Contributor: Sean Lyden, MD
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Abdominal aortic aneurysms can be deadly. But if they are caught early, they can be eliminated and the risk of death can be completely eliminated. The key is to get routine ultrasound screening as appropriate based on your age and risk.
What is an aneurysm?
An abdominal aortic aneurysm is when the lower part of the aorta that extends through the abdominal area becomes enlarged. The aorta is the main blood vessel that carries blood from the heart to the rest of the body.
Like most arteries, the aorta is elastic, which allows it to be filled with blood under high pressure. An aneurysm develops when the wall of the artery becomes weakened and distended like a balloon or a bubble in a garden hose.
Aneurysms usually are discovered before they produce symptoms, such as back pain. But like the weakened garden hose, they may rupture if they become too large.
Since a ruptured aneurysm is extremely dangerous and can cause life-threatening bleeding, they are best corrected by surgery before this happens.
Who is at risk?
The critical issue here is identifying the people who are at significant risk of developing an aneurysm.
An abdominal aortic aneurysm is over seven times more likely to develop in a smoker than a nonsmoker, with the duration of smoking — rather than total number of cigarettes smoked — being the key variable.
We also know that people who have a family history of aneurysm have an increased risk beyond the age of 65.
We recommend one-time ultrasound screening for abdominal aortic aneurysm for all men at or older than age 65, or as early as age 55 for those with a family history of the condition. Women at or older than age 65 who have smoked or have a family history of abdominal aortic aneurysm also should undergo ultrasound screening.
If an aneurysm is identified, the patient should be followed regularly until the aneurysm reaches a point at which it potentially increases the risk of rupture and should be repaired.
We recommend follow-up imaging at 12-month intervals for patients with an abdominal aortic aneurysm of 3.5 cm to 4.4 cm in diameter and at six-month intervals for patients with an abdominal aortic aneurysm diameter between 4.5 cm and 5.4 cm.
If you have questions about this screening, don’t hesitate to talk to your doctor. He or she can recommend appropriate screening based on your medical history and risk.
How to reduce your risk
There are several ways you can reduce your risk of abdominal aortic aneurysm.
For example, if you smoke, you should quit. Also, if you have high blood pressure, high blood cholesterol levels or diabetes, ask your physician how you can manage these conditions.
Cholesterol-lowering medicines called statins should be advised also can be of help. You can derive the most benefit from controlling your blood pressure through a class of medicines called angiotensin-converting enzyme (ACE) inhibitors.
When should it be fixed?
Repair of an aneurysm should be considered when the aneurysm diameter is 5.5 cm or greater in men and 5.0 cm or greater in women.
When you experience symptoms due to the aneurysm or rapid growth of more than 5mm in six months, you also should seek input from a vascular surgeon.