Aortic Aneurysm

Tens of thousands of immediate death cases, due to Aortic Aneurysm rupture

In the United States, each year, approximately 30,000 deaths are reported due to Aortic Aneurysm rupture, with half of the patients dying immediately without any prior warning sign. It is common to assume that in the State of Israel, every year, more than 500 people die due to the rupture of an aneurysm of this kind. The treatment indication for the aneurysmal disease is based on studies conducted on a large population of men, since the incidence of aneurysmal disease in men is four times greater than in women. In recent years, research regarding the effect of gender on the manifestation of diseases has gained momentum. Some studies examined the aneurysmal disease in the abdominal aorta in women compared to men, in order to prescribe dedicated treatment for these groups.

Who is at risk and what is the prevalence of the aneurysmal disease?

The prevalence of aneurysmal disease in women aged 70 years and older with a history of smoking is ten times greater as compared to women who have never smoked, and the prevalence of aneurysmal disease among active women smokers is seventy times greater than among women who have never smoked. It was also found that the fate of women suffering from aneurysmal disease is worse compared to men, since women are diagnosed at a later age – when the disease is at a more advanced stage and the diameter of the aneurysm is larger and consequently the chances of rupture are greater.

In a large study conducted in England, it was found that the risk of aneurysm rupture, having the same diameter, is four times higher in women as compared to men. The rates of treatment complications, length of hospitalization, re hospitalization and mortality rates were also found to be significantly higher in women as compared to men.

The explanation for the above seems to be that the basic diameter of the abdominal aorta in women is about 10% smaller as compared to men, and thus the growth rate of the aneurysm in women is greater than in men. Therefore, a different treatment indication is required for women and men.

In light of the understanding that early treatment of abdominal aorta aneurysm, significantly increases the patients’ chances of survival, the American health authorities approved, as early as January 2007, a law requiring the performance of a one-time abdominal ultrasound examination for populations at risk, as a screening test for early detection of the aneurysm.

Populations at risk were defined as men over the age of 65, current or past smokers, and women with a family history of abdominal Aortic

Abdominal Aortic Aneurysm in Israel: men yes, women no

In Israel, this screening test was included in the “Official Health Basket” in 2015 and it was determined that those entitled to it are men aged 65-74 with a history of smoking. At the same time, women were not defined as eligible to perform this screening test and no unique indicators were defined for their screening reference.

In light of the above, it seems that it would be appropriate to refer women aged 60-74, with a history of smoking and a family history of aneurysmal disease, to undergo the screening test.

A diagnosis of an aneurysm in the abdominal aorta, which has a diameter of about 50 mm, requires a preliminary evaluation by a vascular surgeon and further referral of the patient to a more accurate imaging test, such as a Computed Tomography (CT) to enable planning of optimal treatment.

Aortic Aneurysm therapeutic approaches and awareness

Based on studies conducted on men patients with aneurysm with a diameter of less than 50 mm, will be treated mostly with conservative treatment, based on periodic imaging monitoring. The accepted recommendation for invasive treatment is valid when the diameter of the aneurysm is about 55 mm or when the diameter of the aneurysm increases by more than 10% per year. This recommendation balances the risk of rupture with the risk of invasive treatment.

Two invasive therapeutic approaches are available to the vascular surgeon: open surgery, in which the aneurysmal segment is replaced by a synthetic implant, and the catheter (endovascular) treatment, in which a supporting catheter is inserted into the aorta, to neutralize the blood flow in the aneurysmal segment.

In general, the endovascular approach is preferred as treatment, since the risk of morbidity and mortality in open surgery is about 5 8%, as compared to the risk of morbidity and mortality in endovascular surgery, which is only about 1.0-1.5%.

It was found that in women, who are referred to invasive treatment, according to the accepted standards for men, the chances of morbidity and mortality are higher also with the preferred endovascular procedure. Therefore, referral of women to evaluation and treatment, at an earlier stage than men, is considered.

In Israel, a screening test is available to members of the health insurance funds (Clalit, Maccabi…) and it is included in the “Official Health Basket” budget; Nevertheless, only a small percentage of those entitled to the screening test, take it.

Increasing the public awareness is the key to saving the lives of many women and men.