Abdominal and Aortic Aneurysms – The Silent Killer

Aortic aneurysms are one of the most common causes of sudden death (especially in men over 60) and are frequently considered the “silent killer,” due to patients often not showing any symptoms until the aneurysm ruptures, leading to morbidity in 75% of cases.

The aorta is the largest blood vessel in the body. Although tough and durable, sometimes its walls can weaken and bulge in what is called an aortic aneurysm. On diagnosis of an abdominal aneurysm, in most cases, there is also a high chance of a having a blood clot. These small clots can form around the aneurysm and have the potential to break off and flow into the heart, legs, kidneys, or other organs, which in turn may lead to heart attacks, kidney damage and stroke. An untreated case might also lead to a rupture in the aorta, resulting in tearing pain in the abdomen, flank, groin, or back and may lead to loss of consciousness, and eventually death.

Aortic aneurysms can occur in two possible locations; when located in the chest is known as a thoracic aortic aneurysm (TAA) and when occurring in the abdomen it is known as an abdominal aortic aneurysm (AAA).

Causes and Symptoms

Like in many cases, genetics play a pivotal role in a person's chances of having an aortic aneurysm. Other conditions which can affect the aorta include a bicuspid aortic valve, Marfan syndrome, and Loeys-Dietz syndrome.

Other contributing factors include:

• Smoking
• High blood pressure
• Infection
• Plaque buildup in the arteries (atherosclerosis)
• High cholesterol
• Sudden traumatic injury

Cautionary signs to be aware of:

• Chest or back pain unrelated to orthopedic ailments
• Difficulty breathing or swallowing
• Shortness of breath
• Hoarseness
• A deep pain on the side of the abdomen
• A throbbing sensation near the navel

Detection, Diagnosis & Prevention

An abdominal aortic aneurysm can be detected during a routine exam, and medical research has found that approximately 30% of asymptomatic AAA’s are discovered as a pulsating abdominal mass on routine physical examinations. An attending physician may also suggest an ultrasound screening, especially if the patient is in a higher risk category such as males between the ages of 65 to 75 with a history of smoking.  It is also recommended that men over the age of 60 with a family history of AAA undergo regular screenings for the condition. In families with confirmed familial TAA, it is suggested that both men and women start screening at the age of 25 years, or 10 years below the youngest case in the family if the latter is below 25 years. 

For people at high risk of developing an aortic aneurysm, it is important to avoid smoking and maintain healthy blood pressure. For people already diagnosed with small aneurysms (or in cases of fragile patients), medical management strategies can require the use of statins and occasionally beta blockers. Routine ultrasound studies are frequently obtained in such cases, to monitor the aneurysm’s growth.