What is an
An aneurysm is an abnormal
ballooning of an artery wall to 1 ½ times the normal diameter. This most commonly occurs in the
abdominal aorta, the largest vessel in the body, which carries blood from the heart to all the abdominal
organs as well as the legs. Abdominal aortic aneurysm (AAA) affects between 3 and 9% of the population being much more
prevalent in males and especially if you have a close relative who had a AAA. It is estimated
that 1.5 million Americans have a AAA but only about 50% of those have been diagnosed.
Dangerous ballooning of the artery
If this is
such a large problem, why isn’t routine testing performed? Aortic aneurysms develop slowly and are often asymptomatic, leaving the problem
largely undetected and untreated. Few doctors routinely inquire about aneurysm histories in patients, making
this one of the most neglected diseases. Aneurysms occasionally cause pain or
discomfort by the pressure put on surrounding structures (like back pain if it irritates the nearby
backbone) or small blood clots from inside lining of the aneurysm may break off and block the circulation to the
legs or feet. Unfortunately, most aneurysms cause NO SYMPTOMS until they
rupture. Rupture results in massive internal bleeding usually causing severe pain with shock and loss of
consciousness. Unfortunately, the majority of people with AAA rupture will die so it is important to
know if AAA is present. An AAA is usually discovered on physical exam by the physician, or during an x-ray
examination done for other reasons. If you or your physician are worried that you might have an AAA, an
ultrasound can easily detect this problem.
We know that aneurysms below a certain size are unlikely to rupture so if an aneurysm is
discovered, regular follow-up is required to determine if the aneurysm is enlarging.
Fig. 1 A duplex ultrasound of a noraml aorta - note the smooth uniform
Fig. 2 Note the variable dimensions of this aorta - called "aortic ectasia".
While not quite large enough to be classified as an aneurysm, this should be watched with regular duplex
Figure 3 A small saccular aneurysm of the abdominal aorta
Figure 4 A large abdominal aortic aneurysm that would be considered for
Aortic aneurysms can be successfully treated - If
identified early enough!
Aneurysms have been studied for many years so we know a good
deal about them. For instance, aneurysms below 5 centimeters are very unlikely to rupture. So aneurysms less
than this need regular follow-up with duplex ultrasound every 6 - 12 months to check for enlargement. For
aneurysms larger than 5 centimeters, repair is usually recommended unless the person has other conditions that
would make the procedure more risky, such as bad heart disease for example. Repair is traditionally done
surgically through an incision in the abdomen. A synthetic graft is sewn in above and below the aneurysm,
excluding it. This procedure has been performed for over 40 year and
is highly successful. More recently, endovascular repair is being performed. In this
operation, a synthetic graft is the graft is inserted inside the aneurysm through a small incision in the groin.
Special stents hook the graft in place above and below the aneurysm, effectively excluding it. This procedure
does carry its own set of risks and complications and can not be performed in all patients but is an exciting
development in the treatment of this life threatening disease.
Screening can save lives! Due to insurance regulations, physicians generally cannot order tests unless there
are specific signs and symptoms of disease - a problem for detection of aortic aneurysm and much peripheral
vascular disease. However, according to a study published in The Lancet, a British medical journal
in November 2002, thousands of the elderly individuals with abdominal aortic aneurysms could be saved each year
with regular screening programs. Today, most aortic aneurysms can be detected with a simple, painless and
effective ultrasound-screening test. Find out today if you have the “silent killer!”