6000 patients from 40 Veteran Affairs sites are going to be enrolled in a 12-year prostate cancer prevention study (called the SELECT trial). This is the first clinical trail designed to determine if dietary supplements (vitamin E and selenium) prevent prostate cancer.


Elan, a Dublin-based biopharmaceutical corporation, has developed an experimental vaccine to halt the progress of Alzheimer’s disease. The vaccine is called AN-1792. The first phase of clinical trails have been completed and the results warrant phase two testing. The goal of the vaccine is to trigger the body’s own immune response to the build up of amyloid accumulations that form the amyloid plaques in the brain. The question remains whether or not the vaccine is safe and will it halt the progression of the disease.


Biosite Corporation has developed a simple and quick blood test that measures B-type natriuretic peptide (BNP). BNP levels are related to the severity of signs and symptoms of CHF. See this link for an excellent overview of BNP and CHF http://www.biosite.com/products/bnp/.


What Causes AAA? | Symptoms | Diagnosis | Treatment | Underwriting Discussion

Abdominal Aortic Aneurysm (AAA)

An abdominal aortic aneurysm (AAA) involves the aorta, which is one of the largest arteries that carries blood from the heart to the rest of the body (see this link for an overview of the blood flow of the abdominal aorta http://www.harbor-ucla-radiology.org/VascularAnatomy/abdominalaorta.htm).

An AAA means that the aorta is "dilated" (widening or ballooning out) and at risk for rupture, hemorrhage and death. The dilatation must be permanent, localized and 1.5 times the normal diameter of the aorta to be called an AAA.

  • 5 to 7 percent of people over 60 in the U.S. have an AAA.
  • The male-female ratio over age 60 is 5:1
  • The incidence of AAA has increased three-fold over the past 40 years.
  • 75% of AAAs do not have symptoms (asymptomatic) and are detected during a routine exam or during some unrelated x-ray or surgical procedure.
  • AAA is the 13th leading cause of death in the U.S.
  • Approximately 15,000 people in the U.S. die each year of a rupture AAA.
  • 50% of individuals with a ruptured AAA do not survive long enough to receive medical attention.
  • Of those who make it to the hospital, 25-30% die of postoperative complications.

The most common cause is "hardening of the arteries" called arteriosclerosis. 80% of abdominal aortic aneurysms are from arteriosclerosis. Other causes include:

  • Family history of AAA
  • Male gender
  • Smoking
  • Vascular disease in the legs (i.e. claudication)
  • Increased age
  • Diabetes
  • High blood cholesterol
  • High blood pressure
  • Trauma to the aorta
  • Inflammation of blood vessels
  • End-stage syphilis
  • Fungal infections

Many abdominal aortic aneurysms are without symptoms. They can become enlarge and rupture without warning.

An AAA can also cause pain. This is generally described as a "deep pain" that is steady but may be relieved by changing positions.

The physical examination is one of the most important tools for diagnosing AAA with a reported accuracy of 30 to 90 percent. In addition to the physical examination, other studies can be used to diagnose an AAA. These include:

B-Mode Ultrasound
This is the screening test of choice. It is readily available, inexpensive and accurate (82 to 99%).

CT Scan
The most accurate test for determining size and location of AAA. It is readily available, expensive and requires an injected contrast medium.

CT Angiogram
This is a new medium that combines a CT scan with an angiogram. It eliminates the need for invasive angiography. It is expensive, requires specialized training and an injected contrast medium

MRI
New imaging modality for AAA. It is expensive but does not require an injected contrast medium.

Angiogram
This is the least useful imaging modality for diagnosing AAA. It is expensive, invasive, requires an injected contrast medium and has problems with accurately delineating the aneurysm.

The treatment of an AAA depends on the size of the aneurysm. Size has been correlated with the risk of rupture. Studies have found that a diameter of 6 cm or greater require surgical repair due to the high risk of rupture. Patients with smaller aneurysms can be followed medically using sequential imaging studies to measure the growth of the aneurysm and to determine the appropriate time for intervention. Patients with aneurysms of 3.5 cm or less can be followed on an annual basis. Patients with aneurysms greater than 3.5 should be seen every six months. Rapid enlargement (more than 0.5 cm in six months) warrants close surveillance or intervention.

Patients who undergo elective repair of an AAA have an average five-year survival of 61 percent. The surgical survival rate for aneurysms 6.0 cm and greater is much higher than for patients with the same size aneurysms who do not have surgery. Coronary artery disease is the leading cause of death following repair of an AAA.

A client with a history of an abdominal aortic aneurysm presents underwriting problems for the life insurance carrier. The high incidence of coronary artery disease combined with poor survival rates renders a large group of these applicants uninsurable for individual coverage. Those who are insurable need to demonstrate both successes in treating the AAA and the cause of their AAA.

1) When was the client diagnosed with an Abdominal Aortic Aneurysm (AAA)?

Underwriting Comment: The majority of Abdominal Aortic Aneurysms have no symptoms and are "discovered" during routine medical exams or serendipitously as a result of other diagnostic studies. Once a suspected AAA is found, the client will have the diagnosis confirmed with imaging studies (ultrasound or CT scan). It is important to know exactly when the AAA was diagnosed.

REMEMBER: Aneurysms are dilatation (expansion) of blood vessels. Abdominal aortic aneurysms represent a segment of the abdominal aorta (the part below the kidneys) with a diameter at least 50% greater than normal.

2) What kind of treatment did the client have for AAA? If the client underwent a surgical repair of their AAA, when was the operation done?

Underwriting Comment: Clients with AAAs can be medically managed (without surgical repair) based on the following guidelines:

  • The client is asymptomatic.
  • The AAA is less than 5cm or less than half the infra-renal aorta diameter (the aorta just below the kidneys).
  • The AAA is NOT growing more that 0.5cm per year.
  • There is NO evidence of complications from the AAA (blood clots).

These clients are followed closely with examinations that include ultrasound or CT scan studies.

Clients who fail to meet the above criteria will need to undergo surgical repair of their AAA.

REMEMBER: The "waiting period" for clients with a newly discovered AAA is generally six months to one year for individual coverage. The same applies to clients who undergo surgical repair of their AAA.

3) What are the current medications that the client is taking?

Underwriting Comment: Hypertension is a known risk factor for AAA. It is important to identify all of the medications the client is currently being prescribed.

4) Have all of the follow-up visits and studies been normal?

Underwriting Comment: Clients with AAA, with or without surgical repair, will have ongoing surveillance of the dilatation site. It is important to document that the client is compliant with follow-up visits and, to the best of their knowledge, the client believes all of the follow-up studies have been normal (no evidence of enlargement or return of the AAA).

Featured Topic in September 2001 Newsletter:

Claudication

© Copyright 2001, RiskTutor Inc.