An aneurysm is a bulging or ballooning of an artery that is greater than 1½ times the diameter of that artery.
The most common aneurysm, the abdominal aortic aneurysm, would be found in the aorta, which is located below the kidney arteries. The aorta is the main blood vessel in the body. It carries blood from the heart, all the way to the organs in the stomach, down to the legs.
If the abdominal aortic aneurysm were to rupture, it could potentially cause significant bleeding, possibly even leading to death.
To prevent rupture, aneurysms are repaired when they reach a certain size. For a female, that size is five centimeters; for a male, it’s 5.5 centimeters. Data has shown that females have a higher risk of rupture at a slightly smaller diameter, and males have a risk of rupture at a slightly bigger diameter.
Currently, aneurysms cannot be prevented. There is a great deal of promising research into why aneurysms form in the first place. Studies are being conducted to see if certain risk factor modifications will help or if there are medications that can be taken.
The biggest risk factors for an aneurysm are smoking and a family history. If your mother or father or brother or sister, a first-line relative, had an aneurysm, you are at a higher risk of having one.
The easiest way to find an aneurysm is through a physical exam. Any patient I see for any reason in the office, I perform an abdominal exam, feeling for the presence of what we call a palpable pulsatile mass. I am feeling for a prominent pulse in the abdominal aorta. If there is one present, then I would recommend an ultrasound for that patient. This is to see if my physical exam findings actually uncovered an aneurysm.
One of the more common ways to find an aneurysm would be incidentally. A patient with symptoms of back pain or abdominal pain would undergo an MRI scan or a CT scan, and that is when the aneurysm is discovered. The patient would then be referred to a vascular surgeon for further evaluation and treatment.
If a patient is diagnosed with an aneurysm, we recommend that their relatives be screened for an aneurysm as well. For a familial screening, we recommend an abdominal duplex ultrasound. It’s an ultrasound of the abdomen, looking at the aorta to identify if there is an aneurysm present.
For smokers who are 65 years old or older, there is a Medicare-funded screening. It is a one-time screening for an abdominal ultrasound to help identify if there is an aneurysm present.
The first step in treatment is to check the size of the aneurysm. If it’s below the size threshold for repair, we will establish a surveillance program in which the patient sees one of our four vascular surgeons at regularly scheduled intervals and receives regular testing, usually ultrasound. If the aneurysm meets the size threshold for repair, then there is a discussion regarding the repair options.
When it comes to aneurysm repair, there is the classic option that has been around since the beginning of vascular surgery, which is an open aortic aneurysm repair. This requires an abdominal incision and the sewing in of a graft of appropriate size to replace the aortic aneurysm.
Beginning in the late 1990s, early 2000s, the endovascular method was introduced. With this treatment option, we go inside the arteries to place a stent graft, a tube designed to keep the passageway open to allow normal flow of blood. We deploy the stent graft inside the aorta and the aneurysm so the blood flows through the graft, and it no longer flows into the aneurysm, keeping it from growing. This is a less-risky, minimally invasive way of treating an aneurysm. Today, it is still our first line preferred treatment for most patients.
The endovascular approach has revolutionized the way we treat aneurysms. Previously, repair required a large abdominal incision, and patients were in the hospital for a prolonged period. Now with the endovascular technique, patients go home many times the next day, and their recovery period is much quicker.
The biggest take-home message is that aneurysm risk is greatly increased by smoking, and patients who are smokers need to be informed of that risk.
Controlling blood pressure, cholesterol levels and blood sugars in patients with diabetes are all important risk factor modifications when it comes to heart disease, vascular disease and stroke, but they haven’t necessarily been proven to slow the rate of growth of an aneurysm.
Smoking, though, has been shown to affect aneurysms. Cutting out tobacco use is probably the greatest risk factor modification someone can take in reducing the risk for aneurysms.