Aortic Centers Combat 'Silent Killer'

Greg Kasper, MD, FACS, chief vascular surgeon for Mercy St. Vincent Medical Center in Toledo, OH, knows an aortic aneurysm can be genetic. So when he treated a 94-year-old man for the condition, Kasper thought of the patient's brothers – a 94-year-old twin and 86-year-old "baby brother."

The siblings from Ohio reflect the impact aortic aneurysms have on elderly Americans everywhere. One million people may not realize they have the "silent killer" condition, Kasper said.

Kasper talked about the brothers after I interviewed him for a HealthLeaders Media magazine article about the increasing demand for vascular care, attributed to a growing population of aging Americans. Vascular disease covers a lot of ground, from life-threatening conditions such as aortic aneurysms or arterial blockages, to less dangerous, but painful conditions such as varicose veins.

Hospitals specializing in high-volume aortic centers focus on minimally invasive procedures and invest in new technology. Some processes are being developed within aortic centers at Mercy St. Vincent and other hospitals to provide immediate and 24/7 assistance to local hospitals and physicians for rapid diagnosis and treatment of aortic emergencies.

Patients with acute aortic syndrome face some of the most serious and lethal problems in an emergency department or physician's office, says Kasper.

"What we're seeing in Northwest Ohio, with the aging population, and the incidence of diabetes continuing to rise, there's a huge need for vascular care, and it's only increasing," Kasper said. "People in their upper 80s in years, or young 90s, they may have a vascular problem, and you have to correct it, but a lot of people don't know they have it."

An abdominal aortic aneurysm, the most common type of aortic aneurysm, occurs when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward. Risk factors include smoking, high blood pressure, high cholesterol, and genetic links. A ruptured abdominal aneurysm can be deadly, with a mortality rate of more than 50%.

Aneurysms can develop slowly over many years and often have no symptoms. If an aneurysm expands rapidly, tears open, or blood leaks along the wall of blood vessels, symptoms may develop, such as swelling of the stomach. Anyone can develop an aneurysm, but it is mostly seen in men over 60 with the key risk factors. "It's silent, until it gets to a certain size and ruptures," Kasper said.

Several years ago, the government approved an initiative that enables Medicare patients to get free ultrasound screenings that could detect potential aneurysms, Kasper says. Still, doctors and patients must communicate about the need for monitoring of patients at risk for aneurysms, he adds.

"A vast majority of aneurysms are asymptomatic and found when a test is done for another reason, and the patient comes in and has a CAT scan or ultrasound, and the radiologist looks at it," Kasper said.

The importance of timely interaction for a ruptured abdominal aortic aneurysm is reflected by mortality rates, says Michael Dalsing, MD, a vascular surgeon with Indiana University Health in Indianapolis, which also initiated a rapid response system for vascular care at IU Health.

Under the rapid response approach, the hospital can review CAT scans on a secure website before the patient is transferred from the emergency department, he says.

That allows the patient to go directly from a helicopter landing pad or triage ambulance to the operating room when appropriate. The rapid response has lowered mortality rates to 18% to 25%, from an average of 50%, he says.

 "We have a Level 1 trauma center, and we have an operating room always manned and ready to go," Kasper says of Mercy St. Vincent Medical Center's rapid-response approach. "We're able to move the patient in quickly, using a stent graft and minimally invasive repair" of the aorta. Using minimally invasive endovascular treatment, coupled with the rapid-response approach, is improving outcomes, he says.

But I wonder if physicians are doing enough to get the message across that patients with the condition may susceptible to a potentially grave condition.

The 94-year-old patient, for example, didn't know what was building in his body.

He was found unconscious at home, and eventually diagnosed with an aortic aneurysm. Thanks to rapid response, he recovered at Mercy St. Vincent Medical Center, where a stent graft was placed inside the blood vessel without surgically opening it, and his life was saved.

Before the surgery, Kasper wanted to be sure the elderly patient knew about options for his care.

"I had the opportunity to talk to him, and asked him if (the aneurysm) was something he wanted fixed," Kasper recalls. "He was somebody who lived independently and played golf four days a week. He said, 'let's do it.'"

Kasper examined the man's twin brother, who showed no indication of an aortic condition, and Kasper monitored the twins' younger, 86-year-old brother, who may have a slight aneurysm. "We're keeping an eye on him," he says, and that may save his life.