Vascular Surgeon Rumi Faizer, MD, calls aortic aneurysms a “silent killer”—with good reason.
Unless found by accident—usually during a routine, unrelated medical test—aortic aneurysms may go undetected until they rupture, at which point a person only has minutes to live.
We sat down with Faizer, who sees patients at University of Minnesota Medical Center, to get his answers to some common questions patients may have about aortic aneurysms, including preventive health, possible treatments and risk factors.
Aortic aneurysms are a swelling and weakening in the wall of the aorta, the main artery in the human body. If the aneurysm is not found and identified, it may burst, causing significant and often fatal bleeding. The normal diameter of the aorta is 2 centimeters—or less than 1 inch across. An aneurysm occurs when a portion of the aorta has enlarged to at least 1.5 times its normal size. Aortic aneurysms less than 5 centimeters (2 inches) in size have a low chance of bursting, but an aneurysm more than 6 centimeters in size has a 10 percent chance of rupturing in a year, Faizer said. Many aneurysms go undetected until they burst. Most aneurysms found before a rupture are discovered by accident during an unrelated medical test, Faizer said.
Men are at much higher risk of developing an aneurysm than women, Faizer said. A family history of aneurysms can also increase your risk. For example, a man whose brother was diagnosed with an aortic aneurysm has a one in four chance of suffering one as well. Smoking, obesity, age and high blood pressure can all put a person at higher risk for aneurysms. But Faizer emphasizes that anyone—even people in excellent physical condition—can suffer an aneurysm.
Patients at higher risk for an aortic aneurysm can adopt heart-healthy lifestyle changes, including low-fat and low-cholesterol diets, more physical activity and smoking cessation, Faizer said. Your doctor may also recommend statins, beta blockers or other prescriptions that are generally helpful for the cardiovascular system.
If the aneurysm is less than 5 centimeters in size, your doctor may recommend monitoring and some heart- and cardiovascular-healthy lifestyle changes. Smaller aneurysms rarely rupture, and grow at an average rate of one-third of a centimeter each year. If the aneurysm is more than 5 centimeters in size, or is enlarging rapidly, doctors may recommend surgery to repair the aneurysm. In most cases, doctors will run a catheter through the patient’s femoral artery in the groin to the site of the aneurysm in the aorta, then implant a stent graft. The stent graft reinforces the weakened aorta and eventually the aneurysm will shrink around the graft. Under experienced care, this procedure is often possible with essentially no incisions—only punctures. Though most treatment centers in the nation require patients to be under general anesthesia for a stent graft, our highly specialized M Health care team are able to perform these procedures with only local anesthesia and mild sedation. This approach allows for treatment of about 80 percent of abdominal aortic aneurysms. The remaining 20 percent of aneurysms are often better treated with open surgery to provide a definite cure in a place where a stent graft may be less durable.
The majority aneurysms are small and do not require surgery, but Faizer says the presence of an aneurysm may indicate the patient has related health concerns that need attention.
“The aneurysm is a marker. It is a warning sign as well as being in itself dangerous. It’s warning you about the possibility of heart disease,” Faizer said.
University of Minnesota Health multidisciplinary care teams are leaders in successfully treating aortic aneurysms. Our uniquely equipped “hybrid” operating room and the high level of expertise our care teams possess allows us to treat both low- and high-risk patients. Because we offer state-of-the-art technology and care team expertise, we are leaders in providing aneurysm repair options for high-risk patients. Most repairs can be done without incisions or the stress of general anesthesia, which reduces the risk for patients with heart or lung problems. These advances mean even low-risk patients can get back to their daily routine faster.
University of Minnesota Health experts have developed a pilot program to help primary care doctors determine who should receive an ultrasound screening to detect aortic aneurysms on the basis of a number of health factors. M Health also maintains Minnesota’s life-saving Code Red Aortic Hotline.
“We probably have one of the most advanced vascular surgery facilities and teams for doing this in the country,” Faizer said. “We have the advanced planning capabilities and the broad array of therapeutic options to manage—and in most cases prevent—almost any crisis.”