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Aortic Aneurysms: What To Know About ‘Silent Killer’

An aortic aneurysm is a “silent killer” that can threaten your life with little or no warning.

Your aorta is the large muscular and elastic blood vessel that carries blood and oxygen from your heart to other parts of your body. Very much like a balloon, it needs to be able to expand to handle the intense flow of blood pumping out of the heart.

An aneurysm can occur when the vessel starts to lose some of its elasticity. This creates a bulge in the weak area of the vessel. Typically, the width of the aorta is 3 centimeters or less. Once a bulge reaches 5.5 centimeters, it is at risk of rupturing.

A ruptured aortic aneurysm has a high risk of death. Only half of the people who experience a rupture will make it to the hospital alive. Only half of those will make it to the operating room. Half again will make it out of the operating room. And then half of those make it home again.

Aortic Aneurysm Symptoms

Most aortic aneurysms are found either by accident – during testing for some other problem – or through screenings. Symptoms tend to be mild and unnoticeable, but can include:

  • Shortness of breath or difficulty breathing
  • Feeling full without eating much
  • Pain at the site of the aneurysm
  • Difficulty swallowing
  • Swelling of the arms, neck or face

Only when the aneurysm bursts is it obvious that there is a problem. At that point, it is a medical emergency that demands immediate treatment. A rupture can cause such intense pain in your back or abdomen that you may pass out. It could also cause a complete collapse of blood pressure, which would also cause you to pass out.

Risk Factors

The top risk factor for aortic aneurysms is smoking, particularly for men. There is such a strong correlation between the two that the US Preventive Services Task Force recommends a one-time ultrasound screening for any male between the ages of 65 and 75 who has smoked. This is distinctly different from lung cancer screening recommendations, which are based on the level of smoking history. With aortic aneurysms, all that matters is if you ever smoked.

Other risk factors include:

  • Males are at significantly higher risk than women
  • Age 65 or older
  • High blood pressure
  • High cholesterol
  • Family history of aortic aneurysms

How Are Aortic Aneurysms Treated?

In the case of smaller, unruptured aneurysms, your doctor may suggest careful surveillance (with tests once or twice a year) and medications to help lower your blood pressure and manage cholesterol to reduce the risk of rupture or growth of the aneurysm. If it continues to grow, the goal is to repair the bulge long before it gets close to a rupture. If surgery is recommended, there are two options:

Open aneurysm repair: With this option, the surgeon removes the damaged section of aorta and replaces it with a synthetic blood vessel called a graft. The advantage of the procedure – particularly for younger patients – is that the repair should last a lifetime. The downside is that it’s a more invasive surgery with a large incision in the belly and a longer recovery time.

Endovascular aneurysm repair (EVAR): This is the most common surgical option. It is a minimally invasive procedure that uses a small stent graft to reinforce the wall of the aorta. Your surgeon uses a small incision in the groin to thread a thin tube (catheter) through your arteries to reach the point of the aneurysm. The biggest advantage of the procedure is that recovery is easier, often requiring only a day or two in the hospital. The downside is that the stent requires annual monitoring and will likely need a reintervention in five to 10 years.

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