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Aortic Aneurysm

“Well Jim, the good news is your coronary calcium scan shows no calcified plaque on the arteries that supply your heart.  The not so great news is that the biggest artery coming out of your heart, the aorta, shows the beginnings of an aneurysm.”

“Hmmm, why don’t I have any chest pain or other symptoms?”

So, what is an aortic aneurysm?  For starters, any aneurysm is an excessive localized enlargement of an artery caused by a weakening of the artery wall.  Typically it is officially called an aneurysm when it reaches 50% or greater increase from its normal size.

The aorta is the largest artery in the body.  It arises out of the biggest pumping chamber of the heart, the left ventricle, and then branches out to supply the body with oxygenated blood.

Typically if the aorta dilates (expands) it causes no symptoms at first.  But if it enlarges enough, or eventually tears or begins to rupture, there can be substantial, sometimes excruciating chest, abdominal, upper or lower back or even groin pain.   A person with a sudden leaking aneurysm may even lose consciousness or be in shock.  Over 65% of ruptured aortic aneurysms die before reaching the hospital.

Aortic aneurysms most commonly affect elderly white men, especially smokers.  For this reason, it is recommended that males who have been smokers get a single abdominal ultrasound looking for an aortic aneurysm sometime between age 65 and 75.  Other risk factors include increasing height and weight, hypertension, heart disease, COPD (chronic obstructive pulmonary disease), and positive family history of aneurysms.

So how common are aortic aneurysms?  Ruptured abdominal aortic aneurysm (AAA) is the 13th leading cause of death in the U.S. with about 15,000 cases per year.  Autopsy studies show aortic aneurysm present in between 1-4 % of those over 65 years old, so it’s not rare.

The primary treatment is surgical repair.  Obviously if an aortic aneurysm is tearing, emergency repair is essential and potentially life-saving.  If an aortic aneurysm is seen on an ultrasound or other imaging study, it is usually repaired if it reaches a certain threshold in size.  For example, an aneurysm of the abdominal aorta is usually repaired if it reaches 5 cm. in size, since this has been found to be a size that predicts substantial risk of rupture.

What about prevention?  If you’ve got healthy arteries, or even if you have the beginnings of an aneurysm, what can you do to prevent future problems?  Don’t smoke, do treat high blood pressure, and avoid getting overweight.  There are also studies besides abdominal ultrasounds such as coronary calcium scores and a specialized study of the carotid artery in the neck (a carotid artery intimal medial thickness test) that can be done to assess the health of your arteries.  This will help you and your doctor determine whether you need to more aggressively treat your cholesterol and/or arterial inflammation.

You’ve only got one aorta; take care of it, and if you have risk factors, keep a close eye on it.

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