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DEAR MAYO CLINIC: My father, who is 70, was a smoker for 30 years. I have read that men who used to smoke should be screened for an abdominal aortic aneurysm. What does the screening involve? What would be done if he is found to have an aneurysm?
ANSWER: Because of his history of smoking, you are correct that your father should be screened for an abdominal aortic aneurysm. The screening usually includes a physical exam and an ultrasound of the abdomen. Other imaging tests may be needed in some cases, too. If an abdominal aortic aneurysm is found, treatment depends on the size of the aneurysm, its rate of growth, and if it is causing any symptoms.
The aorta is a large blood vessel about the size of a garden hose that runs from your heart through the center of your chest and abdomen. An abdominal aortic aneurysm is a bulge in the aorta just above the area of your belly button that forms due to weakness in the blood vessel’s wall. The greatest risk of such an aneurysm is that it will rupture. Because it provides the body with much of its blood supply, a rupture in the abdominal aorta can lead to life-threatening internal bleeding.
A number of factors can raise the risk of developing an abdominal aortic aneurysm. One of the most significant is tobacco use. In addition to the direct damaging effects that smoking has on arteries, smoking contributes to the buildup of fatty plaques in the arteries, as well as high blood pressure. Smoking also can cause an aneurysm to grow faster by damaging the wall of the aorta.
Other risk factors include a family history of abdominal aortic aneurysm, male gender, and having atherosclerosis — a condition where fat and other substances build up in the lining of your blood vessels. The risk of an abdominal aortic aneurysm also goes up with age. Most people who have this condition are 65 or older.
Based on these risk factors, many health care organizations, including Mayo Clinic, recommend that men who are smokers or who have smoked in the past get screened for an abdominal aortic aneurysm beginning at age 65. Men and women who have a family history of the disease may need to begin screening earlier. Some organizations recommend that screening begin at age 55.
Most abdominal aortic aneurysms can be detected through a physical exam combined with an imaging test, such as an abdominal ultrasound, CT scan or MRI. Using these screening tools is very important because in the vast majority of cases, aneurysms grow slowly and do not cause any noticeable signs or symptoms until they rupture. Rarely, an abdominal aortic aneurysm that has not ruptured may trigger persistent back pain; deep, constant abdominal pain; or a pulsating feeling near the belly button.
Symptoms of a ruptured abdominal aortic aneurysm include sudden back pain, abdominal pain or fainting. If your father experiences any of these symptoms, it is critical that he receives emergency medical care right away.
If an aneurysm is found on a screening exam, surgery to repair the aneurysm typically is recommended if the aneurysm is 5.5 centimeters in size or larger, if it is growing rapidly, or if it causes pain or shows evidence of forming blood clots. If an aneurysm is small, growing slowly and not causing any bothersome symptoms, a doctor may recommend monitoring it regularly without immediate treatment.
Although having an abdominal aortic aneurysm is a potentially serious health condition, the outlook is good when these aneurysms are identified early. Even large aneurysms can often be successfully repaired. Encourage your father to schedule an appointment with his doctor to be screened for an abdominal aortic aneurysm. — Peter Gloviczki, M.D., Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.