You are here:

Screening savvy: You’re likely at low risk for abdominal aortic aneurysm

A bulging abdominal aortic aneurysm can be deadly, but only certain men should be checked for it with ultrasound.

The aorta is the Amazon River of arteries. It rises from the heart to feed a multitude of lesser vessels that branch through the chest and abdomen. Over a lifetime, the portion that plunges downward toward the kidneys and legs—the abdominal aorta—can become weakened by disease in the vessel wall. Gradually it may bulge outward, forming an abdominal aortic aneurysm (AAA). If the bulge ruptures like the wall of an old tire, the result is often fatal.

A simple ultrasound scan can reveal a hidden aneurysm in an otherwise healthy man. The test is done to see if an AAA exists, to monitor it, and to decide when it should be fixed. The key is knowing your risk and getting checked if it makes sense.

“Certainly any men who have smoked should get checked when they are 65, and earlier if they have a family history,” says Dr. Marc Schermerhorn, chief of the division of vascular
and endovascular surgery at Harvard-affiliated Beth Israel Deaconess Medical Center.

For many, it will be a one-time aorta checkup, Dr. Schermerhorn says. “If it’s a completely normal aorta, then they probably don’t need another study.”

Who is at risk?

Smoking harms the aorta wall and starts a process that can lead to a weakened, diseased aorta later. “There’s some data to suggest that the more men smoked, or if they currently smoke, the risk is greater,” Dr. Schermerhorn says. “But there are quite a few people who have smoked less, which was enough to start the process.”

Men are also at higher risk for AAA if they had a close relative, like a father or brother, who had an AAA that required repair or that ruptured. These men could consider being screened earlier, in their 50s, and then again five to 10 years later, although the research support for this is not absolutely clear.

Abdominal aortic aneurysm (AAA)

Abdominal aortic aneurysm (AAA)

Weakened by disease, the wall of the abdominal aorta can develop a bulge, or abdominal aortic aneurysm (AAA). Rupture is often fatal.

Weigh the risks

The decision to be checked for AAA balances the relatively small chance of an aneurysm rupture against the high risk of death associated with it. A man 65 and older who smoked at any time has a one-in-20 lifetime risk of having an AAA.

Although it’s a small risk overall, AAA rupture is hard to predict and can be fatal. “There are typically no symptoms until it’s about to rupture or rupturing,” Dr. Schermerhorn says. The internal bleeding could cause severe abdominal or back pain, nausea, dizziness, weakness, and fainting. The chance of survival is slim without immediate treatment. If there are any warning signs, a man might feel a strong pulse in his abdomen, or a sudden, sharp pain in the abdomen or lower back.

Most men with AAAs will live out their lives without experiencing rupture. Doctors will do follow-up ultrasounds to see if the bulge grows. If the AAA grows beyond a diameter of 5.5 centimeters (about 2 inches), surgery could be considered. At that point the risk of rupture is up to 15% per year.

Low risk, low reward

If you have never smoked and have no family history, the chance you will develop an AAA in your lifetime is quite low—about one in 100. If you opt for a “just in case” screening test anyway, you would be looking for a disease you most likely don’t have.

Why not do it anyway—just in case?

Although the ultrasound itself is harmless, it could lead to additional follow-up testing. Such testing will probably not help you, and it will cost time and money. You could be harmed if the follow-up testing leads to surgery. Scans often pick up incidental spots and unclear indications that also lead to follow-up, so that “simple” test could get complicated. Make sure you know what you are getting yourself into and why.

Medical centers and other organizations sponsor screening events for AAA ultrasound. In some cases, it is free. Men on Medicare are eligible for AAA screening if thy meet the two conditions listed in “Consider AAA screening if,” above. “The people who have a history of smoking are at highest risk and need screening the most,” Dr. Schermerhorn says.

Posted by: Dr.Health

Back to Top