Ask the Doctors 6/19

Dear Doctor: My dad was having an ultrasound because it seemed like he might have kidney stones, and they found what the doctor thinks might be a small aortic aneurysm. Why does someone get them, and how are they treated?

Dear Reader: An aneurysm is a balloonlike widening within the wall of an artery. In an aortic aneurysm, this has occurred along the aorta. That’s the major blood vessel that carries oxygen-rich blood away from the heart and through the chest and the abdomen.

An aneurysm is cause for concern for several reasons. Any change to the normal tubular structure of blood vessels throughout the body can adversely affect heart function. More important, larger aneurysms create the risk of structural damage to the blood vessel itself. Every beat of the heart results in pressure on the artery walls. The rhythmic force of blood moving through the aorta can gradually enlarge the thinner and weaker walls of an aneurysm, and also fracture them. When the walls of an aortic aneurysm split and allow blood to leak out, it’s known as a dissection. The balloonlike bulge of an aneurysm can also burst, which is known as a rupture. Both are medical emergencies, and are the major causes of death due to aneurysms.

Aortic aneurysms fall into two major categories – thoracic and abdominal. The former occur in the chest. Since your father’s was discovered during a scan of his lower torso, it’s likely that he has been diagnosed with an abdominal aneurysm. One of the major risk factors for developing an aortic aneurysm is a history of tobacco use, which weakens the arterial walls over time. Studies of smokers found they had five times the risk of developing an abdominal aortic aneurysm as nonsmokers. The good news is that quitting smoking was associated with a measurable lessening of that risk. Additional risk factors include being a male, being over 65, being white, having had a previous aneurysm and a family history of the condition.

Diagnosis of an aortic aneurysm often occurs as it did with your dad – in the course of an examination for another condition. When it comes to treatment, the goal is to prevent dissection or rupture. The specific approach depends on two things – the size of the aneurysm and how quickly it is growing. A small and static aneurysm may call for watchful waiting. That includes regular scans to monitor if the aneurysm is growing or has begun to leak. Large, unstable aneurysms typically require surgery.

For patients with any type of aneurysm, it’s crucial to mitigate the risk factors that can be managed. That means taking immediate steps to getting and keeping high blood pressure under control, both with lifestyle changes and medication. And for smokers, that means quitting. Patients are also asked to avoid vigorous physical activity, including heavy lifting, to avoid pressure on the abdomen. If someone experiences sudden abdominal or back pain, low blood pressure or unexplained dizziness or weakness, this can be sign of a dissection or a rupture. Immediate medical care is imperative.

Send your questions to askthedoctors@mednet.ucla.edu.