As you age, screenings for everything from high cholesterol to skin cancer become part of your annual checkup. For some, this list should also include a screening for a condition that can be fatal if not identified early: aortic aneurysm.
We spoke to UVA Health System cardiovascular surgeon Gorav Ailawadi, MD , about the risks of aortic aneurysms and who would benefit most from screening.
What is an aortic aneurysm?
An aortic aneurysm is the dilation or bulging of the blood vessel that leads from the heart and delivers blood to the body. It may occur in the upper portion of the aorta that runs through the chest (thoracic aortic aneurysm), or in the lower portion of the aorta that runs through the abdomen (abdominal aortic aneurysm). Like a balloon, when this blood vessel gets large, it can “pop” or rupture, which can be fatal.
How common are aortic aneurysms?
The incidence of aneurysms increases with age, starting at around age 65. In people over the age of 80, approximately one in ten people have an aortic aneurysm.
Who is at the greatest risk for developing an aneurysm?
Caucasian patients have a higher risk than minority patients. Also, men get aneurysms about 4 to 5 times more frequently than women. The most significant risk factors are smoking, emphysema (COPD) and family history.
Are there any signs or symptoms?
Most aneurysms are asymptomatic or cause no symptoms until they leak or rupture. When symptoms do arise, typically they cause chest, back or abdominal pain.
Is it possible to prevent aneurysms from occurring?
The only method to “slow” the growth is controlling blood pressure and smoking cessation. Other than this, the best course of action is to closely monitor the aneurysm to ensure it gets fixed prior to rupture.
Who should be screened for an aortic aneurysm?
Since aneurysms most commonly occur in Caucasian men, the U.S. Preventive Task Force recommends that white men over the age of 65 who smoke be screened for an abdominal aortic aneurysm once a year between the age of 65 and 75 (Medicare will pay for this subset of patients).
Non-smoking men who have a family history of aortic aneurysms should consult with a physician to determine whether they are at increased risk and if they should be screened.
Although not as common, women can get ascending aneurysms just above their heart, which is often due to an inherited abnormal valve. Thus, they should also make their physician aware of any family history of aneurysms so screening can be considered.
How are patients screened for an aortic aneurysm?
Depending on the location of the aneurysm, screening is performed using an imaging procedure such as an ultrasound, a CT (computed tomography) scan or echocardiogram.
Screening is typically done about once a year or more frequently if there is concern that the aneurysm is getting larger and is getting close to needing repair.
What are the next steps after screening?
If someone has an aneurysm, the size, location and other risk factors will be considered to determine whether it should be repaired. Typically, an aneurysm that measures 4.5-6 cm will require surgical intervention. In women, the size may be even smaller before treatment is recommended.
If an aneurysm is identified before it reaches a critical size, the patient will be monitored closely and prescribed medication as well as lifestyle changes to control high blood pressure and reduce the risks of rupture.
How are aneurysms repaired?
There are many ways to fix an aneurysm. At UVA, we specialize in minimally invasive repairs, approaching aneurysms either through the groin or through minimal incisions.