What you don’t know won’t hurt you—but not in terms of your health.
Different from commonly discussed vascular illnesses like rheumatic and congenital heart disease and coronary artery disease, there is a silent killer that affects almost a million people in Asia every year and is among the top causes of death in the Philippines.
Aortic aneurysm is a less talked-about vascular disease that develops slowly and usually comes without symptoms until it begins to leak, expand and eventually rupture, which more often leads to death.
“When you have 100 patients who have ruptured aneurysm at home, only 50 will reach the hospital alive, and out of the 50 who go to emergency surgery, only 25 will survive,” said Dr. Timothy Dy, head of the Aortic Endovascular Unit of the Heart Institute in Chinese General Hospital and Medical Center.
(Infographic by Marlon Nombrado)
Since all parts of our bodies are pumped by arteries, one can have aneurysm anywhere in the body, but the disease commonly manifests in the aorta, the biggest and most important blood vessel.
Aortic aneurysm develops when the wall of the aorta deteriorates, which then enlarges and becomes thinner, making it more vulnerable to rupture and massive internal bleeding.
Two kinds
There are two kinds of aortic aneurysms—the thoracic aortic aneurysm (TAA), which occurs in the chest area, and the abdominal aortic aneurysm (AAA), which occurs in the abdominal area.
Dy explained that although people at ages 60-65 are more susceptible to aortic aneurysm, it is important to look at factors that make a person at risk of having the disease as early as possible. These risk factors include hypertension (high blood pressure), hypercholesterolemia (high cholesterol), atherosclerosis (existing clogged arteries), obesity and concomitant diseases such as diabetes mellitus. Lifestyle choices—sedentary lifestyle, excessive intake of saturated fats, sugar and alcohol, and a history of smoking—may also lead to aortic aneurysm.
Having any of these factors makes one automatically at risk of having aortic aneurysm, but the disease may also run in the family.
“If you have the risks today, you won’t have aneurysm tomorrow, but after five to 10 years of having these problems,” said Dy.
However, the endovascular expert also stressed how identifying patients with risk factors is crucial in preventing fatal aortic aneurysm cases.
“If you discover your aneurysm before it ruptures, your chances of survival improve … so it is important to get screened as soon as you can,” said Dy.
Being more proactive in getting screened prevents patients from developing a “false sense of security” when it comes to their health.
New less-invasive cure
But for cases of already-ruptured aortic aneurysms, two types of surgical treatment are available in the country’s reputable hospitals: the open surgical repair and the endovascular aortic repair (Evar).
The open surgical repair is performed through a large incision over the area where the aneurysm is located and removes and replaces the aneurysm with a fabric tube called a graft.
Evar, on the other hand, is a newer and less invasive procedure where an endovascular stent graft is inserted through the groin and placed to reinforce the damaged area. No open surgery is performed. Because Evar is less invasive than open surgery, the patient’s hospital stay may be cut to two to four days.
“There are cases where the aneurysm is small and can be addressed with monitoring, medication and with the patient choosing an overall healthy lifestyle. Then there are the more severe cases where Evar is the best course of treatment. Earlier diagnosis is still the optimal course of action to determine the proper course of action for each patient,” said Nelson C. Lee, MD, of the Thoracic Cardiovascular Surgery Unit in Chinese General Hospital and Medical Center.
Surgical cost in the Philippines can be as low as a few hundred thousand pesos to as high as millions depending on the extent of the problem. For abdominal aneurysms, the cost of Evar is fairly comparable to open surgery, while the cost for thoracic aneurysms is generally cheaper with Evar.
A small circle of physicians is already performing Evar in the country. The problem why majority of Filipinos with aortic aneurysms are still not diagnosed and are not receiving adequate treatment, therefore, lies on the lack not only of technical expertise but also of patients’ knowledge about the disease.
Aortic endovascular center
With this dilemma in mind, an aortic endovascular center was established at the Chinese General Hospital and Medical Center in Manila. The center is committed to training local and international physicians on Evar and reaching out to more patients.
Dy said the center’s vision in five to 10 years is to treat more than 1,000 patients a year instead of 60-70 patients at present, which can be possible by having more physicians who are experts on the disease, most especially in the provinces or in areas not easily reached by the center.
But the need to increase awareness on aortic aneurysm also means elevating the dialogue to a national scale.
“In foreign countries, there are nationally instituted programs that screen people at risk,” said Lee. In countries like the United Kingdom which have socialized healthcare programs, it is mandatory for people to have at least one screening, so they are being treated earlier.
“Maybe in the Philippines we can also have a nationwide screening program,” said Lee.