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The weakest link: Understanding abdominal aortic aneurysm

Robert Napoletano, M.D. [August 20 2010]

An aneurysm is a bulge in an artery, a vein or the heart wall. A bulge in the aorta is called an aortic aneurysm. Sometimes the aneurysm occurs in the chest, but about 90 percent of it forms in the abdomen. Three out of four people with an abdominal aortic aneurysm (AAA) have no symptoms, although some patients may feel kidney pain; intense, intermittent abdominal pain; or a pulsating sensation in the stomach.

What causes an AAA?
When the aortic wall in your abdomen weakens or becomes damaged by plaque buildup, an aneurysm can result. Aneurysms that grow too large can burst, causing potentially fatal internal bleeding. Aortic aneurysms occur most often in men older than 65, particularly those who smoke. Most are caused by atherosclerosis—hardening of the arteries, which can result from a fatty, high-cholesterol diet. Other risk factors are high blood pressure, illnesses such as diabetes or syphilis, congenital defects and a family history of aneurysms.
AAA treatment depends on its size and whether it is life-threatening. Most aneurysms are less than 2 inches in diameter and seldom rupture. In this case, your doctor will likely monitor the aneurysm and prescribe blood pressure–lowering medication. But if your AAA leaks, is small but grows quickly, expands over 2 inches or seems about to burst, your doctor may perform surgery.
During open surgery, your doctor will remove the damaged section of the aorta and sew a synthetic tube, or graft, in its place. Doctors can also use less-invasive endovascular surgery to reinforce the damaged section by inserting a synthetic tube, or stent, via an artery in your leg.
A ruptured aneurysm can be fatal, so immediate medical attention is needed. Symptoms of a rupture include sudden, severe pain with rapid pulse, sweatiness or clamminess, anxiety, nausea and vomiting, low blood pressure, dizziness, fainting, dry mouth and paleness. Fortunately, most AAAs rarely reach this point.

The best advice: See your doctor regularly and adopt lifestyle changes that can decrease AAA risk, including:
• not smoking
• eating a low-fat, low-cholesterol diet
• exercising regularly
• controlling your blood pressure
If you're older than 55 and suffer from hardening of the arteries, talk to your doctor about further precautions, such as taking medication to help lower blood pressure.

Robert Napoletano, M.D., is a general surgeon and vascular surgeon at The Hospital of Central Connecticut and a co-director of the hospital's Vascular Center. http://thocc.org/services/vascular/