COMMENTARY

Dr. Underberg and Joe Theismann Discussing Aortic Aneurysm Screening

Tackling AAA

A bone-crunching tackle prematurely ended the football career of former Washington Redskins quarterback Joe Theismann in November of 1985 in a memorable game with the New York Giants. Voted the most shocking moment in NFL history, it was one that he, and many sports fans, will never forget. But although he moved on to become a successful sports commentator and recently made a cameo appearance in the new sports blockbuster movie, The Blind Side, Joe recalls another moment in his life that was just as shocking.

It was five years ago when his 89-year-old father, Joseph John Theismann, told him he’d been diagnosed with an aneurysm, a bubble that forms in the artery that carries blood to and from the heart. “My dad told me he was ‘fine,’ not to worry,” Joe, a native of South River, N.J., recalls, “so I went along with it. I should’ve known better.”

Twenty-seven years before the aneurysm was diagnosed, Joe’s dad also had open-heart surgery. And since then he’s had multiple stents implanted to open clogged arteries caused by atherosclerosis. “He was fine then, too,” says Joe. “My father is that breed of human that says he’s fine no matter what’s going on.”

An eye-opening coincidence

At that time, the high-profile sports commentator and analyst also got a call from a group looking for a spokesperson to help get the word out about a little-known condition—abdominal aortic aneurysm (AAA). The group, Find the AAAnswers (FindtheAAAnswers.org), wondered whether Joe knew anyone with the condition.

“I told them my dad had just been diagnosed with an aneurysm, but I didn’t know if it was triple A,” he says. So he asked his father for the specific diagnosis—it was AAA. Joe began learning about AAA, and realized how lucky his dad was to be alive. He became the group’s spokesperson, and began urgently educating others about the condition through speeches, radio and television interviews, and other media appearances.

Why the urgency? According to Find the AAAnswers, about a million people in the U.S. are walking around with the condition right now—and don’t know it. “My dad was one of those people,” Joe states. People with AAA often don’t experience any noticeable symptoms, making the condition a silent killer and the third-largest cause of death in men over 60 years of age. “If an aneurysm goes undetected, it can burst,” Joe explains, “and you’ve got only a 10% chance of surviving.”

Orange alert

To make people more aware of AAA, Joe often wears orange suspenders at TV and public appearances. “They’re a visual aid—they cover the areas of the abdomen where these aneurysms occur,” he explains. Raising awareness is key to preventing sudden deaths caused by ruptures. If AAA is detected early, doctors can prevent the bubble from bursting, typically by implanting stents that not only unclog arteries, but also provide extra strength to weakened artery walls.

Detection is accomplished through an ultrasound, a painless procedure that takes about 10 minutes and lets the doctor see what is going on in blood vessels. It can be done during a physical and men over the age of 60 should have it done annually.

Most men are happy to find out that the ultrasound doesn’t require special scheduling or preparation. “After all, at one time, if I had a choice between going to a doctor’s appointment and playing a round of golf in the rain,” Joe jokes, “I’d buy a wetsuit.”

Now, however, he makes it a point to get an ultrasound at annual checkups. The fit 62-year-old’s family history of heart disease puts him at higher risk for AAA. Both his father and mother have atherosclerosis. And heart disease of any kind is a major risk factor.

But risky behaviors, like smoking, can also cause AAA (see “What Puts Me at Risk for AAA?”). “Smoking,” Joe stresses, “is a big risk factor. My dad quit smoking almost 40 years ago, but it likely contributed to his condition.”

Living in Virginia with his third wife, Robin, Joe says he feels blessed. “My dad and mom are still with me in this world,” he says. “That makes me a very lucky man.”

When it comes to AAA, though, luck doesn’t apply. “You have to take responsibility and make sure you get tested,” Joe concludes. “If you don’t, you won’t really know if you have triple A.” And early detection ups your odds of survival to 95%, Joe notes. “Those are really good odds.”

How Is AAA Treated?

The sooner AAA is detected, the better. Early detection determines your best course of treatment, according to James A. Underberg, MD, clinical assistant professor of medicine in the division of general internal medicine at New York University Medical School. Dr. Underberg specializes in preventive cardiovascular medicine.

“Treatment for AAA depends on the size of the aneurysm [a bubble in the aortic artery]. If it’s small—between one to two inches—doctors watch it closely,” explains Dr. Underberg. “We also recommend quitting smoking immediately, keeping blood pressure under control, lowering cholesterol if it’s too high, and losing weight if you’re too heavy.” All of this helps to slow aneurysm growth. In some cases, doctors also prescribe medication to reduce the blood pressure on the aneurysm.

When an aneurysm is larger than two inches, surgery is needed to remove it. Often, surgeons perform endoscopic vascular repair, which does not require a large abdominal incision. Instead, a stent (a tube made of metal mesh) is inserted via catheters through the groin and into the artery. The stent is secured in the abdominal aorta to support the weakened area of the artery.

A second option is open surgical repair. Surgeons create an incision and replace a section of the aorta with a tube. Recovery from both procedures is fairly rapid, according to Dr. Underberg, and the likelihood of AAA recurrence is extremely low.

—Kathy Gilligan

Heart Care Health Monitor

Winter 2010