UMHS Statement: Donald Canham / Abdominal Aortic Aneurysm
5/3/2005 12:00:00 AM | General
UMHS Statement:
Donald Canham / Abdominal Aortic Aneurysm
On Tuesday, May 3, former University of Michigan Athletic Director Donald Canham was admitted to the U-M Emergency Department, after being involved in a single-car accident on Saline Road and transferred to U-M from Saline Hospital.
U-M emergency medicine physicians and radiologists immediately diagnosed him with a ruptured, or burst, abdominal aortic aneurysm. Surgery to repair the rupture began just after noon, by a surgical team led by James C. Stanley, M.D., co-director of the U-M Cardiovascular Center and a highly regarded and experienced vascular surgeon.
Unfortunately, Mr. Canham had suffered so much internal bleeding before reaching U-M that, despite the success of the three-hour operation to repair his aorta, he passed away shortly after 4 p.m.
Background information on AAAs and U-M AAA treatment and research:
Abdominal aortic aneurysms, commonly known as AAAs or triple As, are bulges or weak spots in the largest blood vessel in the body, called the aorta. They occur in the portion of the aorta that runs from the heart to the waist, in the abdominal region. They can go undetected for years; experts sometimes refer to them as a ticking time bomb inside a patients abdomen.
When an AAA bursts, blood rushes into the abdomen, causing a loss of consciousness and plummeting blood pressure, or shock. (A burst pipe in a houses main water line is a good analogy.) Emergency surgery is crucial in order to save a patients life, and even after surgery to repair the aorta, the risk of complications or death is high because of the loss of blood to the brain, organs and tissues. Only about 20 percent of people who experience AAA rupture survive.
As many as 20,000 Americans die from ruptured AAAs each year, making them the 13th leading cause of death in the United States and the 10th leading cause of death for older men. About 60 percent of all AAA deaths are in patients who die before they reach a hospital. Of those who do, only about 50 percent are successfully treated by surgery. Of those who suffer a cardiac arrest outside the hospital, few survive.
No one knows exactly why AAAs develop, but a weakness in the tissues holding the vessel together, combined with cholesterol buildup in blood vessels, and high blood pressure, are thought to play a role. This, along with the pumping force of the heart, reduces the elasticity of the aorta, cause the aorta to slowly stretch and bulge, with a high risk of a rupture if left untreated.
The odds of developing an AAA increase with age, and smokers and people with high blood pressure have a higher chance of developing one. Men, and people with a family history of AAA, also have much higher odds. In fact, an estimated 10 percent of all men over the age of 70 may have intact aortic aneurysms. U-M researchers are currently studying whether estrogen might protect people against AAAs.
AAAs cause few symptoms when they are intact, except for occasional back pain or abdominal discomfort. If they are detected during this stage, for instance on a routine physical exam, X-Ray, MRI or CT scan, they can be repaired successfully 95 percent of the time. About 200,000 Americans are diagnosed with intact AAAs each year.
Earlier this year, an advisory panel to the federal government recommended that all men over the age of 65 with a history of smoking be screened for AAAs using ultrasound.
On Saturday, May 21, U-M vascular surgeons will conduct a free screening for people at high risk of AAAs and other vascular diseases.
Appointments are available to people 60 years and older with a history of high blood pressure, diabetes, smoking, high cholesterol or known cardiovascular disease. Call 800-742-2300 and enter extension 6350 to find out more or to arrange for an appointment. Other sites around the country are also taking part in this screening effort sponsored by the American Vascular Association; visit www.vascularweb.org and click Screening to find one.
Treatment options for intact aneurysms include open-abdomen or minimally invasive surgery to install a graft, or artificial replacement section of aorta. The U-M was one of the first hospitals to offer minimally invasive graft surgery, called endografts, after their FDA approval in 2000. Since that time, the U-M Cardiovascular Center has built a well-established program for minimally invasive aneurysm surgery. Patients with small aneurysms, less than 5 centimeters in diameter, may choose to wait to see if their aneurysm grows before having surgery. All patients with AAAs should work to lower their blood pressure through diet, exercise and medication.
U-M researchers have shown that patients with ruptured AAAs do much better if their surgeon is highly experienced, and especially if that surgeon specializes in vascular (blood vessel) surgery. However, many patients have their ruptured aneurysms repaired by general surgeons who lack the same level of experience.
For intact aneurysms, studies have shown that experience also counts, and that AAA patients do better if theyre treated at hospitals that repair a large number of intact AAAs each year. In fact, the Michigan Health & Safety Coalition and other hospital quality groups rate hospitals by the number of intact AAAs they repair. In 2004, the U-M performed the second largest number of AAA repairs in the state, according to the MHSC.
U-M researchers have also found that people without health insurance, who have lower access to regular screening and checkups, are more likely to die after having an aneurysm intact or ruptured repaired.
For more information on AAA:
U-M Section of Vascular Surgery: http://vascular.um-surgery.org
American Vascular Association: http://www.vascularweb.org
U-M news releases on AAA treatment and research:
http://www.med.umich.edu/opm/newspage/2004/hmaneurysm.htm
http://www.med.umich.edu/opm/newspage/2003/vascularsurgeon.htm
http://www.med.umich.edu/opm/newspage/2004/estrogen.htm
http://www.med.umich.edu/opm/newspage/2003/aorta.htm
http://www.med.umich.edu/opm/newspage/2001/endo.htm
