Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a focal enlargement of the major artery in the abdomen. If it ruptures it carries a 60-80% mortality rate. Abdominal aortic aneurysms are more common in males (85%) than females (15%). They are more common with increase in age and are found in 5% of individuals of over 60 years of age. If the patient has a blood relative with an abdominal aortic aneurysm, the incidence increases to 20%. They are the tenth leading cause of death in males and fifteenth leading cause of death overall.

Factors associated with developing an abdominal aortic aneurysm are age, white race, male, family history, smoking and hypertension. The majority of abdominal aortic aneurysms cause no symptoms and are found incidentally by an ultrasound or CT scan of the abdomen for other complaints. If the aneurysm is large enough, a pulsatile mass may be felt in the abdomen by the patient or examining physician.

On rare occasions they do cause back or abdominal pain. Pieces of the aneurysm wall may actually break off and go downstream to the lower extremities and cause symptoms. The rupture of an abdominal aortic aneurysm often mimics other abdominal catastrophes with abdominal pain and shock in 70% of the cases.

The risk of rupture increases with size of the aneurysm, smoking and history of hypertension. If the aneurysm measures 4 cm, the chance of rupture in five years is 15%. If the aneurysm increases in size to 8 cm, the five-year rupture rate is 75%. Since the death rate of abdominal aortic aneurysm rupture is 80%, it is recommended they be repaired once they reach 5 cm in diameter (two inches or greater). If the aneurysm measures less than 5 cm, the rupture rate is fairly low and the risk of surgery outweighs the risk of observation. The risk of open surgery is 2-4 % with open repair when the aneurysm is not ruptured and less with the new endoluminal technique.

Elective repair of abdominal aortic aneurysm involves a large abdominal incision and replacing the major artery in the abdomen with a Dacron graft. Within the last few years a new technique has been developed that involves incisions in the groin and placing of the graft within the aneurysm excluding the aneurysm, and the surgical risk is much less.

There are occasional free screenings in the Baton Rouge area for abdominal aortic aneurysms through Aneurysm Outreach. This organization can be contacted at 225 673-0682 or 225-622-1577.

Our practice, Vascular Associates, in conjunction with the Society for Vascular Surgery, provides free screening for abdominal aortic aneurysm and other vascular diseases once a year, usually in May. There is another screening company called Lifeline Screening, which screens for abdominal aortic aneurysm and other vascular diseases for a nominal fee. Aneurysm Outreach has a web site (www.alink.org) that can accessed for more information on abdominal aortic aneurysm.

John D. Frusha, MD is a board certified vascular surgeon with Vascular Associates of Baton Rouge.