It’s usually symptomless, often found incidentally, and life-threatening. It’s much more common in men than women, and the risk increases after age 60.
I’m speaking of the most common kind of aortic aneurysm (pronounced, “an-your-ism”).
What Is an Aneurysm?
An aneurysm is a dangerous bulge in the aorta, the biggest artery in the body. It’s a problem that I encountered many times in my cardiology practice.
Your heart pumps blood directly into the aorta, which then branches off at multiple sites to supply the whole body from top to bottom. The big danger zone – 80% of aneurysms occur there − is where the aorta passes through the lower abdomen. The walls of the aorta become damaged and weakened in one spot and bulge out like a balloon. If the balloon bursts, death can occur rapidly.
A ruptured abdominal aorta was the cause of death of Albert Einstein in 1955.
More than 15,000 people die from this a year. According to the U.S. Centers for Disease Control, aortic aneurysms caused almost 18,000 deaths in the United States in 2009 (they were the primary cause of death in about 11,000 cases).
Risk Factors
Abdominal aneurysms affect four to six times as many men as women, and occur in up to 8 percent of men ages 65 and older. Researchers estimate that 1% of men between the ages of 55 and 64 have “clinically relevant” aneurysms, and with each decade that follows comes a 2 to 4% increase in prevalence. On average, women tend to be affected 10 years later than men.
Abdominal aneurysms are commonly associated with smoking, arterial disease, high blood pressure, low HDL cholesterol levels, and a family history of aneurysms. An aneurysm higher up in the aorta, in the chest, tends to affect men and women equally, and usually involves high blood pressure or sudden injury.
Symptoms / Areas Affected
Aortic aneurysms usually develop slowly over many years. Many times, there are no symptoms, and the problem is identified by ultrasound, CT scans, or MRIs when doctors are looking for something else.
If an aneurysm expands rapidly, ruptures, or blood leaks along the wall of the vessel, symptoms may develop suddenly. They include a pulsating sensation in the abdomen, severe, sudden, persistent, or constant pain in the abdomen or groin that could radiate to the buttocks and legs, nausea, and the appearance of an abdominal mass. If in the thoracic (chest & upper back) region, symptoms could manifest as difficulty breathing or swallowing, and sharp, sudden pain.
Aneurysms can also occur in peripheral arteries. Though less likely to rupture, the slower blood flow in these arteries can cause blood clots to form.
Size of the aneurysm is considered a strong predictor of rupture risk. The larger the aneurysm the greater the risk. And the risk increases significantly when the diameter of the bulge exceeds 5.5 cm (more than 3 cm is considered an aortic aneurism, and 4 cm indicates “clinical significance”). Surgical repair is warranted at that size as well. Smaller aneurysms are generally subject to watchful waiting.
Screening / Testing
Screening is crucial. According to the U.S. Preventive Services Task Force, men between the ages of 65-75, and particularly individuals who have smoked in their lives, should obtain an ultrasound screening for an abdominal aortic aneurysm. There is no such recommendation for men of that age bracket who have never smoked, and a screening is not recommended for women. The Canadian Society for Vascular Surgery, however, recommends screening for women with multiple risk factors, such as smoking, cerebrovascular disease, and family history. The American College of Cardiology recommends a screening for men over 60 who have a sibling or parent with an aortic aneurysm. High risk individuals should also have an echocardiogram (an ultrasound diagnostic procedure for the heart) to determine any suspicious enlargement of the aorta artery close to the heart.
Treatment / Surgery
For decades, surgeons repaired this condition primarily by placing a synthetic graft through a large surgical incision. Cutting into the abdomen is always risky business. Recovery can take months. Moreover, older and compromised patients run the risk of renal failure, cardiovascular complications, and adverse reactions to anesthesia. Many an older patient with an aneurysm told me they would rather wait it out than subject themselves to surgery. That’s one tough decision because an aneurysm is like sitting on a time bomb. In some of those cases, the aneurysm ruptured and patients died.
In recent years, a newer procedure − called endovascular aneurysm repair − has become widely adopted by surgeons. EVAR, as it is called for short, involves embedding a fabric covered stent at the damaged site via a catheter inserted through the femoral artery in the groin. The blood bypasses the aneurysm. The procedure involves only a tiny incision, much less anesthesia, and has a much quicker recovery time.
Studies have shown that the new procedure is considerably safer but requires more follow-up interventions of a minor nature.
Prevention
You’ve likely read my mantra, “prevention is easier than cure” elsewhere on this site, but I cannot reiterate it enough. Keep your arteries strong and healthy. Here are some tips:
- Exercise. Regular physical activity helps to keep your blood vessels healthier and protects their sensitive inner lining from age-related changes. Even a minimum can make a difference.
- Reduce the sugar and refined carbohydrates in your diet. They spike blood sugar (glucose) and cause damaging changes in the lining of your blood vessels. Make sure you eat plenty of fruit. A study among 80,000 middle-aged and older Swedes found that those who ate two or more servings of fruit daily had a much lower risk of aneurysms.
- For individuals with aneurysms I recommend nutritional supplements such as omega-3 fatty acids (fish or squid oil, 1-2 grams daily), CoQ10 (200-300 milligrams), and magnesium (250-500 milligrams). They are all helpful against high blood pressure and contribute to healthy blood vessels. I would also suggest vitamin K-2 (the MK-7 form, 150-300 micrograms) to help remove calcium out of hardened arteries.
- If you still smoke, quit! Here are some tips that I hope will help.
References:
- U.S. Centers for Disease Control and Prevention. Aortic Aneurysm Fact Sheet.
- Paravastu SC, et al. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev, 2014.
- Aggarwal S, et al. Abdominal aortic aneurysm: A comprehensive review. Exp Clin Cardiol. 2011;16(1):11-15.
- Virdis V, et al. Endothelial dysfunction and vascular disease in later life. Maturita.2010;67(1):20-4.
- StackelbergO, et al. Fruit and Vegetable Consumption With Risk of Abdominal Aortic Aneurysm. Circulation. 2013;128:795-802.
- American Heart Association. Eating more fruit may lower your risk of lethal aneurysm. 2013.
© Stephen Sinatra, MD. All rights reserved.