Why is it Important to Know if You Have an Abdominal Aortic Aneurysm?
What is an Abdominal Aortic Aneurysm (AAA)?
What are the Symptoms of an AAA?
Who Supports AAA Screenings?
Are You at Risk for Abdominal Aortic Aneurysm (AAA)?
How Can You Reduce Your Risk for Abdominal Aortic Aneurysm (AAA)?
What is an Abdominal Aortic Aneurysm (AAA) Screening Exam?
References
Why is it Important to Know if You Have an Abdominal Aortic Aneurysm?
Futura Health Screening offers abdominal aortic aneurysm (AAA) screening to the public to detect those individuals at high-risk for having an aortic rupture. Ruptures, in most cases, can be avoided through early detection, education, medical treatment and risk factor modification.
An AAA is an enlargement of the aorta in the abdomen caused by arterial wall weakness resulting in expansion to an abnormal size. There are nearly 200,000 people in the United States who are diagnosed with AAA annually. Of those 200,000, nearly 15,000 may have AAA threatening enough to cause death from rupture if not treated(1). Although AAAs may not show symptoms for years, as many as 1 in 3 eventually rupture if left untreated(2).
Abdominal aortic aneurysms are the 10th leading cause of death in men over the age of 50 in the United States(3). More than 15,000 people die each year in the U.S. from aortic aneurysm rupture with 9,000 being attributed to abdominal aortic aneurysms and the remainders are due to thoracic (chest cavity) aortic aneurysms(2). A ruptured abdominal aortic aneurysm (AAA) can cause severe internal bleeding, which can lead to shock or death. However, in most cases, the AAA may be entirely asymptomatic (no symptoms and thereby no warning) until rupture.
A basic tenet of our healthcare system, primarily the result of insurance costs, is a requirement that “medical necessity” be established prior to receiving care. In the case of AAA, most insurance policies require that you must have signs or symptoms of AAA before diagnostic testing can be undertaken. The good news is that a low-cost, high-quality AAA screening program is now available through Futura.
What is an Abdominal Aortic Aneurysm (AAA)?
The aorta is the largest artery in your body which passes from the heart to the rest of the body. The portion located in the abdomen can swell or balloon due to arterial wall weakness, thus forming an AAA. An abdominal aorta with a diameter of greater than 1.2” (3.0 cm) is considered to be an aneurysm. Aneurysms expand at an average rate of 0.12” to 0.16” (0.3 cm to 0.4 cm) per year and the risk of rupture increases significantly if the diameter is approximately 2” (5 cm) or greater(4).
The force of blood pushing against the walls of an artery combined with damage or injury to the artery’s walls can cause an aneurysm. This degenerative process is often attributed to atherosclerosis, however, the exact cause is not known. Atherosclerosis is a disease process which causes hardening and narrowing of the arteries due to the build-up of a fatty material called plaque. Atherosclerosis can weaken the aortic wall and the pressure of the blood flow through the aorta cause widening at the site of weakness. Aging, smoking and high blood pressure are other factors that can damage or weaken the walls of the aorta. Other causes of aortic aneurysms are genetic, post-trauma, fungal infection, and arteritis (inflammation of the aorta).
Graphics Courtesy of U.S. Dept of Health and Human Services
What are the Symptoms of an AAA?
Most people with AAA do not have any signs or symptoms for years, until rupture. If symptoms do develop, one or more of the following may occur:
- Pulsing feeling in the abdomen.
- Severe, sudden pain in the abdomen or lower back.
- Pain, discoloration, or sores on the toes or feet due to peripheral embolization.
Note: If the AAA ruptures, then you may suddenly feel weakness, dizziness or pain, and you may eventually lose consciousness. This is a life-threatening situation and you should call 9-1-1 immediately for medical attention.
Who Supports AAA Screenings?
The U.S. Preventive Services Task Force (USPSTF)
USPTF recommends one-time screening for AAA by ultrasonography in men aged 65-75 who have ever smoked(10).
The Society for Vascular Surgery (SVS)
SVS recommends a one-time AAA screening for all men 65 years of age or older. However, if there is a family history of AAA, SVS recommends AAA screening as early as 55 years. AAA screening for women is recommended at age 65 years or older only if there is a if there is a family history of AAA or if they have ever smoked(11).
Medicare AAA Screening Coverage
Medicare covers a one-time screening ultrasound if you get a referral for it as a result of your “Welcome to Medicare” physical exam. You must receive the physical exam and the screening ultrasound referral (not the ultrasound exam itself) within the first twelve months that you have Medicare Part B.
Individuals who meet the following criteria are eligible for the Medicare benefit:
- He or she must get a referral for the AAA ultrasound screening from a physician or other qualified non-physician practitioner as a result of the “Welcome to Medicare” physical exam.
- He or she has never had an AAA ultrasound screening paid for by Medicare.
- The person with Medicare has at least one of the following risk factors:
- A man or woman with a family history of abdominal aortic aneurysm
- A man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime.
If you are an AAA Screening Medicare beneficiary, please contact your healthcare provider to schedule a complete AAA diagnostic evaluation.
Unfortunately, the AAA screening Medicare benefit excludes those individuals who may qualify but have already been a participant in the Medicare program for sometime. It also excludes those who do not have the inclusive Medicare beneficiary risk factors (history of smoking or family history of AAA). Such individuals, without insurance access to appropriate diagnostic testing based on conventional healthcare practice, could benefit from a cost-effective and high-quality AAA screening examination.
(See Medicare Website for More Information on AAA Coverage)
Are You at Risk for Abdominal Aortic Aneurysm (AAA)?
Risk factors are traits and lifestyle habits that increase the risk of disease. Besides atherosclerosis, other factors that can increase your risk of AAA include:
- Age older than 60
- Gender and Race
- Cigarette Smoking
- Increases both the risk of developing an AAA along with increasing the risk of rupture.
- Smoking can damage and weaken the walls of the aorta.
- 90% of persons with aneurysms have smoked(9).
- Family History
- Having an immediate relative, such a parent, grandparent, sister or brother, who has had an AAA.
- Approximately 25% of AAA cases are in persons with immediate relatives with AAA(8).
- High Blood Pressure (Hypertension)
- Blood pressure is considered high if it stays at or is above 140/90
How Can You Reduce Your Risk for Abdominal Aortic Aneurysm (AAA)?
Having any of the AAA risk factors doesn’t mean that you will have an aneurysm, but you can take steps to help prevent the disease. Some risk factors for AAA such as age (over 60) and family history of AAA can’t be changed. However, there are other risk factors that can be changed, treated or controlled. By choosing to reduce your risk factors, you can prevent AAA’s deadly consequence of a ruptured aneurysm. Through screening, early detection of AAA can allow treatment by lifestyle modification, medication or surgical/endovascular treatments.
- If you smoke, stop!
- Know your blood pressure.
- High blood pressure usually has no signs or symptoms.
- See your doctor to get your blood pressure checked, at least once each year.
- Work with your doctor to keep your blood pressure under control.
- Eat a healthy diet.
- A diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.
- Eat foods that are low in total fat, saturated fat, trans fat, and cholesterol to help control blood cholesterol levels.
- Reduce sodium (salt) intake to help control blood pressure.
- Reduce your calorie intake to help avoid becoming obese.
- Exercise every day.
- Try to get a total of at least 30 minutes of activity on most or all days.
- Talk to your doctor about what types of activity are safe for you.
- See your doctor regularly.
What is an Abdominal Aortic Aneurysm (AAA) Screening Exam?
Futura Health Screening uses duplex ultrasonography which is a painless, noninvasive examination that accurately diagnoses the presence of AAA. During an AAA screening exam, the technologist will pass a transducer (probe) over your abdomen. Measurements of your abdominal aorta will be taken in several areas to detect any possible widening.
To enhance visualization of the aorta, the screening participant should not eat or drink (except water and medication) 4 hours prior to the exam. Diabetic individuals, however, should eat a light meal and take medications as usual.
AAA Ultrasound Image
Each screening exam will only take about 10-15 minutes. A final report will be mailed to you and your primary care physician within 10 working days. If critical results are found, we will contact your primary care physician before you leave.
Note: Many deaths related to AAA rupture can be prevented by early identification of those individuals without any symptoms who are at risk for AAA. If an aneurysm is small and there are no symptoms, your doctor may recommend periodic evaluation. This usually includes a yearly ultrasound, to see if the aneurysm is getting bigger.
For featured AAA stories, refer to Find the AAAnswers to view testimonials about AAA screening.
References
1 “Abdominal Aortic Aneurysm.” Vascular Web. Society for Vascular Surgery, 01/19/2010. Web. 17 Mar 2011.
2 “Screening for Abdominal Aortic Aneurysm: A Best-Evidence Systematic Review.” Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services, 2005. Web. 21 Jul 2010.
3 “Abdominal Aortic Aneurysm Screening.” Centers for Medicare & Medicaid Services. Department of Health & Human Services, 05/04/2010. Web. 14 Jul 2010.
4 “The Natural History of Abdominal Aortic Aneurysms.” National Center for Biotechnology. PubMed.gov, Am J Surg.1991 Nov; 162(5):481-3. Web. 17 Mar 2011.
5 “AAA Risk Factors | Find the AAAnswers.” Find the AAAnswers. Find the AAAnswers, 2009. Web. 14 Jul 2010.
6 “Abdominal Aortic Aneurysm Symptoms, Causes, Treatment – Who is most likely to have an abdominal aortic aneurysm.” MedicineNet. MedicineNet, 2010. Web. 14 Jul 2010.
7 “Risk Factors | AAA | Vascular Disease Foundation.” Vascular Disease Foundation. Vascular Disease Foundation, 12/01/2009. Web. 14 Jul 2010.
8 “Abdominal Aortic Aneurysm: eMedicine Vascular Surgery.” eMedicine. Medscape, 10/28/2009. Web. 14 Jul 2010.
9 “JAMA — Aortic Anerusyms, November 11, 2009, Zeller et al.302 (18): 2050.” JAMA. American Medical Association, 11/11/2009. Web. 14 Jul 2010.
10 “Screening for Abdominal Aortic Aneurysm: Recommendation Statement.” Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services, 02/2005. Web. 21 Jul 2010.
11 “SVS Position on Vascular Screening.” VascularWeb. Society for Vascular Surgery, 01/2010. Web. 17 Mar 2011.
