Aortic Aneurysm
Are You at Risk?

Larry Horesh, M.D.

An aortic aneurysm is a weakened and bulging area of the main blood vessel carrying blood from the heart to the lower body (aorta).  If the aorta ruptures, it causes internal bleeding with a less than one in five chance of survival.  Aortic aneurysms are associated with more than 15,000 deaths per year in the United States.   These aneurysms occur because of weakening in the elastic components of the artery, a phenomenon which is seen in all arteries, but primarily in the aorta in the abdomen.  In a large study of aneurysms, The Veterans Association of America found that four percent of men and one percent of women over the age of 50 had aneurysms. 

    Although the exact cause of aneurysms is not known, there are a number of factors which are strongly associated with their development. The highest risks are for men (four times more likely to have an aneurysm), current or previous smokers (three times more likely to have an aneurysm), and people with a family history of aneurysm (siblings of aneurysm patients have a one in five chance of having an aneurysm).
    The risk of aneurysm rupture increases sharply as the aneurysm grows beyond five centimeters (around two inches).  Some aneurysms that grow rapidly may cause back or abdominal pain and may also need to be repaired.
    When an aortic aneurysm enlarges, there may be a pulsating sensation near the navel or tenderness or pain in the abdomen or chest but typically aortic aneurysms do not have symptoms. Because of the asymptomatic nature of this problem, screening of patients who are at risk of having an aneurysm is advised. Large screening studies have shown a 40 percent reduction in death by detecting and repairing aneurysms before they rupture.  If you are at risk for aneurysms, you should consider regular screening for the condition.
    There is no medical therapy for aneurysms so, once an aneurysm is detected, it is recommended that a vascular specialist track the growth of the aneurysm and help decide when it is appropriate to repair it (typically at five to five and one half centimeters).



    There are two methods for repairing aneurysms – conventional open surgery and minimally invasive surgery with an aortic stent graft.  
     Conventional open surgery (opening the abdomen and removing the aneurysm) is a proven technique but does carry higher risks and longer recovery times.   This type of surgery is recommended for a patient who cannot be fitted with the available stent grafts or who is young and has no history of heart or lung disease (typically 50-65 years of age). Open surgery requires general anesthesia with a large incision in the abdomen or left flank along with a five to seven day hospital stay.  Recuperation usually takes months before people are back to normal activity.  
    A stent graft is part of endovascular therapy - minimally invasive therapy provided by treating the problem from within a vein or artery.  A stent graft is a metal cage wrapped in a special fabric that is placed, while in a closed position, through small incisions in the groin. The stent is threaded into the aorta and is then opened on the inside to effectively strengthen the wall of the artery where the aneurism has occurred. This minimally invasive operation can be performed with local or general anesthesia.  Current studies show that stent graft repair has one fourth the risk of death than that of conventional surgery (for typical risk patients). Also, recovery time is much faster.  Stent graft repair, however, must be followed by X-rays for life because of a minor risk of the aneurysm coming back.  This situation may be dealt with by either repeat stent graft or open surgery.

IMPORTANT TAKE HOME MESSAGES INCLUDE:

1.     Am I at high risk for an aneurysm?  If you are a male age 65 years or more who smokes now or previously, you are at high risk.  If you have a family history of aneurysms then you are also at high risk.
2.     What should I do if I am at high risk?  Studies have shown that screening programs (typically using ultrasound) reduce the risk of death by detecting aneurysms.  Once an aneurysm is found consultation with a vascular specialist can help determine when and how it is best to fix the aneurysm.
3.      Am I a candidate for endovascular stent graft repair of my aneurysm and who can I see who does this procedure?  A vascular specialist with extensive experience can determine with you what the best method of repairing your aneurysm is.
4.      Is a vascular surgeon going to be involved with my care in a high volume (greater than 35 cases per year) hospital?
5.      If you have an aneurysm and develop back pain or abdominal pain, seek the closest emergency room immediately.


Dr. Horesh  can be contacted at Savannah Vascular and Cardiac Institute and can be reached at (912) 352-VEIN or contactus@savannahvascular.com.