VDM Speaks with Dr. Clem Darling about the AAA Awareness Campaign Making National Headlines

What is the “Find the AAAnswers Coalition”?

The Find the AAAnswers Coalition is an alliance of medical societies that have come together to provide information about abdominal aortic aneurysms (AAAs) and to advocate for changes in the screening, diagnosis and management of the disease. Due to the sheer number of preventable deaths each year, the Coalition is working to raise awareness among at-risk individuals and their loved ones, as well as healthcare professionals. I serve as the Coalition partner representative from the Society for Vascular Surgery (SVS); other coalition partners include the American College of Preventive Medicine (ACPM), the Peripheral Vascular Surgery Society (PVSS), the Society for Vascular Nursing (SVN), and the Society for Vascular Ultrasound (SVU). The Find the AAAnswers public education campaign launched in September 2009 and is sponsored by Medtronic. Professional football legend Joe Theismann serves as the national spokesperson due to his personal connection to the disease. His involvement has helped to elevate abdominal aortic aneurysm awareness to the national media’s agenda — we’ve been featured on Larry King Live’s Blog, Good Morning America Health and U.S. News & World Report. In addition, in September 2010 we announced a national retail partnership with Kmart Pharmacy to offer free screening, risk assessment and education to customers across the U.S. We’re hoping that the term “Triple A” will eventually become mainstream and associated with this devastating vascular condition versus just an automobile association.

There are so many disease awareness campaigns — what was the need to create one for AAA?

Good question. The statistics really say it all. It is estimated that more than one million people are living with an undiagnosed AAA.¹ While 95% of AAAs can be managed and treated if found early, only 10–25% of patients will survive if the aneurysm ruptures² making AAA the third leading cause of sudden death in men over the age of 60.³ The Find the AAAnswers campaign was launched to help reduce the number of unnecessary deaths each year caused by this silent killer through public education and awareness among at-risk individuals, their loved ones, and physicians who are in a position to refer their at-risk patients for screenings.

What role can or do vascular clinicians play in improving outcomes for patients with AAAs?

AAAs are a potentially lethal disease process. However, if diagnosed early and treated appropriately by board-certified vascular surgeons, mortality can be 4,5 AAAs are a marker for patients with atherosclerotic heart and vascular disease, so not only will patients benefit from early diagnosis and treatment, but also by getting them involved in heart-healthy activities, being seen by their cardiologist and family practitioner and having their cholesterol and blood pressure controlled, their long-term outcome post operation is much improved. Also, once diagnosed with even a small aneurysm, it is important that these patients get followed carefully by serial ultrasounds in the hands of specially trained and certified ultrasound technologists in order to make sure the size does not increase, and once it gets to a certain diameter, the patient can be referred to a board-certified vascular surgeon for appropriate therapy. Thus, we can improve the overall health of patients with vascular disease and AAAs as well as the outcome of patients who undergo intervention for AAAs.

How can AAA screening guidelines be improved to promote better outcomes for patients?

It has been well recognized that elective repair of AAAs by endovascular means has a mortality of 4,5 This is significantly better than those patients who are not diagnosed early and are only diagnosed at the time of rupture. Mortality for those patients can exceed 90% and would be at best 50% if they reach the hospital.^6–9 Thus, the sooner we can diagnose AAAs and the more closely we can follow these patients, the better the short- and long-term outcomes will be. Patients with a history of cardiovascular risk factors such as smoking, hypertension, hyperlipidemia, and most importantly, those patients with a familial history of AAA disease should be screened. Currently, only men over the age of 65 are subject to screening during their “Welcome to Medicare” physical, and this should be expanded to include women and those with a familial history of AAA disease, as well as patients with significant cardiovascular risk factors.

How can clinicians get involved in the Find The AAAnswers campaign?

The campaign’s website (www.findtheaaanswers.org) has a lot of great resources that healthcare professionals can use to help educate their at-risk patients and referrers about the importance of AAA education.

• Free Customizable Resources: clinicians can order free AAA practice resources that are available for customization and printing from the website. These resources are great for in-office patient literature, recruitment and signage for screening events and referring physician communications (www.FindtheAAAnswers.org/patienteducation). • DoctorFinder directory: clinicians can list their practice on the website, indicating they treat/screen for AAA: www.FindtheAAAnswers.org/doctorfinder.

Outside of surgery, what other interests do you have?

Being a vascular surgeon is an all-consuming process; however, I am fortunate to work in a group of very supportive fellow vascular surgeons who allow me to enjoy my family. I grew up skiing, playing tennis and sailing in the Northeast. It’s a pleasure to be able to do this with my wife and three children and to watch them grow up has been an experience as rewarding as doing surgery.

References

1. Society for Vascular Surgery. Protect yourself from an AAA rupture. https://www.vascularweb.org/practiceresources/Documents/BrandingPDFs/newsletter_story_aaa.doc. Accessed August 3, 2009.

2. Earnst CB. Abdominal aortic aneurysm. N Engl J Med 1993;328:1167–1172.

3. Ohki T, Veith FJ. Endovascular repair of ruptured AAAs in treating AAAs, endovascular repair may hold the key over open repair to lowering mortality. Endovascular Today 2004;47–51.

4. Matsumura JS, Brewster DC, Makaroun MS, Naftel DC. A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg 2003;37:262–271.

5. Lifeline Registry of EVAR Publications Committee. Lifeline registry of endovascular aneurysm repair: Long-term primary outcome measures. J Vasc Surg 2002;36:297–304.

6. Brown MJ, Sutton AJ, Bell PR, Sayers RD. A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 2002;89:714–730.

7. Mureebe L, Egorova N, Giacovelli JK, et al. National trends in the repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2008;48:1101–1107.

8. Johansen K, Kohler TR, Nicholls SC, et al. Ruptured abdominal aortic aneurysm: The Harborview experience. J Vasc Surg 1991;13:240–245. Discussion 245–247.

9. Bengtsson H, Bergqvist D. Ruptured abdominal aortic aneurysm: A population-based study. J Vasc Surg 1993;18:74–80.

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VASCULAR DISEASE MANAGEMENT 2011;8(2):E51–E52

R. Clement Darling III, MD serves as the Find the AAAnswers Coalition Representative on behalf of the Society for Vascular Surgery (SVS). He also currently serves as the Director of The Institute for Vascular Health and Disease; the Chief Division of Vascular Surgery and Attending Surgeon at Albany Medical Center Hospital; Professor of Surgery at Albany Medical College. Dr. Darling specializes in vascular surgery and has conducted extensive research within this area throughout his career. Email: darlingc@albanyvascular.com