Medicare to start reimbursement for aortic aneurysm screenings
Pittsburgh Business Times - by Kris B. Mamula
Testing for a deadly problem that mostly affects men is getting a new focus with Medicare's decision to pay for screening starting this year.
Medicare recipients are now entitled to a one-time ultrasound test for abdominal aortic aneurysms. The test is recommended for people who have smoked or have a family history of the problem. The aorta is a large blood vessel that can weaken, balloon without warning and burst, sometimes causing sudden death.
"People might not realize they have them," said Dr. Michael Makaroun, vascular surgery chief at the University of Pittsburgh Medical Center.
If the aneurysm goes undetected and untreated and the aorta bursts, patients can die quickly from internal bleeding.
"Only half of the people who get to the hospital make it," said Dr. Satish Muluk, Allegheny General Hospital vascular surgery division director. "A lot of people never make it to the hospital."
Paul Lapcevic was one of the lucky ones.
He was watching TV in bed one night three years ago, when he put the remote control on his belly. To his surprise, the retired 78-year-old high school teacher watched the control bump up and down with the beating of his heart.
"I'd always been thin," he said, "but I didn't remember that happening before."
He'd inadvertently placed the device atop an undiagnosed aneurysm.
"I'm almost positive I have an abdominal aneurysm," he told the nurse at his doctor's office. Lapcevic's aorta had bulged to 6.8 centimeters, about triple the normal size.
His family doctor referred him to Allegheny General Hospital on the North Side where surgeon Daniel Benkart repaired the problem using a minimally invasive technique where a synthetic fabric tube is snaked to the affected artery from a small incision in the groin.
This procedure has become the preferred method of treatment since 1995, Makaroun said.
"It turned out really, really well," said Lapcevic, who attributed the surgery's success to a lifelong passion for staying fit.
Eight out of 10 people with abdominal aneurysms are men, although the risk of rupture is higher for the same size aneurysm in women when compared to men, according to Muluk.
No intervention is necessary until an abdominal aorta roughly doubles in size, said Makaroun, adding that Medicare's decision to reimburse for one screening test, "is clearly not adequate, but it's a first step."
The conventional treatment for aneurysm repair is open surgery, where an incision is made in the belly, and the affected artery is clamped above and below the weak spot, which allows the surgeon to sew the fabric tube into place.
Big differences in recovery time distinguish the two approaches. The minimally invasive method allows the patient to go home the next day and back to work in a week, Makaroun said.
Open surgical repair means a five- to seven-day hospital stay and six weeks of recovery.
The less invasive procedure is also safer: open surgical repair has a mortality rate of less than 5 percent, compared to 1 percent to 2 percent for the simpler procedure.
The downside is that the less invasive approach requires follow-up monitoring, Muluk said, because in 10 percent to 12 percent of patients, the synthetic tubes will slip out of place or leak.
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