Doctors encourage screening for aortic aneurysms

U.S. envoy Richard Holbrooke most likely was unaware that his aorta had ballooned into an aneurysm, according to doctors not involved in his care.Holbrooke, 69, died Monday night after surgeons tried to repair a dissection, or tear, in his aorta, the main artery that carries oxygenated blood from the heart to the rest of the body.

About 3,000 Americans die each year from an aortic dissection, although the actual number probably is higher. If an autopsy isn't done after someone dies suddenly, "it takes away the opportunity to put pieces of the puzzle together," says Cam Patterson, chairman of cardiology at the University of North Carolina-Chapel Hill.

Aortic aneurysms don't cause symptoms, but screening with ultrasound and sometimes CT or MRI scans can detect them before they tear, when they can be easily surgically repaired.

Because the risk of an aortic dissection increases with age, Patterson says, he recommends that all of his patients 65 and older be screened. However, he says, Medicare covers the screening only for men, in whom dissections occur at a younger age, and then only if it's performed at their first Medicare visit.

"This isn't something that will change in months or even years," Patterson says of aortic aneurysms. "This is something that takes decades to develop." Holbrooke's death "emphasizes to me that patients should look physicians in the eye and say, 'Is this something I need to worry about?' "

Though high blood pressure and smoking raise the risk of an aortic aneurysm, genes appear to play a role in a significant number of cases. Up to one in five people who suffer a dissection have a family history of the disease, says Dianna Milewicz, professor and director of genetics at the University of Texas Health Science Center at Houston.

Milewicz's team has identified five genes that explain about 20% of cases of aortic aneurysms that run in families and is looking for more. Members of more than 600 families, all of whom are related to someone who had an aortic aneurysm, have enrolled in a genetics study conducted by the John Ritter Research Program at the Houston health science center.

Milewicz directs the program named for the actor who died of an aortic dissection in 2003.

Anyone who has had a parent, brother or child die of an aortic dissection, such as Holbrooke's children, should be screened every couple of years for their entire life, she says.

The risk of dissection is "very low" in young children, Milewicz says, but, because the age at which it can occur can vary widely in families, screening should begin when children are old enough to cooperate.

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