Articles from prior issues of The Advocate

March/April, 1999

Aortic Aneurysms Detecting And Treating Enlarged Blood Vessels
from the Mayo Clinic Health Letter, March 1999

APPROXIMATELY 15,000 AMERICANS DIE FROM a ruptured aortic aneurysm each year. However, when detected in time, an aortic aneurysm can usually be repaired with surgery. And fortunately, we can lower the risk of developing an aneurysm by following the same practices that keep the heart healthy.

A weakened artery

An aneurysm occurs when the wall of a blood vessel becomes weak or damaged. Over time, the constant pounding of blood flowing through the weakened vessel can cause a section of it to slowly enlarge, creating a bulge an aneurysm. This weakness is usually caused by an accumulation of cholesterol-containing fatty deposits (atherosclerotic plaques). Smoking and high blood pressure can also damage blood vessels. Age also plays a role. People over 55, particularly men, are at increased risk for aneurysm. In addition, an injury or infection can weaken blood vessels, as can some congenital conditions. Heredity may also play a role. Aneurysms are serious because of the possibility they will burst, causing life-threatening internal bleeding. In addition, they often house small blood clots. These clots may break loose and block a blood vessel elsewhere in the body, causing impaired function, pain or potentially life-threatening problems.

Mainly in the abdomen

Aneurysms can develop in any blood vessel, anywhere in the body. They can develop in the artery of the knee or the small arteries in the eye or brain. (Brain aneurysms usually develop because of a congenital weakness in a blood vessel or from years of smoking, rather than from atherosclerosis.) Most aneurysms occur in large blood vessels, especially the aorta the body’s largest artery. This major blood vessel, which runs down the center, delivers blood from the heart and lungs to the rest of the body. Although an aneurysm can develop anywhere along the aorta, more than three quarters occur in the section running through the abdomen (abdominal aneurysms). The rest occur in the section that runs through the upper chest (they’re called thoracic aneurysms). The aorta’s diameter normally ranges from 3/4 to 1 inch about the thickness of a garden hose. A small aneurysm might double this diameter. Some aneurysms span 3 or more inches in diameter.

Silent danger

Not all aneurysms reach a point of rupture. Many start small and stay small. The dangerous kind slowly expand over time. They increase little by little (typically 1/8 inch to 1/4 inch) each year like a balloon that’s slowly being overinflated. Some expand at even faster rates. A few people may feel back pain as an abdominal aneurysm enlarges. But most aneurysms exist or enlarge silently. They cause no symptoms. This makes detecting them difficult.

Detecting aneurysms

In some cases, an aneurysm is discovered during a physical examination. The doctor may feel a pulsating bulge in the abdomen or pick up sounds with a stethoscope of turbulent blood flow in the abdomen. However, most aneurysms are found incidentally through routine medical tests such as an X-ray or ultrasound. If further evaluation is needed, the doctor may use other, more specialized tests. These tests might include a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan.

Prevention is key

If an aneurysm goes undetected and ruptures, it often proves fatal. More than 80 percent of people with a ruptured abdominal aneurysm die, most before they reach the hospital. That’s why reducing the risk for aneurysms is so important. You can help prevent aneurysms by reducing factors that can weaken arterial walls. That means keeping blood pressure under control, stopping smoking and reducing cholesterol in the diet. If you’re 55 or older and have hardening of the arteries (atherosclerosis), talk to your doctor about your potential risk. Abdominal aneurysms can also run in families. If you have a sibling who’s had an aneurysm, talk to your doctor about your risk. If you’re at high risk, your doctor may recommend periodic screening.

Treatment options

Treatment for an aneurysm depends on its size and location and the patient’s general health. If the aneurysm is small and there are no symptoms, the doctor may advocate a “watch-and-wait” approach. In fact, in general, people with small abdominal aneurysms can be safely monitored with ultrasound and don’t require surgery until the risk of rupture outweighs the risk of surgery. However, if the aneurysm is enlarging rapidly, is large, is leaking or shows signs that rupture is likely, surgery must be performed. There are two main types of surgery:

Open abdominal or chest surgery This is the standard operation to repair an aortic aneurysm. It involves opening the abdomen or chest and stopping blood flow in the aorta so that the damaged section of the aorta can be replaced with a synthetic tube. While this surgery is generally successful, it requires an incision in the abdomen or chest. Recovery may take several weeks, including a 5 to 7 day stay in the hospital.

Endovascular surgery

Doctors at several major medical centers are using in clinical trials a new surgical procedure. It may benefit those who need surgery to repair an aortic aneurysm but are at high risk for complications because of existing medical problems. In this procedure, a synthetic graft is attached to the end of a catheter a thin tube that’s inserted into the bloodstream, usually through an artery in the leg. The catheter is threaded upstream to the aorta and used to position the graft at the site of the aneurysm. Once in place, the graft is expanded and fastened with metal stents, small hooks or pins. The graft reduces pressure on the walls of the aorta. Although endovascular surgery reduces recovery time to a few days, it still carries risk. And long-term results are unknown.

Not an easy fix

The doctor may recommend measures, including medications, to lower blood pressure and relieve stress on weakened arteries. But there’s no one pill one can take to prevent aneurysms. The best approach is to keep the blood vessels as healthy as possible.

Aortic Aneurysms Also Occur In The Chest The largest artery in the body, the aorta, is shaped like a candy cane. It rises out of the heart then rounds downward toward the abdomen. Aneurysms that develop in the portion of the aorta in the chest are called thoracic aneurysms. Large thoracic aneurysms may press on the back or chest wall, causing chest or upper back pain. But generally they give no warning sign. Most are found incidentally on a routine chest X-ray. Like abdominal aneurysms, aneurysms in the chest are often caused by years of fatty buildup in the aorta (atherosclerosis). If a thoracic aneurysm is 2 to 3 inches in diameter or more, surgical repair using a synthetic graft is generally required. However, surgical risks are high. Fortunately, a 1998 study by Mayo Clinic researchers found that people with chest aneurysms are living longer today than they did 15 years ago, thanks to modern tests and surgical techniques. However, the study also found that chest aneurysms are more common in elderly women. Ask your doctor about your potential risk. Aneurysms can also develop in the wall of a heart that’s been damaged by a heart attack. These pose a low risk of rupture but may cause heart problems.