George C. Scott … Died From Aortic Aneurysm
The actor George C. Scott, celebrated for his performance in the title role of the movie "Patton" and many other roles on the screen and stage, died on September 22, 1999. One news source stated: "…George C. Scott died of a stomach hemorrhage….Scott had been warned by his doctor about the risk of rupturing a blood vessel in his stomach but delayed treatment."
Mr. Scott did not die of a bleeding stomach. He had a ruptured aortic aneurysm, according to the Associated Press who quoted Mr. Scott's "publicist and friend Jim Mahoney." Mr. Mahoney said that the actor ‘had never been treated properly' for an aneurysm that he suffered in 1996."
Common in Older Men
This type of aneurysm involves the aorta, the great artery that carries blood from the heart to the rest of the body. The aorta bulges at the site of the aneurysm like a weak spot on an old worn tire. Although aortic aneurysms can develop anywhere along the length of the aorta, the majority are located along the abdominal portion of the aorta.
Most abdominal aneurysms are located below the level of the renal arteries, the vessels that leave the aorta to go to the kidneys and two-thirds of abdominal aneurysms are not limited to just the aorta but extend from the aorta into one or both of the iliac arteries.
Most aortic aneurysms are fusiform and are shaped like a spindle ("fusus" means spindle in Latin) with widening all around the circumference of the aorta. The inside walls of aneurysms are often lined with a laminated thrombus (a blood clot that is layered like a piece of plywood).
Abdominal aortic aneurysms are most common after the age of 60 and men are 5 times more likely to be affected than women -- Mr. Scott was 71. Abdominal aortic aneurysns are not rare; about 5% of men over age 60 develop one.
The main cause of aortic aneurysms is arteriosclerosis ("hardening of the arteries"). At least 80% of aortic aneurysms are arteriosclerotic. The arteriosclerosis can weaken the aortic wall and the pressure of the blood being pumped through the aorta causes expansion at the site of weakness.
Lower Back Pain a Symptom
Abdominal aortic aneurysms may cause pain that typically has a deep quality as if it were boring into the person. It is felt most prominently in the lower back region. The pain is usually steady but may be relieved by changing position. However, many aneurysms are without symptoms. They may become large and even rupture without warning.
Careful feeling (palpation) of the abdomen by the doctor may reveal the abnormally wide pulsation of the abdominal aorta. Aneurysms that are rapidly enlarging and on the verge of rupture are often tender. Ultrasonography usually gives a clear picture of the extent and size of an aneurysm. Ultrasound has about 98% accuracy in measuring the size of the aneurysm.
The natural history of abdominal aortic aneurysms depends on their size. Rupture of aneurysms is uncommon when they are less than 5 cm wide. Rupture is far more common in aneurysms that are over 6 cm wide.
Surgical repair is therefore usually recommended for all aneurysms over 6 cm wide. Elective repair is also generally recommended for aneurysms between 4 and 6 cm in patients who are good surgical risks.
Rupture a Feared Complication
Rupture is a dreaded complication of an abdominal aortic aneurysm. Half of all persons with untreated abdominal aortic aneurysms die of rupture within 5 years. Abdominal aortic aneurysms are the 13th leading cause of death in the U.S. Rupture of an abdominal aneurysm is a catastrophe. It is highly lethal and is usually preceded by excruciating pain in the lower abdomen and back, with tenderness of the aneurysm. Rupture of an abdominal aneurysm causes profuse bleeding and leads to shock. Death may rapidly follow.
Peripheral embolization of clot within the aneurysm can occur when a piece of clot comes loose and travels further out in the arterial system. This clot fragment can lodge in a smaller artery and block the flow of blood. Infection of aneurysms can occur due to turbulent blood flow from the rough inner surface. Spontaneous occlusion (closure) of the aorta can also occur.
Treatment for Abdominal Aortic Aneurysm
Traditionally, repair of an aortic aneurysms has been done surgically. The surgery has usually involved opening the abdomen, removing (excising) the aneurysm, and sewing a synthetic (Dacron) tube in its place. More recently, "minimally invasive" procedures have been devised using stent grafts that can be guided to the site of the aneurysm without the need to cut open the abdomen. According to a U.S. national multi-center study, the "minimally invasive" installation of the stent graft carries a lower rate of complications and permits people to get back on their feet faster than traditional open surgery.
Threatened rupture of abdominal aneurysms is a surgical emergency. The operative risk for a ruptured aneurysm is about 50%. If kidney failure occurs after surgery, the prognosis (outlook) is particularly poor.
To prevent an aortic aneurysm from rupturing, it must of course be detected with time to spare. Then it must be meticulously monitored. If the aneurysm stays small, only monitoring is needed. If it enlarges to a worrisome diameter, surgery should be done. To procrastinate and face emergency surgery or rupture is not an appealing prospect.
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Last Editorial Review: 4/1/2002