Sean V. Ryan, MD, FACS
Vascular and Endovascular Surgery
Chester County Hospital; West Chester, PA
Published: December 9, 2013
Aneurysms occur due to a weakness in the wall of a blood vessel resulting in progressive dilation of that vessel. Depending on the location of the aneurysm, this typically occurs without symptoms. Unrecognized, the natural history of an aneurysm is slow expansion until rupture, after which death usually occurs. Aneurysms can occur with almost any blood vessel of the body, but our focus in this article is on the most common aneurysm - Abdominal Aortic Aneurysm (AAA).
The aorta is the main blood vessel of the body carrying blood from the heart to the organs and extremities of the body. Its normal caliber ranges in size from 2 cm to 2.5 cm or roughly the size of your thumb. Abdominal Aortic Aneurysms are defined as a dilation that is at least one-and-a-half times the normal diameter.
Risk factors for Abdominal Aortic Aneurysm include typical risk factors for artery-occluding atherosclerosis such as smoking, high blood pressure, elevated cholesterol or a family history of aneurysms. It's important to recognize that this overwhelmingly occurs after the age of 60 and is about four times more common in males. In about a quarter of patients diagnosed with an Abdominal Aortic Aneurysm, a parent or sibling is noted to have or had an Abdominal Aortic Aneurysm.
How do you know you have an Abdominal Aortic Aneurysm? The answer is that most of the time, you don't know since most are asymptomatic (without symptoms). Most are coincidentally discovered while getting a radiologic study for something else. Physical exams can sometimes find an Abdominal Aortic Aneurysm, but has been shown to be unreliable. The easiest way to diagnose an Abdominal Aortic Aneurysm is a simple ultrasound examination. If you have risk factors, a screening study is appropriate. If someone in your family has an Abdominal Aortic Aneurysm and you are over the age of 60, it's worthwhile to ask your doctor to order a screening study ultrasound exam.
Medicare will pay for a one-time screening, if the appropriate risk factors are present. If your insurance does not cover screening for Abdominal Aortic Aneurysm, consider paying the small out of pocket fee for a screening exam at a hospital or at a private company.
Symptoms are rare until rupture occurs. Rupture is heralded by severe back or belly pain. This is catastrophic and, as noted above, usually fatal. The time to treat an Abdominal Aortic Aneurysm is obviously before rupture occurs.
Finding an Abdominal Aortic Aneurysm before rupture is the key to successful treatment. Simple periodic monitoring will be recommended before the Abdominal Aortic Aneurysm is greater than 5 cm in diameter, and surgical repair above 5 cm.
Surgical treatment of Abdominal Aortic Aneurysms has changed dramatically in the last two decades. It has transitioned from major open abdominal surgery, which required a week or more in the hospital, to the current percutaneous (through the skin) delivery of a stent graft via an artery in the groin and typically requires only an overnight stay in the hospital.
If you are over 60 and have risk factors for an Abdominal Aortic Aneurysm, get checked today. This is truly a silent killer better found before rupture occurs. Modern vascular repair, in most cases, is straightforward and involves minimal risk and a fast recovery.
This article was published as part of the Daily Local News Medical Column series. It has been reprinted by permission of the Daily Local News.
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