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Lee Kirksey, MD  
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Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Abdominal Aortic Aneurysm-treatable but underdiagnosed vascular disorder

Oct 04, 2014 - 12 comments
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Abdominal Aortic Aneurysm (AAA) is an abnormal enlargement of the aorta at a level below the blood vessels to the kidneys or renal arteries. AAA are generally without symptoms, or asymptomatic, until it arises to a size where its associated with abdominal or back pain. These symptoms arise from stretching of the sensory nerves within the wall of the enlarging aorta. As a general comment, a symptomatic aneurysm suggest impending rupture and merits immediate medical evaluation which frequently leads to surgery.

Unfortunately, because the aorta is located in the retroperitoneum , the blood vessel frequently reaches a large size when it remains asymptomatic. AAA that rupture are associated with an 80-90% out of hospital mortality. A patient who survives to make it to the hospital and to the operating room has a 50% mortality within 30 dys operation. This mortality is a reflection of the risk of heart attack, stroke, pulmonary infection, and renal failure.

Risk factors associated with AAA formation include a 20:1 M:Fdistribution, more common in Caucasians, non diabetics, smokers and first degree relatives (regardless of gender) of patients who have an AAA.

To this end, early diagnosis permits monitoring and planning for repair of the AAA when it reaches a threshold of 5.5cm. The rationale is that the risk of rupture before a patient reaches this threshold is quite low (but not zero). In a scenario of a patient with a AAA< 5.0 centimeters the aneurysm is usually monitored at 6-12 month intervals with US or CT imaging.

Currently 70% of AAA can be treated with a minimally invasive device called an aortic stent graft. This allows the aneurysm to be treated via small groin or puncture site. This approach is in comparison to the Open repair of an aneurysm. Open repair first done in the early 1950's is performed through a midline incision from the ribcage down to the bladder area.


The minimally invasive procedure or (EVAR) is associated with shorter lengths of hospitalization, decreased blood loss and high patient satisfaction. Improvements in technology have resulted in a greater number of abdominal aneurysms that can be treated with EVAR.  The drawback with EVAR is that 20-30%, will develop a secondary intervention that requires a secondary revision. Most revisions can be done via an endovascular route. However, a subpopulation of patients will require open repair of their AAA with explantation of the stent graft.

If you or your family member have been diagnosed with a AAA, seek an opinion on management options from a Board Certified Vascular surgeon





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Avatar universal
by Night0wl, Oct 15, 2014
Very concerned my Dad in ER now with a 5.5cm and high blood pressure. They have been trying to control his BP for several months now. Meds aren't working. Drs at ER are dragging their feet. Trying to decide if we should put our foot down and ask for surgical evaluation now!

Avatar universal
by karmagirl222, Oct 19, 2014
you should allways trust your intuative impulses,allways ask for other opinions, ask alot of questions, til you understand exactly what is going on with your dad,then research what you have been told. i hope this helps

Avatar universal
by inarome, Nov 01, 2014
I have pulsating feeling in ears, abdomen, pelvis, arm and thigh pain,  some chest pain, 45 and female,  no period for a year,  could this be AAA?  I noticed it in my ears a year ago, then the abdomen about a month ago and now the pelvis.  I don't want to run to the E.R.  Also,  my abdomen is itchy around the navel.  Any thoughts?

Avatar universal
by inarome, Nov 01, 2014
Forgot to mention also pulsating around ribs.

Avatar universal
by Six_seconds, Nov 11, 2014
To inarome,

I am not sure what you mean by a pulsating feeling. For me it feels like a tremor almost like I have Parkinson Disease where I can feel the constant tremor inside my upper body. What I do know is I have an adenoma on my right adrenal gland, my thymus gland is swollen and I have several herniated discs in my spine. The tremors started after I had several pheochromocytoma events where my normal BP which has always been low 110/70 peaked at 245/145 and my pulse was 122. Despite having seen a cardiologist in the past two months ago I am still waiting for the test results. One of the test involved pressing on my abdomen while measuring a protrusion in my neck. This was done by several people. Interesting that my navel area is itchy as well. I will check back if I hear anything or to see if you have been given a diagnosis. I am located outside the USA.

Avatar universal
by Marisolsanchez, Dec 17, 2014
im a teen and i had sex i took 2 test and they came out negative but i stilk think im pregnant?
I had sex in April I missed my period and weeks after I had all the symptoms and I took a test in May and they came out negative but I still think I'm pregnant so I told my mom and sister and they said that I'm not because I don't look like it but I really think I'm and pulse my stomach haves been growing so I told my sister and she said that she doesn't think I'm because I should be Really big by now  I should be like 9 and a half moths and plus I still having all the pregnancy symptoms and sometimes I feel something moving in there and they think I'm just putting on some weight can someone please help I would really appreciate it


Avatar universal
by MedForumRider83, Jan 16, 2015
Marisol: you're not pregnant. You are feeling gas in your stomach and the pulsating feeling these woman are talking about that is around there mid-low abdominal area is directly related to the article posted on top of this forum. There is a major aortic artery that runs under the naval area and bilaterally splits around the kidney area. They feel the pulsating more often then not ( everyone feels that occasional twinge of blood pumping around our stomachs) along with abdominal/low back pain and possibly other factors that make them increasingly susceptible to having AAA. This serious medical condition (that often leads to death) however it occurs more often in men over a certain age and not teenage girls. I'm wishing them well and hope they get manageable diagnosis for their legit medical problems, but I'm here to tell you right now that you are most certainly not pregnant. Of course I'm sure you've figured this out by now on your own since I'm sure you haven't given birth to this alleged baby. There are tween/teen forums online that are specifically for attention seeking girls who want desperately to justify that regretted loss of their virginity from almost a year ago with a boy who probably broke your heart within the week of giving it up.  Try those forums please and don't put your own jaded tween pangs of lost "love" next to  possible severe medical problems of these women, that with any luck and extreme medical advances, you'll never have to experience.

Avatar universal
by h_g, Mar 26, 2015
Dr. Lee Kirskey
Thanks for your article, My husband 56 14th April, next month will be undergoing a AAA open due to thrombus on 24th April 2014, This runs in his family, Mum  was 83 and was to have operation in 2012 June  died in her sleep dec 2011, and Uncle who has undergone this operation late 70s, I am worried as he also has protein in his urine it was 600 and they did a scan about 2 yrs ago and it was accidentally discovered since then they have changed his meds and he is on coversyl  for BP, Mr. Adrian Ling is his doctor,  Just want to know once he does this would he need check ups frequently, he has quite smoking about 2 weeks now, God Bless you all
hg

Avatar universal
by brandi97, Apr 04, 2015
Best of luck to you and your family, HG. This is SO interesting - I learned it when I quit smoking in 2006.

Within ...
20 minutes             Your blood pressure, pulse rate and the temperature of your hands and feet have returned to normal.
8 hours                   Remaining nicotine in your blood has fallen to 6.25%- a 93.75% reduction.
12 hours                Your blood oxygen level has increased to normal. Carbon monoxide levels have dropped to normal.
24 hours                 Anxieties have peaked in intensity and within two weeks should return to near pre-cessation levels.
48 hours                 Damaged nerve endings regrow. Your sense of smell and taste are returning to normal.
72 hours                 You will test 100% nicotine-free. Air sacs are beginning to relax in recovering smokers.
10 days to 2 weeks  Blood circulation in your gums and teeth are now similar to that of a non-user.
2 to 4 weeks            Acetylcholine receptors in the frontal, parietal, temporal, occipital, basal ganglia, brain stem, and cerebellum regions of the brain are down-regulated, and receptor binding has returned to normal.
2 weeks to 3 months  Your heart attack risk has started to drop. Your lung function is beginning to improve.
3 weeks to 3 months  Your circulation has substantially improved. Walking has become easier.
8 weeks                     Insulin resistance in smokers has normalized despite average weight gain of 2.7 kg
1 to 9 months             Shortness of breath has decreased. Cilia have regrown in your lungs.Energy has increased.
1 year                        Your risk of heart disease, heart attack and stroke has dropped to less than half of a smoker.
5 years                      Your risk of a subarachnoid haemorrhage has declined to 59% of your risk while still smoking.
5 to 15 years             Your risk of stroke has declined to that of a non-smoker.
10 years                    Your risk of being diagnosed with lung cancer is between 30% and 50% of a smoker.

He is on the right track.I hope for the greatest outcome!

Avatar universal
by njm465, Apr 26, 2015
My mother is 90 yrs old and has an AAA which is at 7cm now.  The doctors don't want to operate due to her age.  She's very healthy with normal BW and only takes 1 Amlodopine 25mg daily.  Her BP is under control ,she weighs 100lbs.  The question I have is it safe for her to fly with the AAA?

Avatar universal
by gracemurphy, May 09, 2015
I saw a heart MD and with testing learned my heart has 6 leaks/murmurs and aorta in that area calcified but testing saw no aneurysm...  Until I read anothers question here I would never have thought I could not fly ... it is safe/OK to ?  I sure hope so!

Avatar universal
by Kristel90s, Oct 13, 2015
I had the mirena IUD for five years, i had it removed on April 2015, that same day i got the shot for three months. So i never went back to get the shot again because i want to get regular periods again. I havent gotten my period for so long. Whats going on. I am not in any birth control ever since July! I understand the IUD doesnt let my period to come regular but i took it off long time ago..... Any comment on that?...

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