Aneurysm

What is an aneurysm?

An aneurysm is a bulging of an artery caused by uncontrolled hypertension or injury or weakness to the artery itself. The pressure from blood flow against the arterial wall causes the aneurysm to slowly grow in size, giving it its bulging characteristic. Typically, atherosclerotic disease (plaque buildup within the arterial wall) is present.

Aneurysms can occur in any blood vessel in the body, but the most common type arises in the largest artery in the body--the aorta. This condition affects over 200,000 Americans and is referred to as an abdominal aortic aneurysm (AAA).

An AAA is a very serious condition that claims the lives of 15,000 Americans every year. As the aneurysm continues to grow, it has the potential to rupture or leak. If this occurs, more than half of these individuals go into shock and die as a result of massive internal bleeding. The key is to detect an AAA at its earliest stage so it can be properly treated.

What are the warning signs and symptoms of an aneurysm?

Abdominal aortic aneurysms (AAAs) are referred to as "the silent killer", as the majority of people do not have symptoms. However, AAAs are more likely to develop in persons with any of the following characteristics:

• Age greater than 60
• Male (men represent 70 - 80% of AAA cases); although this statistic is changing as more women are diagnosed with cardiovascular disease
• High blood pressure, smoking, or high cholesterol levels
• A family history of either cardiovascular disease or aneurysms

If you have one or more of the above risk factors, we recommend that you discuss with your doctor certain tests that can detect an AAA early so it may be properly treated.

Sometimes, people will experience symptoms that suggest the presence of AAA:

• Pain in the abdomen, back, or flank (side)
• An overwhelming feeling of "fullness" after eating even a small amount of food
• Frequent nausea and vomiting
• Pulsating in the abdomen--for example, when reading a book that is resting on the abdomen, the book moves up and down

If you experience any of the above symptoms, you should be evaluated by your doctor immediately. Prompt action may prevent a life-threatening situation.

How is an aneurysm detected?

Abdominal aortic aneurysms are sometimes detected during a routine physical examination. Your physician may hear pulsations in your abdomen (also called bruits) with a stethoscope. However, they are usually difficult to detect (especially in persons who are overweight). If your physician suspects that you may have an aneurysm, either due to pulsations in the abdomen or other risk factors such as family history, high blood pressure, high cholesterol, old age, etc., he or she will likely perform any of the following imaging studies to make the diagnosis:

• Doppler Ultrasound
• Chest or abdominal X-Ray
• CT Scan
• Magnetic Resonance Imaging (MRI)

What are the treatment options for an aneurysm?

Once an aneurysm (including AAA) is diagnosed, your physician will determine the appropriate treatment depending upon its size and location. If the aneurysm is small, your physician will likely monitor its growth with repeated ultrasound imaging. If it is large (greater than 5 centimeters), or is growing rapidly and showing signs that it might rupture, an interventional catheterization or surgery may be required.

• Open Abdominal Surgery: This traditional approach is the surgical removal of the aneurysm. During this surgery, you are asleep while the surgeon removes the aneurysm and sews a synthetic graft in its place. Usually, you can expect to stay in the hospital for about a week, and recuperation time is about six weeks.
• Endovascular Intervention: Some patients may be candidates for a minimally invasive alternative. The endovascular approach requires small incisions in the groin. A graft attached to a catheter is threaded through your arterial system until it reaches the location of the aneurysm. The graft is left in place to prevent the aneurysm from growing by keeping blood pressure away from the arterial walls. Not all individuals are candidates for this minimally invasive alternative. Furthermore, while your hospital stay (about 2 days) and recuperation time (about 1 - 2 weeks) is much less than traditional surgery, the procedure still carries risk and will require follow-up monitoring.

Consult your physician about which option is best for you.