According to an article in the September 2009 issue of the New England Journal of Medicine, approximately 33,000 patients undergo repair of abdominal aortic aneurysms each year, with associated illness, death and health care costs. Rupture of aneurysms accounts for about 15,000 deaths annually in the U.S.
Identification
An aneurysm is an abnormal bulge in a blood vessel, caused by a localized area of weakness. The most common site for aneurysms is the aorta, the body's largest artery. The aorta begins at the heart and travels down the chest and abdomen, before dividing into two smaller arteries. Most aortic aneurysms occur in the abdomen. Atherosclerosis is the most common cause of an arterial wall weakening. Risk factors include smoking, hypertension, older age, family history, being Caucasian and being male, according to the Mayo Clinic.
Symptoms
Most patients have no symptoms, as aortic aneurysms tend to grow slowly. As the aneurysm enlarges, some patients may experience pain in the back or abdomen or a pulsating sensation in the abdomen, according to the National Heart Lung and Blood Institute. It is difficult to determine how fast an aneurysm will grow; some aneurysms never rupture. If an abdominal aortic aneurysm does rupture, patients may experience severe pain in the abdomen or back, light-headedness and rapid heart rate. A ruptured aortic aneurysm is a medical emergency.
Diagnosis
Abdominal aortic aneurysms tend to be discovered incidentally, usually during a physical examination or an investigation done for another reason. Ultrasound or CT scan are the investigations of choice for diagnosing aortic aneurysms. If the patient is symptomatic or rupture is suspected, ultrasound is the preferred investigation, as it can be done rapidly at the bedside. If there is no immediate danger of rupture, a CT scan provides a more accurate picture of the aneurysm.
Treatment
Treatment is determined by the size of the aneurysm and its associated risk of rupture. This is because the surgical repair itself carries a significant risk to the patient. Generally, surgery is carried out for aneurysms more than 5.0 to 5.5 centimeters in diameter or aneurysms that grow more than 0.5 centimeters within six months regardless of size, the Mayo Clinic notes. Patients with smaller aneurysms are usually treated more conservatively, by monitoring the aneurysm with ultrasound every six months. Medication may be prescribed to relax the blood vessels and prevent rupture.
Considerations
The best way to prevent aortic aneurysm formation is by reducing controllable risk factors. This means quitting smoking, maintaining a healthy blood pressure, exercising regularly and eating a healthy diet. Even patients who have been diagnosed with an abdominal aortic aneurysm can lessen the likelihood of rupture by reducing lifestyle risks and following their physician's treatment plan.
References
- "New England Journal of Medicine"; Understanding Abdominal Aortic Aneurysm; Neal L. Weintraub; September 2009
- Mayo Clinic: Aortic Aneurysm
- The Merck Manual For Healthcare Professionals: Aneurysms
- National Heart and Lung Blood Institute: Aneurysm
