Health Matters: Monitoring small aneurysms
Q. My doctor found that I have a small aneurysm in my belly. She says nothing needs to be done now, but she wants me to have periodic ultrasound examinations. I'm worried the aneurysm could rupture. Why isn't she referring me to a specialist for ...
Q. My doctor found that I have a small aneurysm in my belly. She says nothing needs to be done now, but she wants me to have periodic ultrasound examinations. I'm worried the aneurysm could rupture. Why isn't she referring me to a specialist for surgery?
A. An aneurysm is an out-pouching of the big blood tube (aorta) that brings blood rich in oxygen from the heart to all parts of the body. The aorta lies just to the left of the spine, and we can sometimes feel its pulsations in the upper part of the belly.
Particularly in male smokers, the aortic wall may weaken and allow a bulge in the wall to form. Just as you fear, rupture of the aneurysm is serious, and fixing the bulge with surgery or a tube inserted through the groin before a rupture occurs dramatically reduces the risk of subsequent rupture and death. But the reason your doctor is recommending only serial ultrasound examinations is because there is a predictable relationship between the size of the aneurysm and the risk of subsequent rupture.
Small aneurysms are very unlikely to rupture, so we simply watch them with periodic ultrasounds to be sure they are not enlarging. If they do, we then take care of the aneurysm before it can rupture. Women are less likely than men to have abdominal aortic aneurysms, but they appear to be at increased risk of rupture compared with men, so extra care is required in women.
Q. I have always been quite overweight, and I've tried every diet under the sun, but I'm still overweight. My doctor has recommended surgery as a last resort, but I'm worried about the risks. Should I travel to a large center that specializes in this type of surgery?
A. I'm sorry to hear about your weight problems. Unfortunately, you are not alone, as many of us are overweight, and some, like you, dangerously overweight.
Bariatric surgery has been a major advance in the care of morbidly obese people and usually can be performed at low risk. There are complications; although, with more experience and better procedures, the risk has decreased substantially over the past decade.
A recently reported study regarding the need for referral to a specialized center for bariatric surgery provides a resounding "no" to your question. In a study of more than 300,000 patients, there was no evidence of improved outcomes after the federal government mandated referral to a center of excellence for Medicare patients undergoing bariatric surgery.
In fact, outcomes improved from 2004 to 2011 across the board, whether covered by Medicare or other insurance. The most recent data show a serious complication rate of about 2 to 4 percent for patients undergoing bariatric surgery. Thus, there is no obvious need to travel to a specialized center of excellence for bariatric surgery, although you should do your homework to make sure that the medical facility that you choose has adequate experience and satisfied patients.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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