Abdominal Aortic Aneurysm
Many of our patients have heard of aneurysms, although most associate them with the brain. An aneurysm is a weakened section of arterial wall that bulges significantly due to increased pressure within the blood vessel. The aorta is a large artery that runs through the trunk of the human body. Much like an artery in the brain, an aneurysm can occur in the aorta as well. Most aortic aneurysms happen in the abdomen – They are known as abdominal aortic aneurysms / AAA or Triple A.
Abdominal aortic aneurysms are a very serious concern as they tend to get progressively worse over time. Once the aneurysm forms, the outpoutching worsens until it eventually ruptures or dissects the artery. A rupture or dissection can be fatal, if not treated immediately. Ideally, the aneurysm is found before it causes a life-threatening situation.
Causes of Abdominal Aortic Aneurysms
The risk factors associated with abdominal aortic aneurysms are similar to the risk factors of cardiovascular disease as a whole. These include advanced age, family history and genetics, hypertension, high cholesterol, smoking, diabetes and obesity. Male patients have a significantly higher risk of developing AAA than females, however women with larger aneurysms have a greater likelihood of a rupture than men.
Certain diseases, traumas and infections can also increase the risk of AAA.
Symptoms of Abdominal Aortic Aneurysms
Up to 75% of abdominal aortic aneurysms are asymptomatic – in other words, they have no symptoms at all. Typically, these aneurysms are found incidentally, when the patient is being scanned for other concerns. X-rays, CT scans and MRIs can all potentially detect an asymptomatic aortic aneurysm.
For the quarter of patients that do experience symptoms, the most common sign is pain. This pain may be sharp or dull and exist in one or more areas of the chest, abdomen, back or groin. Severe pain may indicate imminent rupture. As with any abdominal pain, it should be evaluated urgently.
Consequences of Untreated Abdominal Aortic Aneurysms
As mentioned before, aneurysms tend to be progressive. This progression may be rapid or slow depending on patient. While not all aneurysms will rupture, the likelihood increases as the aneurysm becomes bigger. Because of the severity of the consequences of a rupture, it is important that swift action be taken to mitigate its effects. Of course, some patients have no signs of an aneurysm and therefore are not screened. Patients who have a sudden onset of symptoms should seek urgent medical care at an emergency room or by dialing 911.
Recent Research into Antibiotics and Aortic Aneurysms
In December 2018, the Food and Drug Administration or FDA reported that certain antibiotics have been shown to increase the risk of aortic aneurysm in high risk patients. These antibiotics, known as Fluoroquinolone, are often used to treat a wide range of bacterial infections. Common brand names include Cipro, Factive, Levaquin, Avelox, Noroxin and Floxin. If any of the risk factors mentioned above apply to you and you are prescribed these antibiotics, please make your prescribing doctor aware. We also encourage you to call our office to ensure that the benefits outweigh the risks. If you are currently taking these antibiotics, do not stop. Rather, call our office promptly and continue taking your medication until you have received the advice of your cardiologist. While the risk of aortic aneurysm remains low, the FDA has decided that it is significant enough to make a public announcement.
Common Treatments for Aortic Aneurysms
Treatment options largely depend on the rate at which the aneurysm is growing. Smaller and slow-growing aneurysms are often monitored by your cardiologist with periodic MRI or CT scans. Certain medications and lifestyle changes (reducing blood pressure, quitting smoking, losing weight, etc.) to reduce cardiovascular risk can also be employed. Larger and fast-growing aortic aneurysms have a greater chance of rupture and are often treated with surgery. This can include repair or removal of the aneurysm or inserting a stent to minimize the chance of rupture.
Surgical Treatment for Abdominal Aortic Aneurysms
Traditionally, open surgery has been the primary invasive treatment for an abdominal aortic aneurysm. Newer technology has allowed this same surgery to be performed using an endovascular technique (approaching the aneurysm from within a blood vessel).
Open surgery requires a large incision in the abdomen to repair the aorta. A specially made fabric graft is then sewn to the aorta to strengthen the arterial wall. This is the most common technique and is the only options for all AAAs above the kidneys.
An endovascular repair requires just one small incision in the groin. Using fluoroscopy or continuous x-ray, a stent and graft is placed using a catheter threaded through a vein. Currently this is only available for patients with an AAAs beneath the level of the kidneys.
Endovascular repair of AAA requires a shorter recovery, a lower likelihood of infection and hernias at the incision site, less pain and a lower potential for blood loss.
As with any invasive procedure, a patient’s surgical risk will be taken into account when choosing the appropriate technique for repair of the aneurysm.