Question: I was adopted and just learned my father and his brother died from an aneurysm. A second brother had an operation because of an aneurysm and is the one who told me of this. I am 60 years old. Can you explain what an aneurysm is? How does one prevent this or check if he or she is in danger? What age range is particular is susceptible? — Rod, of Lima
You should have a screening ultrasound to evaluate for an aneurysm since your father had one, and below are the reasons why.
An aneurysm is an enlarged localized outpouching of an artery caused by a weakening in the artery wall. There are a variety of causes of aneurysms — atherosclerosis (hardening of the arteries), trauma, heredity, infection and abnormal blood flow in the vessel.
The most common cause is atherosclerosis and occurs usually between the ages of 40 and 70. The most common site is the abdominal aorta. Other common sites are in the brain, popliteal artery (knee), splenic artery (abdomen) and the thoracic aorta (chest). They are usually found when a CT scan is done to evaluate a cause of pain or other symptoms. Most are found incidentally while evaluating other causes. Screening ultrasounds are another way that they are commonly found.
If they are very large, they can be felt as a pulsatile mass, a bump that pulses or thumps. They are more common in men and smokers. They also tend to run in families, especially if there is a first-degree relative with one.
The symptoms of aortic aneurysms include a pulsation near the navel, abdominal pain, back pain, a cold foot, fever or weight loss.
The diagnosis is usually made by history, physical exam and a diagnostic scan such as CT or ultrasound.
Once one is found, then the size determines whether treatment is indicated. If it is small, then it can just be followed with annual exams. Controlling blood pressure and smoking cessation are the two main treatments to slow the growth.
Abdominal aortic aneurysm treatment is indicated for those larger than 5 centimeters (about 2 inches) in women and 5.5 centimeters in men. Tremendous improvements in the treatment of AAA has occurred in the past 25 years. Before, these required large operations and a long recovery period. Now, most are treated by accessing an artery in the groin with endovascular stent grafts and many patients are able to go home and resume normal activities within 1 or 2 days of surgery. They do however require lifelong follow up with annual physician visits with a specialist in the treatment of aneurysms and radiologic imaging.
The mortality from ruptured AAA remains high and is much lower with elective repair. Screening is recommended to find them early and allow for elective repair prior to rupture. Many hospitals offer screening ultrasounds to check for these and can be obtained easily. Medicare will provide a screening ultrasound for all males at age 65 who have smoked more than 100 cigarettes in their lifetime when they apply for Medicare.
Ronald L. Pohl, MD, FACS, Lima Memorial Cardiothoracic and Vascular Surgeons Inc., 1003 Bellefontaine Ave., Suite 200, Lima, Ohio 45804