Checking for an abdominal aortic aneurysm: Who, when, and why?

The body’s largest artery, the aorta, curves out of the heart down through the center of the body, where it branches into smaller arteries that send blood to various organs and the legs. Over a lifetime, the bottom section of this vessel — the abdominal aorta — may weaken. A thin, weak spot can balloon outward, forming an abdominal aortic aneurysm, or AAA.

Most of these bulges remain small, grow slowly, and pose no serious danger. But a small number swell to two inches or greater in diameter and may rupture, usually without warning and with potentially fatal consequences. (The vessel is normally less than an inch across.)

To help people avoid that dire fate, individuals at greatest risk are advised to undergo a onetime screening ultrasound to check for an AAA. Recently updated guidelines from the U.S. Preventive Services Task Force recommend AAA screening only for men ages 65 to 75 who have ever smoked.

Other reasons for screening

But Dr. Marc Schermerhorn, chief of vascular surgery at Harvard-affiliated Beth Israel Deaconess Medical Center, says that older men and women with risk factors other than smoking might also consider screening. “Those factors include a family history of an AAA, chronic obstructive pulmonary disease, or atherosclerotic heart disease,” he says. If you’re 65 or older and have one or two of these risk factors, ask your doctor about AAA screening, he suggests.

The screening test is simple and painless, and it costs roughly $50, which is fully covered by Medicare for men who meet the guideline criteria, as well as for people ages 65 to 75 with a family history of AAA. If you have a parent or sibling with an AAA, screening is especially important because familial cases tend to occur at younger ages and progress more rapidly, says Dr. Schermerhorn.

The smoking gun

Men who turn 65 this year were 18 years old in 1973, when about 37% of the population smoked. Even those who only smoked for a short time — as few as 100 cigarettes — have a heightened risk of an AAA. The reasons aren’t entirely clear, says Dr. Schermerhorn. “It may be as simple as triggering a genetic switch, and the more you smoke, the more opportunities there are to turn on that switch,” he says. But quitting helps, no matter when you do it. For those with an AAA, continuing to smoke leads to more rapid growth of the aneurysm and a higher risk of rupture.

Although it’s a small risk overall, AAA rupture is hard to predict and often fatal. There are usually no warning signs, although some people feel a strong pulse in the abdomen, or a sudden, sharp pain in the abdomen or lower back. If a rupture occurs, the internal bleeding could cause severe abdominal or back pain, nausea, dizziness, weakness, and fainting. The chance of survival is slim without immediate treatment.

Monitoring and treatment

AAAs with a diameter less than about 1.5 inches or 4 centimeters (cm) should be checked every two years. If an AAA reaches 4 cm, checks are recommended annually, and every six months if it grows larger than 4.5 cm. But the odds of an aneurysm reaching that size are quite small — less than 0.5% for all men ages 50 and older, and even lower for women.

In addition to smoking cessation, keeping your blood pressure under control may also slow down the growth of an aneurysm. Regular exercise, such as brisk walking or cycling, is recommended for overall cardiovascular health. But people with AAAs should avoid heavy lifting.

If an AAA reaches a certain size (about 5.5 cm for men or 5 cm for women), experts often recommend a CT scan of the abdomen, which provides more anatomic details and helps determine the best way to repair the bulge. Some are repaired with open surgery, but most repairs are done using a minimally invasive technique known as an endovascular approach. By threading a catheter (through either a small puncture or incision in the upper leg) up to the aorta, the surgeon places a fabric-coated metal cage to reinforce the bulging aorta.

The decision if and when to repair an AAA differs from person to person and depends on age, life expectancy, and preferences with respect to the up-front risk of the surgery versus the chance of a rupture.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Romans 12:1-2 ESV I appeal to you therefore, brothers, by the mercies of God, to present your bodies as a living sacrifice, holy and acceptable to God, which is your spiritual worship. Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

Romans 7:23 ESV But I see in my members another law waging war against the law of my mind and making me captive to the law of sin that dwells in my members.

Matthew 21:22 ESV And whatever you ask in prayer, you will receive, if you have faith.”

James 1:8 ESV He is a double-minded man, unstable in all his ways.

Philippians 2:5 ESV Have this mind among yourselves, which is yours in Christ Jesus,

Ephesians 4:22-24 ESV  To put off your old self, which belongs to your former manner of life and is corrupt through deceitful desires, and to be renewed in the spirit of your minds, and to put on the new self, created after the likeness of God in true righteousness and holiness.

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