 to 7 percent of people over age 60, but often carry no symptoms. They're easily detected through an ultrasound test -- a quick, painless procedure using sound waves.
"It's an underused modality," said Dr. Paul Blom, an interventional radiologist at The Western Pennsylvania Hospital. West Penn has scheduled free screenings for the public on April 21 and April 28 as one way to raise awareness.
There are no generally accepted recommendations about who in the general population should be screened, although there are risk factors.
Blom said a person with a primary relative, such as a parent or sibling, with this condition has an 11-fold increased risk for developing aneurysms.
"The etiology behind the disease is still up for grabs," he said. "People are saying high blood pressure causes the disease, some people say it's an inherited collagen defect or arterial defect. It's not clearly worked out about the etiology."
Aneurysms less than 2 inches in diameter rarely rupture and are monitored with ultrasound. Patients are urged to stop smoking and keep blood pressure under control. Without control, the aneurysms will continue to grow about a half centimeter a year. "Eventually, all aneurysms will grow to a size that justifies fixing them," Blom said.
Because of their slow growth, they're usually found in people 65 and older.
Medicare and most insurance companies will cover the ultrasound tests as diagnostic procedures if patients are referred by doctors based on symptoms or risk factors. Medicare doesn't cover the tests as preventive screenings.
Life Line Screening, which provides screenings in 33 states, has been urging Medicare to cover screenings as a preventive test, said Chris Moir, health coordinator for the Cleveland-based company. The company finds abnormalities in about 35 percent of people who seek its tests, many of whom have no risk factors or symptoms.
During screenings in Brackenridge on Friday, for example, an ultrasound detected an aneurysm 5.8 centimeters in diameter on a 61-year-old man with no family history of aneurysms, Moir said. Life Line staff urged the man to see his doctor within 24 hours for treatment.
David Plummer, 72, owner of AutoRama garage in Altoona, didn't have a family history of aneurysms when his wife urged him to get a screening two years ago because of his high cholesterol. The test found an abdominal aneurysm 4.2 centimeters in diameter. That was large enough to require monitoring, but not surgery. A few months later, it had swelled to 5.3 centimeters and required repair.
"They call this the silent killer," Plummer said. "I'm very, very lucky."
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