Aneurysm expert
details optionsNot every weakened artery
in the abdomen requires surgery,
says a pioneer in the field
An internationally known vascular surgeon whose New York group pioneered a new treatment for abdominal aortic aneurysms disagrees with doctors who believe every abnormality must be treated.
"Just because you have an aneurysm or narrowed artery doesn't mean you need to be treated," Dr. Frank J. Veith said here in an interview.
"Just because you can do something doesn't mean you should. You should get a second opinion and make the doctor tell you why he's doing what he's doing...
"You've got to be sure the natural history of the disease is worse than the risks of treatment, otherwise the patient shouldn't be treated."
Veith, professor and vice chairman of the Department of Surgery, Albert Einstein College of Medicine in New York, was among surgeons attending Straub Foundation's Fifth Hawaii Vascular Scientific Symposium earlier this month.
His surgical group was the first in the nation to perform a minimally invasive endovascular aneurysm repair procedure.
An abdominal aortic aneurysm (AAA) is a widening or weakening of the wall of the large artery or aorta, which conducts blood from the heart to the lower extremities in the pelvis, he explained.
It's the 10th leading cause of death in men over age 55 but is less common in women, he said.
The wall of the artery becomes weakened and expands like a balloon because it's the high pressure part of the circulatory system, he said. "When the size of the aneurysm increases to a certain degree, the wall becomes so weak it actually bursts."
Frequently, there are no symptoms but it can be detected by feeling the widened pulse in the abdomen during a physical exam, or seen on a CT scan or sonograph, he said.
Most aneurysms don't need to be treated unless they're more than two inches in size, Veith said.
The standard treatment is to replace the diseased part of the aneurysm with a plastic graft, he said. This was done in the past by making an incision in the abdomen or side, getting control of the aorta, opening the aneurysm and putting the graft inside it, he said.
The endovascular approach is to go through the groin by placing a needle and a wire inside the channel of the artery, guiding a graft into position with fluoroscopy, then expanding it inside of the artery to take the aneurysm out, Veith said.
He said about 50 to 60 percent of abdominal aortic aneurysms are being treated the new way, which has both advantages and disadvantages.
Veith said there's no question that too many surgical procedures are done, from hysterectomies to heart operations. "The problem is the system because surgeons are paid by what they do."
Carotid arterial and venous diseases also were discussed at the conference, Veith said. "It's a rapidly advancing field in terms of treatments."
But it was stressed that such procedures should be done by specialists dedicated to treating vascular disease, he added.