A bulge in the belly can be a silent killer: But can be treated if found before it’s too late

Abdominal Aortic Aneurysm

Andrew DeLuca woke up with back pain a day after moving an air conditioner unit. Within hours he was close to death. The 82-year-old from Tinley Park didn’t realize he had a ruptured abdominal aortic aneurysm (AAA), a condition with a survival rate of only 15%. His family rushed him to Northwestern Medicine Palos Hospital, where a surgical team was prepared for this complex emergency.

The abdominal aorta, which is about the size of a garden hose, carries blood away from the heart to lower parts of the body. The vessel can weaken and bulge, and if left untreated, the aneurysm can burst.

According to the American Heart Association’s 2023 statistics, there were 150,000 global deaths attributable to aortic aneurysms in 2020, a 26% increase from 2010.

“Blood was pouring from Mr. DeLuca’s aorta into the free space inside the belly. He was dying in front of us,” said Gabriel Wallace, MD, board certified vascular surgeon and director of vascular surgery at Northwestern Medicine Bluhm Cardiovascular Institute at Palos Hospital. “He needed immediate surgery.”

Dr. Wallace had developed a streamlined protocol for this type of emergency. When an aortic rupture is diagnosed, Dr. Wallace sends a text to the operating room team, and they have all the necessary equipment for minimally invasive treatment already in a bag for quick deployment.

“Rapid treatment is the difference between life and death. 85% percent of people with an aortic rupture will die with 50% not even making it to the hospital,” said Dr. Wallace.

Without opening Mr. DeLuca’s chest, Dr. Wallace stopped the bleeding and repaired the aorta using a minimally invasive technique called endovascular aneurysm repair (EVAR). During the procedure, a small flexible tube called a catheter is inserted through a small incision in the groin up to the aorta using x-ray guidance. Often, the patient does not even require general anesthesia.

After an occlusion balloon in inserted to stop the bleeding from the inside, Dr. Wallace inserts a stent graft, a tube made of thin metal mesh covered with a thin polyester fabric. When the stent graft reaches the aorta, it is opened and fastened into place to reline and repair the aorta wall, stop the internal bleeding, and restore blood flow.

“It all came on so suddenly. We just thought it was back pain. We had no idea it was related to his heart,” said Carol DeLuca, Andrew’s wife. “Andrew is doing well and with daily exercise he has continued to improve his health and regain his quality of life. He is looking forward to golfing once the weather warms up.”

Men are more likely than women to have an abdominal aortic aneurysm. Risk factors include smoking, high blood pressure, family history and age. Men 55 to 75 years old who have ever smoked should get an ultrasound screening for abdominal aortic aneurysms.

"If we know about an aneurysm before it ruptures, we can often treat it and have the patient go home the next day,” said Dr. Wallace. “There are usually no symptoms until it may be too late, so that is why screening is so important.”

Northwestern Medicine recently developed an AAA self-referral program for patients who have seen a Northwestern Medicine primary care physician within 3 years. Patients who meet the screening criteria can self-schedule through their MyNM account. If patients are outside the criteria, they should discuss screening with their primary care physician. 

AAA screening criteria:

• Men >50 with 1st degree relative with AAA and personal smoking history
• Men >55 with 1st degree relative with AAA, non-smoker
• Men >65 with smoking history
• Women 65-75 with first degree relative with AAA or smoking history

Medicare Part B covers a one-time AAA ultrasound if you are at risk for AAA and receive a referral from your provider. Medicare considers you at risk for AAA if you have a family history of AAA or, you are a man aged 65-75 and have smoked 100 or more cigarettes in your lifetime.