One of my friends has a family history of a spooky, deadly medical condition—it’s called abdominal aortic aneurysm (AAA)—a weak spot in the main blood vessel that carries blood from the heart to the rest of the body. Many years ago, several of her family members died when their AAAs ruptured. In the last 40 years or so, this kind of problem has become potentially much more controllable, thanks to sophisticated imaging technology. With ultrasound in particular, doctors can now identify and monitor this killer of 15,000 Americans annually—so that when an AAA grows to the point of being dangerous (typically, larger than five centimeters in diameter), it can be repaired. Improved monitoring and developments make treating an AAA much less difficult and risky.

TAKING SOME OF THE PRESSURE OFF

A little background: The aorta is the master artery, conducting blood from the heart to vessels leading to the rest of the body. Occasionally an area of the vessel’s wall weakens and begins to bulge—and this is what’s known as an aneurysm. People most at risk are men older than age 60, anyone who smokes (or used to) and people with a history of atherosclerosis. Age plays a role, with about 8% of people over age 65 being affected by AAAs. Four times as many men as women have AAAs. And when the condition runs in families as it does in my friend’s, especially if there’s been a female relative with an AAA, the risk is higher.

For decades, the only solution to the problem had been dramatic and dangerous surgery. The late 1990s brought a new option—a procedure using a catheter to place a stent inside the aorta (similar to a surgeon using an angioplasty stent to unblock an artery). But one significant problem remained—the surgeon had only one chance to position the stent as accurately as possible, something that can be very difficult to achieve when the AAA is in certain locations.

Now we reach today’s news—a second generation of aortic stents that allow for easy repositioning once or even several times during the procedure until the doctor finds the absolute sweet spot for aneurysm repair.

SECOND-GENERATION STENT SUCCESS

I recently talked with Ross Milner, MD, chief of vascular surgery and endovascular therapy at Loyola University Hospital in Chicago, who is among the first surgeons to use these second-generation stents. Dr. Milner explained that most AAAs are near the arteries leading to the kidneys from the aorta. Stents are quite large, and if doctors place them too close to the renal arteries, they can do damage by interfering with blood supply to the kidney(s), putting the patient at risk for kidney failure. “The new stent gives us the ability to be particular about how we place it, knowing that if it isn’t exactly where we want it we can easily fix it,” said Dr. Milner.

ANOTHER BREAKTHROUGH COMING

On the horizon is yet another positive step in aneurysm control. Today patients must have periodic monitoring postprocedure with CT scans to be sure that the stent is working properly. The problem, of course, is that CT scans involve high doses of radiation and contrast dyes that can hurt the kidneys. A much easier approach is via a tiny sensor placed in the artery but outside the stent. The sensor measures blood pressure within the aneurysm. By putting an antenna over the patient’s abdomen, doctors can activate the device for a pressure measurement that then goes to a computer for a readout. If pressure is normal, they know that all is well with the stent. This device enables doctors to ascertain success of stent procedures both during the procedure and for follow-up. The team at Loyola has a clinical trial underway to gain FDA approval for long-term patient monitoring, something, Dr. Milner says will likely take several years.

Abdominal aortic aneurysms have had haunting mortality figures in the past. At least 50% of patients do not survive to make it to the hospital if an AAA ruptures. It used to be that half of the remaining 50% did not make it out of the hospital after surgery—now, about 80% of those who have the surgery survive. Thanks to the techniques available today, the condition is much more treatable, and patients can look forward to long, full lives.