Aortic Aneurysms
- Daniel Torrent
- May 21, 2024
- 2 min read
An aneurysm is the result of a weak spot in the wall of a blood vessel. Because there is a weak spot, the blood vessel will bulge. This bulge is what is being referred to. In general, as they get bigger the wall gets thinner and weaker. For most types of aneurysms in arteries, the concern is that eventually they can rupture or burst. When discussing aortic aneurysms, this is what we are concerned about because when they rupture this is life threatening and results in death without emergency life saving surgery. Even with emergency surgery the risk of not surviving the event is very high. Because of this, the goal is to fix the aneurysm before it gets to this point.
Most aortic aneurysms do not have any symptoms and a majority are found incidentally. This means they are discovered when a patient is being checked for something else. There are several risk factors that we know about including a history of high blood pressure, a family history, and tobacco use. With a family history and tobacco use particularly guidelines recommend a screening ultrasound to evaluate for this since it is so often a silent disease. The recommended age for screening depends on gender and which risk factors are present. When an aortic aneurysm is diagnosed, the treatment depends on the risk of rupture.
When the risk of rupture is very low it does not make sense to take the risk of undergoing surgery. As the risk increases a repair may be indicated. The most common risk factor that prompts a repair is size. Small aneurysms pose a very minimal risk of rupture. Once the aneurysm gets above 5.5 centimeters in men and 5.0 centimeters in women the rupture risk begins to increase and we will typically offer surgery at this point. There are other risk factors that we look at including faster than expected growth, certain shapes of the aneurysm, and new belly or back pain that can indicate inflammation of the aneurysm. On the other hand, even if the size criteria is met, sometimes it makes sense to hold off on surgery in someone who has high risks of complications. For aneurysms that do not need surgery the plan is typically for surveillance. This means that at certain periods the aneurysm will be checked for overall size and how fast it is growing. This is usually done with ultrasound or CT scan. Once the aneurysm gets to where it needs to be fixed there are different options. There is open surgery as well as endovascular surgery with stents placed. These days the majority are fixed with stents as this is less invasive and allows for a faster recovery. However, there are situations where an open repair is the better option.
