An aneurysm is a dilation of a blood vessel and is a condition that can occur anywhere in the body. Some locations are more common than others and they cause different problems depending on which blood vessel is affected. The most common arteries affected are those in the brain, the aorta in the chest and abdomen, and the popliteal arteries in the legs. Aneurysms in the brain (intracranial aneurysms) are treated by neurosurgeons. Almost all others are managed by vascular surgeons.
Risk Factors for aortic aneurysms
There are four main risk factors for developing an aortic aneurysm.
1. Smoking: Cigarette smoke contains hundreds of toxic chemicals, some of which damage the elastic tissue in the aortic wall. As the aorta loses elasticity, it is prone to forming an aneurysm. Smoking has also been shown to accelerate the rate of growth of aortic aneurysms.
2. Sex: Men are more likely to develop abdominal aortic aneurysms than women. Thoracic aneurysms affect men and women equally.
3. Age: Advanced age increases the likelihood of developing an aneurysm.
4. Family History: Genetics, or a history of aneurysms in the family, increases a patient’s risk of developing one themselves.
Who Should Be Screened for an Aortic Aneurysm?
Medicare will cover a screening exam [(AAA Screen) –link to non-invasive vascular lab AAA Screening] for men aged 65-75 who have smoked a total of 100 cigarettes or more in their lifetime.
Any person with a family history of aneurysms
How do we monitor patients with a small aneurysm?
Abdominal aortic aneurysms are frequently found during a screening exam or when imaging of the abdomen is obtained for other reasons. If a small aneurysm (one that is not large enough to warrant treatment) is found, the importance of routine surveillance cannot be overstated because aneurysms tend to enlarge over time. While there are many patient-specific factors we consider when determining a surveillance plan, generally, aortic aneurysms grow 2-3 millimeters per year; therefore the frequency and type of surveillance depends on the size of the aneurysm when it is initially discovered. In most cases, the threshold for repair is 5.5cm.
Aneurysm Size Follow-Up Interval Test
<3.0cm 3-5 years Ultrasound 3.0 -3.9cm 2-3 years Ultrasound 4.0-4.4cm 2 years Ultrasound 4.5 -4.9cm 1 year Ultrasound 5.0 – 5.4cm 6 months CT scan vs Ultrasound 5.5cm – Threshold for repair