Q&A with Dr. R. Clement Darling About the Find the AAAnswers Campaign and Abdominal Aortic Aneurysm Awareness

Tell me about the Find the AAAnswers campaign and how it began.

There are about 1 and a half million people in the United States who have an undiagnosed problem called an abdominal aortic aneurysm. If they are under- or undiagnosed during the patient’s lifetime, there is a significant chance that they may rupture, and if they rupture, about 90% of the patients die.

It’s a pathology that 1 and a half million people have that, if they are fixed electively, can have low mortality, around 1% if it’s done endovascularly, or 3% if it’s done via conventional surgery. It’s a very curable problem that once identified, will help over 1 million people, which is why our goal was to try to get people to be more knowledgeable about it, to get referring physicians to understand it and to get the public to understand it. That’s why the SVS, along with the Society of Vascular Ultrasound, the Society of Vascular Nursing, the Preventive Medicine Society, and the Peripheral Vascular Surgery Society have gotten together and formed a coalition to try to educate people around the country. We’ve actually done extremely well. We’ve had free clinics around the country and had Joe Theismann as our national spokesperson, who has given wonderful speeches to help educate people. Kmart most recently has helped with screenings and free clinics in order for us to identify more patients with aneurysms but more importantly, to educate sons, daughters, mothers, and fathers about this because about 20% of people with AAA will have a first degree relative who had one.

What does this program offer to those at risk for AAA and who is eligible to participate in the campaign?

There are certain risk factors we’ve identified: patients who have peripheral vascular disease, patients over 60, patients who smoked at one time during their life, patients with hypercholesterolemia or heart disease, and especially patients who have a family history of abdominal aortic aneurysm disease. What this campaign offers is some free screenings in areas through the Find the AAAnswers campaign coordinated with Kmart in order to help us screen patients who are at risk. They call up, get pre-interviewed, and then they get put on the list of patients to be seen.

A screening can be done very easily with an ultrasound. It has no radiation, takes about 10 minutes, and you can get the answer right then and there whether or not you have an aneurysm.

How many people have come out to the screening events in recent years?

Right now, we’ve screened over 2500 people at risk for aneurysms and we screen about 100 people at a time. During those screenings, we’ve found between 5 and 7 patients who’ve had aneurysms and need to be followed or treated. It’s actually had a fairly good yield but more importantly, it has brought a very lethal problem to the forefront. People know more about it. They understand who’s at risk and they can be evaluated by a board-certified vascular surgeon for appropriate treatment or just to be followed. One of the problems with aneurysms is that they don’t grow in a linear fashion. If it’s 4 cm today, we can’t predict exactly what it will be in 1 or 2 years. It grows in what we call a burst fashion where the growth may accelerate which is why it must be followed in 6 to 12-month intervals by ultrasound and occasionally by CAT scan.

With screenings at many different locations, how do you conduct them in a mobile exam room?

Most of the time we have volunteers who are part of the coalition who will help organize the local screening. The Society for Vascular Ultrasound has been good about finding board-certified sonographers who are vascular certified to perform the tests. The tests are usually performed in a physician’s office and it’s usually performed with a vascular nurse available so that they can help with the education.

In those places where we do not have an office, we do have a customized RV with 2 exam rooms. Either way, it’s a comfortable, protected, quiet, and secluded spot where people get examined. They get to know their results right away and it not only gives them a good education on what aneurysm disease is, but it also gives them peace of mind knowing whether they have an aneurysm or not.

Are the doctors and nurses involved all on a voluntary basis? Why do they feel this is important?

Yes, this is an educational program that we are very invested in and we think that it is extremely important that not only the elderly patient learns about this but also the younger caregiver who may be the one directing their parents or elder siblings care. This is a global education process, not just trying to identify patients with the disease because finding that patients have aneurysm disease also indicates a marker for patients at higher risk for stroke or heart problems. It’s extremely important that people get identified early for either aneurysm disease or peripheral vascular disease and see the appropriate physicians to be followed and monitored for it.

How can our audience of professionals in the peripheral interventional field get involved in the campaign through volunteering and educating their patients further?

There are a few ways to do it. First, they can visit our website, which is www.FindtheAAAnswers.org and then they have some free customizable resources on that website, which talk about AAA, how to be evaluated, and which physicians are the ones that deal with it primarily. 

What is the main message that Find the AAAnswers is trying to convey about AAA and screening?

The main goal we’re trying to achieve is education about the lethal potential of AAA and also how, if identified early and electively, this can be a very low-mortality, low-morbidity diagnosis, meaning chance of dying is less than 1% for minimally invasive and less than 3% for open conventional surgery in most high-volume centers. Not only should patients be educated about AAA disease, but they need to be encouraged to live a heart healthy lifestyle and vascular healthy lifestyle to help them minimize their risk for peripheral vascular disease.

Is there anything that you would like to mention that wasn’t covered?

One thing I’d like to mention is that technology has improved over the last 20 years. We can now treat many of these complicated problems in very ill patients with minimally invasive techniques that have excellent results and much lower chance of dying or having a significant complication. About 70% of people will fall into that category. The other 30% can still be treated effectively and reasonably with good outcomes by conventional open surgery. 

Dr. Darling is president of The Vascular Group, PLLC, and is currently chief of the Division of Vascular Surgery at Albany Medical Center Hospital, professor of surgery at Albany Medical College, and chair of the Vascular Educational Endowment Fund. He is board certified in both general surgery and vascular surgery.