Abdominal aneurysms: Uncommon but potentially dangerous

An aneurysm — an abnormal bulge or balloon-like pouch in an artery — can form in different places in the body and the brain. But most arise in the body’s largest artery, the aorta, as it passes through the center of the body (see illustration). These abdominal aortic aneurysms (AAAs) occur in up to 7% of people ages 50 and older, most commonly in older male smokers.

Most of the time, these bulges stay small, grow slowly, and pose little risk. But a small number expand quickly and may rupture with little warning. The resulting massive bleeding inside the abdomen is usually fatal.

“Unfortunately, abdominal aneurysms don’t cause any symptoms until they’re about to rupture or are rupturing,” says Dr. Marc Schermerhorn, chief of vascular surgery at Harvard-affiliated Beth Israel Deaconess Medical Center. Located deep inside the body just on top of the spine, this section of the aorta is about 2 centimeters (cm) wide. During routine physical exams, primary care providers usually can’t feel small aneurysms in the abdominal aorta, and even a large aneurysm is easy to miss, says Dr. Schermerhorn. That’s why people at greatest risk for an AAA should be screened with a one-time abdominal ultrasound — a simple, painless test that takes about 30 minutes.

643bc38c-b6e7-4084-9f0f-fa3a12e4327eAbdominal aneurysms usually form near the center of the body, below the kidneys.

Who should be screened?

The screening test for an AAA is fully covered by Medicare Part B for

  • anyone with a family history of AAA
  • men between ages 65 to 75 who have smoked at least 100 cigarettes at any point during their lives.

However, few people seem to be taking advantage of this free screening. If you qualify and your physician hasn’t recommended the test, ask him or her to order the screening, says Dr. Schermerhorn.

Why aneurysms form

Cigarette smoking is a potent risk factor for many diseases, and AAAs are no exception. Even men who smoked only casually for a brief time when they were younger face a heightened risk, says Dr. Schermerhorn. “The effect triggered by smoking can happen during your 20s but not show up until years later,” he says. The more you smoked, the higher your risk. Quitting after you’re diagnosed definitely helps, since people who continue to smoke tend to fare much worse than those who stop, he adds. High blood pressure can also increase the odds that an aneurysm will grow and rupture.

Monitoring AAAs

If your screening test detects a small aneurysm (a diameter of less than about 4 cm), it should be rechecked every two years. If the aneurysm expands to 4 cm, annual checks are recommended, and every six months if it grows larger than 4.5 cm. Dr. Schermerhorn urges his patients not to worry too much about small aneurysms. “We want people to be just concerned enough to show up for their next surveillance test,” he says. Most never reach a size that would require an intervention, but surveillance can detect the rare cases that warrant treatment.

The risk of a rupture rises as an aneurysm grows larger. If that happens, it usually causes a sudden, sharp pain in the back, or sometimes in the front of the belly. Occasionally, the pain radiates to one side (usually the left) or toward the groin. Many people with AAAs also have chronic low back pain, but the pain associated with a rupture feels new and different, says Dr. Schermerhorn.

Treating an AAA

If an AAA grows large enough, the risk of a rupture outweighs the risk of repairing it. For men, that’s about 5.5 cm; for women, about 5 cm. However, the person’s overall surgical risk and how quickly the aneurysm has grown are also important considerations. A CT scan of the abdomen provides a more detailed look of the aneurysm, which helps surgeons determine the best treatment option. Some AAAs are repaired with open surgery, but most are done with a minimally invasive technique: the physician threads a catheter through a vessel in the upper leg up to the aorta and places a fabric-coated metal cage to reinforce the bulging portion.

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

Whoever would foster love covers over an offense, but whoever repeats the matter separates close friends. Proverbs 17:9 NIV

Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you. Ephesians 4:32 NIV

For if you forgive other people when they sin against you, your heavenly Father will also forgive you. Matthew 6:14 NIV

Bear with each other and forgive one another if any of you has a grievance against someone. Forgive as the Lord forgave you. Colossians 3:13 NIV

If my people, who are called by my name, will humble themselves and pray and seek my face and turn from their wicked ways, then I will hear from heaven, and I will forgive their sin and will heal their land. 2 Chronicles 7:14 NIV

Do not judge, and you will not be judged. Do not condemn, and you will not be condemned. Forgive, and you will be forgiven. Luke 6:37 NIV

Who is a God like you, who pardons sin and forgives the transgression of the remnant of his inheritance?
You do not stay angry forever but delight to show mercy. Micah 7:18 NIV

You, Lord, are forgiving and good, abounding in love to all who call to you. Psalm 86:5 NIV

Therefore, my friends, I want you to know that through Jesus the forgiveness of sins is proclaimed to you. Through him everyone who believes is set free from every sin, a justification you were not able to obtain under the law of Moses. Acts 13:38-39 NIV

He is the atoning sacrifice for our sins, and not only for ours but also for the sins of the whole world. 1 John 2:2 NIV

Whoever conceals their sins does not prosper, but the one who confesses and renounces them finds mercy. Proverbs 28:13 NIV

In him we have redemption through his blood, the forgiveness of sins, in accordance with the riches of God’s grace. Ephesians 1:7 NIV

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