What is an aneurysm and how does it relate to my health?

An aneurysm is an enlargement or “bulge” that develops in a weakened area within an artery. Depending upon the artery involved, it can rupture leading to catastrophic hemorrhage and death. The major risk for aneurismal rupture is related to its size and progressively increases with aneurysm diameter. Alternatively, occlusion of the aneurysm or dislodgement of particulate material from within it may occur, resulting in impairment in blood flow to the organ supplied by the involved artery. For these reasons, surgical repair may be indicated whether based exclusively on size or possible symptoms. Complication rates as well as mortality significantly increase if the operation is done emergently rather than on an elective basis. Therefore, a timely diagnosis is a necessity. Aneurysms are most commonly due to degeneration of the arterial wall and are frequently associated with cholesterol plaque. The two most important affected areas are the thoracic and abdominal aorta.

What are the risk factors for aortic aneurysm?

The major risk factors include age, male gender, family history of aortic aneurysm, high blood pressure, elevated cholesterol, and tobacco use. Other causes include connective tissue abnormalities such as Marfan’s syndrome and bicuspid aortic valve as well as trauma and bacterial infection of the aorta.

What are the risk factors for aortic aneurysm?

Most people feel no symptoms as most thoracic aortic aneurysms and abdominal aortic aneurysms (AAA) are detected when tests are conducted for other unrelated reasons. Those with symptoms describe them as a pulsating feeling in their chest or abdomen, or severe, unexplained pain in their back or abdomen that may be a foreboding of rupture or dissection (tearing of the aorta).

Who should be screened?

It is recommended that all men between the age of 65 and 75 with a smoking history should undergo a screening abdominal ultrasound for AAA. Other indications include men or women with 1st degree relatives that have been diagnosed with an aortic aneurysm. Medicare recognizes the importance of good vascular health and offers a free screening process to check for AAA. This screening process is expected to save thousands of lives.

What is the treatment?

Once you have been diagnosed with aortic aneurysmal dilation, the size of the enlargement and if symptoms are present will affect how you will be treated. If a thoracic aneurysm is found in the ascending aorta (the first portion of the vessel coming off from the heart), it can followed medically until it is 5.5cm, after which surgical repair is recommended. This cutoff is reduced to ³5.0cm if you have a bicuspid aortic valve or Marfan’s syndrome. For an AAA, 5.5cm is used as the surgical cutoff. These standard cutoff values are used as the rupture risk starts to significantly increase once these values are reached. Medical management focuses on blood pressure control, as even mild elevations can accelerate the growth of the aneurysm. These patients must be followed regularly both in the office and by follow-up imaging studies which may include ultrasound, CT scanning, and MRI/MRA. For ascending aortic aneurysms, surgical repair utilizes a gortex graft to replace the thinned and damaged aortic wall. Repair of AAA generally offer greater options including endovascular means (EVAR) using stent grafts or the traditional open surgical repair.