Don’t let an abdominal aortic aneurysm surprise you

Think of an abdominal aortic aneurysm – a bulge or enlarged area in your body’s major blood roadway – as a time bomb. If it bursts, things are not going to go well.

“It’s rather like continuing to put air in a balloon; the balloon will continue to grow bigger,” said Elizabeth Mahanor, MD, FACS, a vascular surgeon with Cape Cod Healthcare’s Vascular Care Group in Hyannis and Mashpee. “Then, unfortunately, aneurysms will burst if they reach a certain size. When it bursts, this is a very bad day for the patient. About 90 percent die before making it to the hospital because there’s a hole in the biggest blood vessel you own.”

Abdominal aortic aneurysm, or AAA, ranks 15th in leading causes of death among people ages 55 to 85, according to research cited by the National Institutes of Health. Risk factors include a history of smoking, which accounts for about 75 percent of all AAAs, according to the NIH. And it doesn’t matter how long ago you quit, Dr. Mahanor said. Other risk factors include high blood pressure, genetics and gender. Men are four times as likely to have an AAA, although the reason is unknown, the NIH says.

So how can you avoid this unwelcome surprise? Dr. Mahanor, whose practice does two to four abdominal aortic aneurysms surgeries a month, recently chatted about AAA and how it can be prevented and treated. (Her answers have been edited for length.)

What is an abdominal aortic aneurysm?

The basic definition of an aneurysm for any blood vessel is if it's one and a half to two times bigger than average. Sometimes it can be the whole thing, or it can be a part.

The biggest vessel is the aorta and an aneurysm could happen either in the chest or in the belly. The abdomen is where they occur the most.

What indicates you are a candidate for screening for AAA?

You’re a candidate if you have a history of smoking and high blood pressure at age 65 or higher, particularly men, since they're the ones that get it more so than women. But women do get them. Usually screening is part of the Medicare intake exam, usually at age 65.

How do you screen for abdominal aortic aneurysm?

An ultrasound is a great way to start. Also, a lot of aneurysms are found incidentally on an X-ray done for a completely different reason. CAT scans and other things are being used so much more frequently now. And so many times that will pick something up that either we or the patient were not aware of.

What’s the ultrasound like?

It's the exact same type of ultrasound that would be used during pregnancy. They’ll put the gel on the abdomen and use the wand to try and get a look at the aorta and the abdomen behind. It actually lives behind everything, so sometimes it can be hard to see if the intestines are full of gas or other things. But usually the techs are really savvy and excellent at what they do, so they can generally get a good look.

What happens if you spot something?

It depends on size. If an aneurysm is small, then we will continue to watch it with ultrasound. If it’s above a certain size or it grows quickly, that will get our attention. Then we’ll do a CAT scan to get a really good look at the anatomy and pinpoint the exact size and location.

And what happens if you think it needs to be fixed?

There are a couple of different ways it can be done. The older way is open surgery where we make an incision and we sew in a graft or a brand new aorta. These are not done as much because of the newer technology: stents. When we put a stent in, we are lining a pipe with another pipe so that the blood will flow through the stent. The goal is to not have blood flow into that weakened aneurysm sack anymore.

How do you get the stent into the body?

Stents start at about 22 mm (about ¾ of an inch) and they go up from there. They are basically all rolled up, furled like a flag. We go in through the femoral artery or an incision in the skin using what we call a sheath – basically a really large IV. When we’re happy with the position, we open the stent. The newer ones also allow you to recapture it. So, if we’re not happy with the placement, we can move it up or down. It really is super cool. This is just an amazing thing because most patients will go home the day after the stent. There’s increased comfort if you do the percutaneous – going in through the skin.

What is recovery like for the stent patient?

It’s generally a matter of days for most folks. There are some restrictions afterwards. We don’t want heavy lifting. We don’t want you to drive for a few days. It’s typical things that you might anticipate after any surgery, but the recovery tends to be pretty quick once the general anesthesia is out of your system. If you had open surgery, you’d be in the hospital anywhere from five to 10 days. And then the recovery time was an awful lot longer because of pain and incisions. Now it’s rare we even have to give pain medications afterwards because it is so much less invasive.

What can I do to avoid an abdominal aortic aneurysm?

If you have been a smoker, that puts you at increased risk to have one. But if you continue to smoke, it will cause them to grow. And, control your blood pressure. Those are probably the top two things people can do.