It was an ungodly hour in our rural emergency department, and empty aside from myself and two of my best nurses. The patch came through: male, in his 60s — vital signs absent. His daughter called 911 after he collapsed on his kitchen floor. Paramedics were en route, lights and sirens; but there would be a delay. Like many of our patients, he lived a distance from any hospital.
After what seemed like hours, he arrived; his family shortly thereafter. Devastated. Aware of the prolonged lack of oxygen to his brain, his wife and daughter made a decision to stop his resuscitation. This is what he would want. Time of death: 0359.
Cause of death? Autopsy confirmed a ruptured abdominal aortic aneurysm (AAA). He didn't have a chance.
Twenty-five years ago, the Canadian Task Force on Preventive Health Care told doctors there was insufficient evidence to recommend for or against screening to find AAAs. That all changed this week, however, when the Canadian Medical Association Journal (CMAJ) published new guidelines from the Task Force that updated their recommendations in favour of screening. Why? Results from four trials published since the release of their previous guidelines demonstrate that screening saves lives.
It could save yours, too. Here's what you need to know about AAAs and how to detect them early.
What is an Abdominal Aortic Aneurysm?
AAAs are a bulge in the wall of the body's largest artery, the aorta, caused by weakening in the vessel wall. If these bulges rupture, they cause internal bleeding which often results in death. In Canada, AAAs are responsible for approximately 1,200 deaths every year.
What's scary is that people often don't have any warning signs until it's too late. But if caught early (through screening with an ultrasound), these aneurysms can often be surgically repaired with a graft to decrease risk of rupture.
Should I get screened?
Men between the ages of 65 and 80, take note: you are four to six times more likely to develop an AAA than women of the same age, and advancing age is also a risk factor. You should consider being screened once.
Research showed that patients who underwent an ultrasound screening were less likely to die from an AAA, when followed up at both three to five years and 13 to 15 years. To prevent one AAA-related death at 13 to 15 years, 311 men would need to be screened. The biggest impact was seen in all-cause mortality: for every 1,000 men screened, 6.1 fewer deaths occurred at 13 to 15 years of follow-up.
Women have a much lower baseline risk of developing AAA, and research thus far has not demonstrated a benefit to women who undergo screening. In addition, older men weren't studied directly in the research. And, when offered screening, they were much more likely to decline.
What else do I need to know?
As with any screening test, it's important to think about potential harm. Although an ultrasound in itself doesn't have a harm of radiation, there are risks, including overdiagnosis and false positive results. Many patients are diagnosed with an AAA and don't need immediate surgery, but periodic ultrasounds are required to assess the stability of their aneurysm, and this can be anxiety-provoking. Interestingly, research showed that screening did not significantly improve quality of life.
Finally, remember that prevention is the best medicine. Don't smoke, and lower your cardiovascular risk by making healthy lifestyle choices. Because — in addition to age, gender and a strong family history of AAA — smoking, high blood pressure and heart disease are all risk factors for aneurysm development. So, if you're a man between the ages of 65 and 80, or if you have these other risk factors, book an appointment with your family doctor to discuss whether or not screening is a good option for you. You are your own best advocate.
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