Treatment for aortic aneurysms safer and more effective when done proactively
G. Matthew Longo, MD, vascular surgeon
- What is the prevalence of aortic aneurysms?
- Aortic aneurysms are the most common type of aneurysms and are more common as we age. We typically start seeing a rise in aortic aneurysms in individuals over age 60. Abdominal aortic aneurysms (AAA) are more common in men; however, its prevalence has been increasing in both men and women. It is one of the leading causes of death in the United States. At least 9,000 people in the United States die from an aortic aneurysm rupture yearly.
- What types of symptoms are associated with aortic aneurysms?
- Approximately 75 percent of people are asymptomatic upon presentation. In most cases, it is found by a physician incidentally. If a patient does develop symptoms, they usually present with severe back pain that can radiate to the groin. Our goal is to diagnose patients before they develop symptoms since it is much safer to repair an aneurysm electively.
- What are the greatest risk factors?
- Smokers and those patients who have a family history of aneurysms are at greatest risk. Other risk factors include individuals with atherosclerosis, connective tissue diseases such as Marfan’s syndrome and Ehlers-Danlos syndrome, persons with other extracranial aneurysms, individuals with a history of aortic dissection or trauma to their aorta, and persons who have had an aortic infection. The following individuals are at a higher risk of rupture: those with a known aneurysm, an aneurysm with an eccentric shape or a rapidly expanding aneurysm (?0.6 cm/year); women and smokers.
- What are the chances of survival if the aneurysm should rupture?
- An aortic aneurysm that ruptures is associated with massive bleeding and is often fatal. While it is possible to repair a ruptured aortic aneurysm, most people will die before they reach the hospital. Mortality rates for aneurysm rupture are typically 70 to 90 percent. Thus, it is desirable to repair aneurysms before symptoms develop in which mortality rates are under 2 percent.
- What is the treatment for aortic aneurysms?
Treatment for aortic aneurysms is much safer and more effective when done proactively. Treatment involves a choice of two surgery procedures, an open aneurysmorrhaphy or an endovascular aortic aneurysm repair. The endovascular repair requires that a patient have a segment of normal aorta below the renal arteries before the aneurysm begins. This procedure has a four-fold decrease in morbidity and mortality, has a quicker recovery time and shorter hospital stay than the open surgical repair.
A patient will need to undergo a CT angiogram and be seen by a surgeon to determine the most appropriate type of surgery.
- Who should have surgery?
- Men with aneurysms more than 5.5 centimeters (cm) in diameter and women with aneurysms greater than 5 cm are candidates for surgery. Aneurysms less than 5 cm in diameter in women and less than 5.5 cm in men should be monitored with a CT scan or ultrasound every 6 to 12 months. Aneurysms typically expand .5 cm a year, but this varies for each individual, thus the need for regular surveillance.
- Who should be screened for an aortic aneurysm?
- An ultrasound screening is recommended by the U.S. Preventive Services Task Force for all men ages 65 to 75 who have ever smoked. However, this ignores women whose rates of aneurysm development have begun to catch up with men. I recommend screening male and female smokers over the age of 60, anyone with a family history of abdominal aneurysms at age 50, and every five years thereafter, persons suffering from connective tissue disease, and any individual with a history of aortic dissection or trauma.