Holbrooke's Death Brings Attention to Screening for AAAs

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The death of U.S. envoy Richard Holbrooke, 69, has brought attention to the abdominal aortic aneurysms (AAAs) which can balloon in size and rupture as his did.

An abdominal aortic aneurysm is when the large blood vessel that supplies blood to the abdomen, pelvis, and legs (the aortic artery) becomes abnormally large or balloons outward. Surgery is usually recommended for patients who have aneurysms bigger than 2 inches or 5.5 cm across and aneurysms that are growing quickly.

AAAs develop slowly over years. Often they cause no symptoms until they rupture or tear. Most (75-90%) individuals with ruptured AAAs do not survive to hospital discharge.

The symptoms of a ruptured AAA include:

  1. Pain in the abdomen or back -- severe, sudden, persistent, or constant. The pain may radiate to the groin, buttocks, or legs.
  2. Clammy skin
  3. Nausea and vomiting
  4. Rapid heart rate
  5. Shock

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In 2005, the U.S. Preventive Services Task Force (USPSTF) issued recommendations on who should be screened for abdominal aortic aneurysm (AAA). The recommendations are:

  1. One-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 who have ever smoked.
  2. No recommendation for or against screening for AAA in men aged 65 to 75 who have never smoked.
  3. Recommends against routine screening for AAA in women.

Abdominal palpation for an AAA has poor accuracy. AAAs should be screened by ultrasound (sensitivity ~95%, specificity ~100%). CT or MRI ordered for other indications can be used for AAA screening as long as the infrarenal aorta was visualized and measured.

The exact cause of AAA is unknown, but risk factors for developing one include smoking, high blood pressure, high cholesterol, male gender, genetic factors, and obesity.

An abdominal aortic aneurysm can develop in anyone, but is most often seen in males over 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to rupture and break open.

There are some physicians (not the USPSTF) who feel that anyone who has had a parent, brother or child die of an aortic dissection, such as Holbrooke's children, should be screened every couple of years for their entire life.

Sources
U.S. Preventive Services Task Force
MedlinePlus

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