Abdominal Aortic Aneurysms: What You Need to Know

Abdominal Aortic Aneurysms (AAA) might sound like a mouthful, but understanding them is important for your health. Picture your aorta as a big, stretchy hose carrying blood from your heart to your belly and legs. If there is a weak spot the pressure in the aorta can cause it to balloon out and if it stretches far enough it can rupture. This is an abdominal aortic aneurysm. It can be dangerous if it bursts, so catching it early is key.

Why Screening Matters
The United States Preventative Services Task Force (USPSTF) recommends screening for AAA for certain people at higher risk. This includes men over 65 who are or were smokers and some men over 65 even if they never smoked if they have other risk factors,  women who are or were smokers, but not for women who never smoked unless they have a family history of AAA. Screening means checking if your aorta is healthy and catching any issues before they become big problems.

The Screening Process
Screening for AAA is simple and painless. Doctors often use an ultrasound, like the ones used to check babies in pregnant bellies. You just lie down, and a small device is moved over your belly to take pictures. These images help doctors see if your aorta is healthy or if there's a problem.

Benefits of Screening
Getting screened helps catch any issues early, so you can take action to keep yourself healthy. If a small AAA is found, your doctor can keep an eye on it and make sure it doesn’t grow. They can also recommend lifestyle changes like quitting smoking or managing high blood pressure, which can help prevent AAA from getting worse.

Risks of AAA and Rupture
AAA can be scary because they often have no symptoms until they burst. Imagine a water balloon getting bigger and bigger until it pops. That's what can happen with an AAA. If it bursts, it can cause sudden, severe pain in your belly or back, and it's a medical emergency that needs surgery right away. Sadly, many people don't survive if this happens. If the sonogram detects that the aneurysm has reached a critical size then your doctor may recommend that you have a procedure to repair the aneurysm. Sometimes its possible to achieve this goal with a stent that is introduced through an artery in the groin. This non-surgical approach may not always be an option due to the size and location of the aneurysm or for other technical reasons. In those cases surgery may be recommended.

Balancing Risks and Benefits
Like everything in medicine, screening for AAA has both risks and benefits. The main risk is finding something that might not actually harm you. Sometimes, small AAAs are found that never cause any problems. And there is also the risk of finding something that doctors call "incidentalomas". These are incidental abnormal findings which are usually harmless but require additional testing that may require x-ray exposure or even invasive testing but which turn out to be nothing and yield no significant health benefits. On the other hand without the sonogram there's the risk of missing something important. If an AAA isn't found until it's big or bursts, it can be very dangerous. The goal as in all testing is to identify which people who are at greatest risk and would gain enough benefit to out weigh the risks of the tests.

What are the main risk factors?

There are a number of factors that increase the risk of developing a AAA. No one risk factor alone will determine if someone will develop a AAA but the more risk factors a patient has the greater their lifetime risk.

• Age: The risk of AAA increases with age, especially in individuals over 65 years old.
• Gender: Men are at higher risk of developing AAA compared to women.
• Smoking: Smoking is one of the most significant risk factors for AAA. Smokers have a much higher risk of developing an AAA compared to non-smokers.
• Family History: Having a close family member, such as a parent or sibling, who has had an AAA increases your risk of developing one yourself.
• High Blood Pressure (Hypertension): Chronic high blood pressure can weaken the walls of the aorta over time, making it more prone to developing aneurysms.

Who Should Get Screened?
The decision to get screened for AAA depends on your risk factors and age. If you're over 65 and have ever smoked or have a family history of AAA, talk to your doctor about screening. Even if you don't have any risk factors, it's good to ask your doctor about AAA during your regular check-ups. (See USPSTF link below for specific recommendations)

What You Can Do
Whether or not you get screened, there are things you can do to keep your aorta healthy. Quitting smoking is one of the best things you can do to lower your risk of AAA. Eating a healthy diet, exercising regularly, and managing conditions like high blood pressure and cholesterol also help keep your blood vessels strong.

Final Thoughts
Abdominal aortic aneurysms might be hard to say, but they're important to understand. Screening for AAA in high risk individuals can help catch any issues early and prevent them from becoming serious. If you're at higher risk, talk to your doctor about getting screened. And remember, taking care of your overall health is the best way to keep your aorta and the rest of your body happy and strong.