What are aortic aneurysms and why are they important?
The aorta is our largest artery, carrying blood from the heart through the chest into the abdomen. It has several branches in the chest supplying blood to the head and upper extremities. After entering the abdomen, it supplies blood to the liver, kidneys and the intestines. The aorta ends at the level of the belly button where it divides into two arteries that go down to the lower extremities supplying blood to the pelvis and buttocks on its way. The aorta decreases in size as it gives off its branches and in the abdomen it should not be wider than 2.5 cm. or one inch. Occasionally, the aorta enlarges and when it becomes wider than 3.75 cm. it is said to be aneurysmal. Generally, aneurysms slowly increase in size over years and just like a balloon which breaks when it gets too large, aortic aneurysms break when they become too large. When an aneurysm ruptures, you bleed into your abdomen and are at great risk for dying. Consequently, it is important to repair aneurysms before they break. The risk of aneurysm rupture increases as the size of the aneurysm increases. Because every medical procedure entails risk, we generally recommend repair when the risk of your death from the aortic aneurysm equals the risk of repair. That is why we usually watch small aneurysms and recommend repair when they become large, generally around 5.5 cm. in diameter.
What causes aortic aneurysms?
Although there are many causes, arteriosclerosis is the most common cause of abdominal aortic aneurysms. They are usually found in patients over the age of 50. Arteriosclerosis narrows some arteries such as your heart arteries, causing heart attacks, and weakens others such as the aorta, causing aneurysms. As the wall of the aorta weakens, the pressure of the contained blood causes the weakened artery to enlarge resulting in the aneurysm. When the pressure of the blood flowing in the aorta exceeds the remaining strength of the aorta, the aneurysm ruptures. This is a catastrophic situation. Consequently, we recommend aneurysm repair when its risk of causing your death is greater than the risk of repair.
How can I determine if I have an aortic aneurysm?
Unfortunately, it is often difficult to detect abdominal aortic aneurysms by examining the abdomen. In addition, non-ruptured aneurysms seldom cause symptoms such as pain. However, when they rupture, patients usually have pain and sometimes faint. Because they are usually difficult to detect on physical examination until they become large, aneurysms are nowadays most commonly detected by ultrasound or CT scans done for unrelated reasons. If there is a habit of smoking in your life or if you have a family member with an aneurysm, a screening abdominal ultrasound can be indicated to determine whether your aorta is larger than it should be. Nowadays, abdominal aortic aneurysms are most commonly found in males, in people with a history of smoking and in those who have a family member who has been found to have one. It should be reassuring to know that aortic aneurysms are infrequently found in the general population without these risk factors.
What tests are used to monitor the size of aortic aneurysms?
Because of the girth of many abdomens, abdominal aortic aneurysms may be difficult to detect and monitor. An ultrasound is the least expensive and safest exam to detect and monitor the size of abdominal aortic aneurysms. If more information is needed, or if a stent graft repair (see below) is contemplated, a CT scan will be done to obtain the additional information. Currently, great efforts are being taken to minimize the dose of radiation during these tests.
If I have an aortic aneurysm, should I alter my lifestyle?
The progressive nature of arteriosclerosis, the leading cause of aneurysms, is accelerated by smoking. Consequently, the most important advice we can give you is to STOP SMOKING. Eating less fat and reducing your cholesterol are helpful but are not as beneficial AS GIVING UP YOUR SMOKING HABIT. Diabetes does not cause abdominal aortic aneurysms. Unfortunately, your physicians cannot change your inherited genes which may predispose you to an aortic aneurysm, but we can reduce the risk of aneurysm rupture by detecting, monitoring and repairing it before it ruptures. No physical activity affects the rate of aneurysmal growth.
If my aortic aneurysm needs treatment, how is it repaired?
Hopefully, you will never develop an aortic aneurysm but if you do, we hope it remains small and never needs repair, but if it should need repair, there are two common ways. The traditional repair, which is very durable, requires an abdominal operation to splice in a strong fabric tube replacing the enlarged segment of aorta. After this operation, patients usually remain in the hospital for five to seven days and recovery often takes several weeks. Alternatively, if the CT scan indicates that the aneurysm is repairable with a stent graft a sleeve can be inserted into the weakened area of the aorta from the groins. It is similar to building a ship inside a bottle. The hospital stay is often as little as one day and your recovery is shorter. However, not everyone is a candidate for a stent graft and they are not as durable as the traditional procedure. When stent grafts are used, periodic CT scans or ultrasounds are required to monitor the repair for the rest of your lives and sometimes, additional procedures will be required to maintain the success of the stent graft repair.
This is general information and we encourage a full and thorough discussion with you and your family about your aneurysm.