Carotid and Abdominal Aneurysms
(5/29/07)- The Society for Vascular Surgery, which represents 2,400 vascular surgeons, has recommended for the first time three tests to screen for artery disease in people 55 years and older.
The first test is an abdominal ultrasound to see if the body's main artery, the aorta, has an aneurysm in the abdomen. The second test is a carotid ultrasound to detect fatty plaque in the neck arteries that could lead to a stroke. The third test is an "ankle-brachial" test to detect fatty plaque building in the arteries to the legs and throughout the body.
These tests can be quite expensive, so if you are looking to take these tests start with the Society's site at www.vascularweb.org for sites where you may be able to get these tests for free. Many hospitals and medical schools offer free or even cheaper versions of these tests.
There is a commercial company, Life Line Screening, that offers all three tests, plus one for osteoporosis for a total of $129, or $45 each. The test for abdominal aneurysms is paid for by Medicare, but only in an initial exam when people become 65. The CMS has recently announced that it would hold public hearings before putting stricter limits before paying for corotid aneurysm tests.
(2/16/06)- The budget bill that was recently signed by President Bush allocated funds, starting in 2007, for the free screening test of new enrollees to Medicare who are considered to be at high risk for abdominal aortic aneurysms. Abdominal aneurysms are responsible for at least 15,000 U.S. deaths each year.
One of the groups considered to be at high risk is men who have smoked more than 100 cigarettes in their lifetime. Another high-risk group is men and women whose family history includes aortic aneurysms. The free test for aortic abdominal aneurysms does not include those who are already covered by Medicare, only the new enrollees starting in 2007.
The backers of the bill for the free coverage estimate that about 58,000 people would be covered by its provision for the free screening test.
(2/21/05)-Senators Chris Dodd (Dem.-Ct.) and Jim Bunning (Rep.-Ky) have introduced a bill in the Senate that would make most men and women over the age of 65 eligible for free Medicare abdominal aortic aneurysm screening. The groups that were specifically selected under the bill are those with a family history of .aortic aneurysms, those with high cardiovascular risk factors such as smoking or high blood pressure and those with atherosclerotic disease (blocked arteries). The U.S. Preventive Services Task Force recently endorsed the screening, but only for all men ages 65 to 75 that smoked or have smoked.
(2/16/04)-A panel of influential medical experts has recommended to the U.S. Preventive Services Task Force that all men ages 65 to 75 that have ever smoked a total of 100 or more cigarettes in their lifetime have an ultrasound screening. The purpose of the screening would be to see if they are developing an abdominal aneurysm that could kill them.
The U.S. Preventive Services Task Force is an independent panel of medical experts that advises the federal Agency of Healthcare Research and Quality. Primary care physicians generally follow its recommendations. It is estimated that the condition kills at least 9,000 people a year in the U.S. It is also estimated that the cost of the ultrasound screening runs between $300 to $400, and if an aneurysm is found, the operation to repair it can cost $15,000 to $20,000. If an abdominal aneurysm bursts, there is very little if anything that can be done to prevent a death.
The test was not recommended for any ages for women, or men under 65 unless there is a family history of abdominal aneurysms. Almost no one is screened now for these aneurysms according to vascular surgeons. There are no symptoms as the aneurysm grows, but once it reaches over five and one half centimeters in diameter it may burst at any moment. Smaller aneurysms are not worth repairing since there is an increased risk for a fatality in undergoing the operation.
The condition is about four times as great in men as it is in women, and it is about three times as likely in smokers than it is in non-smokers. After 75 the life expectancy is considered too short for the risky operation. About 4 % of the surgery patients die from the operation. Medicare does pay for the repair of the aneurysm by either of the two methods that are used today.
(2/4/05)- The following was emailed to therubins by one of our viewers. We thank him very much and appreciate his efforts:
Men between the ages of 65 and 75 who are or have been smokers should have a one-time ultrasound to screen for abdominal aortic aneurysm, according to a new recommendation from the U.S. Preventive Services Task Force. Nearly 70 percent of men in this age group have smoked and would benefit from routine screening to check for aneurysms. The recommendation is published in today's issue of the Annals of Internal Medicine. The recommendations and materials for clinicians are available on the AHRQ Web site at www.ahrq.gov/clinic/uspstf/uspsaneu.htm
(4/2/04)-Eight major medical societies, along with a bipartisan group of senators and congressmen are preparing legislation that would require Medicare to pay to screen Americans over the age of 65 for abdominal aortic aneurysms. The test, a simple ultrasound that costs about $45 will be added to the list of other preventive tests that Medicare pays for.
Medicare traditionally does not pay for screening tests, so that is why an act of Congress will be required to institute such screening. In the past Congress has enacted such legislation that now enables Medicare to cover tests for breast, uterine, prostate and colon cancer, as well as glaucoma and osteoporosis. Aortic aneurysms are more common in males than females, and they tend to run in families that have a history of such an illness. Aortic aneurysms can be treated with surgery, or with the installation of a fabric-lines, inverted-Y-shaped device called a stent-graft.
Edwards Lifesciences LLC a company based in Irvine, Ca. has brought a patent infringement lawsuit against three makers of devices used in the repair of abdominal aortic aneurysms. The three are Medtronic Inc., Cook Inc., and W.L. Gore & Associates. The suit, which was filed in the federal court in San Francisco, seeks to stop sales of devices, which are used for treating enlargements of the aorta. Edwards claims that it has an exclusive license on the patent, which is owned by an Australian company formed by its inventors.
Edwards is selling an endovascular device and delivery mechanism in Europe and Australia, and hopes to receive approval from the U.S. Food and Drug Administration to market the device by the end of 2004. Edwards hopes to market its product before the final court ruling in this matter. Ruptured aneurysms in the abdomen and chest kill an estimated 18,000 people in the U.S. every year. It is a problem of growing seriousness especially in men over 55 years of age.
Aneurysms are ballooned arteries that can burst without any prior pain or warning. In the vast majority of cases when it bursts it results in a fatality. As a matter of fact though, if they are discovered in time, treatment to remove them or bolster them with stents is successful almost 90% of the time. Aneurysms kill more people in the U.S. (estimated-about 25,000 a year) than brain cancer or AIDS. Contrary to popular opinion, aneurysms grow slowly over time and can be treated by surgery.
Aortic aneurysms can be detected through the use of high tech scans such as CT; abdominal ultrasound; MRI and echocardiograms. The scans cost anywhere from $40 to $2,000 depending on where the aneurysm is located. Medical geneticists have also identified high-risk groups in who the condition ought to be suspected. The success rate of replacing damaged sections of aorta with Dacron hose is about 90%.
British researchers at the University of Birmingham in England have concluded that it is highly cost-effective to screen men over 50 for aortic aneurysms in their abdomen. The U.S. Preventive Service Task Force, a quasi-governmental agency, is studying whether to recommend insurance coverage for screening for abdominal aortic aneurysms.
In the Birmingham study, doctors gave screening tests, on and off, beginning in 1991, to 13,400 men in the Huntington district north of Cambridge. The researchers found that the screening prevented about 11 aneurysm ruptures and 8 deaths per year. Even though there was about a 4% death rate among those patients getting elective surgery, getting the operation proved highly beneficial for the study group.
Thomas M. Burton writes in an article entitled "Aortic Aneurysm Kills Quietly" in the Wall Street Journal that the most common aortic aneurysm is in the stomach and is the nation's 13th leading cause of death. "It results from atherosclerosis, or fatty blockage in the artery system. That means smokers and anyone with known atherosclerosis or diabetes ought to consider a screening for aneurysm." Anyone over the age of 50 who was a smoker at one time or another is a more likely candidate for an aneurysm. If you have a family history of aneurysms, you are at a higher risk of getting one yourself. If you have a family history involving aneurysms, you should be aware that even at a young age, you should have this checked into.
Men are at a much higher risk from suffering an aneurysm than are women. Aortic aneurysm normally strikes those over the age of 60. A federal heatlh panel is considering whether to recommend routine screening for abdominal aortic aneurysms. Health insurance companies are beginning to pay for such examines for high risk individuals.
An abdominal aneurysm can be detected with an abdominal ultrasound test. When the test is done in a hospital or clinic it can cost between $200 to $300. Mr. Burton's article points out that there are cheaper alternatives. For smaller and harder-to-see cerebral aneurysms, it is best to have an MRI done to detect it. Cerebral aneurysms can break even when they are much smaller than the other types of aneurysms.
A company called Life Line Screening of America, which is based in Cleveland, has 47 screening vans that criss-cross the U.S. An ultrasound there costs $45. To find out if the van will be coming to your location go to their Web site at www.lifelinescreening.com . Healthscreen America at www.healthscreenamerica.com offers the test in the Atlanta area for $59.
Insurance companies generally will not cover the cost of an aneurysm screen unless a doctor specifically orders it. The advent of CT, MRI and ultrasound technology has produced an estimated 200% increase in the diagnosis of aortic aneurysms. Unlike many other tests there is no ambiguity in a CT scan that detects an aneurysm.
The article goes on to point out that the abdominal test won't detect the less common variety of aortic aneurysm, called the thoracic aneurysms. This type of aneurysm occurs in individuals with a hereditary disorder called Marfan's syndrome. Screening for an aneurysm in the chest often requires a CT, which can cost from $800 to $1,000, or an MRI which can cost even more.
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updated May 29, 2007
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