What is a AAA? It is an increase in the diameter of the walls of the aorta in one area, in this case, the abdomen. The aorta is the “water main” for supplying blood to the body from the heart.
Abnormal enlargement weakens the walls and increases the rupture risk. If the aorta ruptures, hemorrhaging creates a substantial likelihood of death.
Estimates suggest that AAAs occur in 4 to 9 percent of the population. Fortunately, there are possible interventions if they are caught before they rupture.
While the cause of AAA is not known, it is thought that inflammation and oxidative stress play an important role in weakening smooth muscle in the aorta.
People who are at highest risk for aneurysms are those over age 60. Other risk factors include atherosclerosis or hardened arteries; high blood pressure; race (Caucasian); gender (male); family history; smoking; and having a history of aneurysms in other arteries.
Men are more than four times more likely to have a AAA; however, women are at a higher risk of having one rupture.
Is it important to get screened?
Yes, especially if you have risk factors. Although some people do experience nondescript symptoms, such as pain in the abdomen, back or flank pain, most cases are asymptomatic. A smaller AAA is less likely to rupture and can be monitored closely with noninvasive diagnostic tools, such as ultrasound and CT scan.
What are the treatments?
There are no specific medications that prevent or treat abdominal aortic aneurysms directly. Medications for treating risk factors, such as high blood pressure, have no direct impact on an aneurysm’s size or progression. But the mainstay of treatment is surgery to prevent rupture.
When to watch and wait and when to treat is a difficult question; surgery is not without its complications and risk of death is higher than many other surgeries.
Size is the most important factor. In women, AAAs over 5.0 cm may need immediate treatment, while in men, those over 5.5 cm may need immediate treatment. Smaller AAAs are trickier.
The growth rate is important, so patients should have an ultrasound or CT scan every six to 12 months. If you have an aneurysm, discuss this with your physician.
One of the most powerful tools is prevention with lifestyle changes, including smoking cessation and dietary changes.
Smoking has the greatest impact, because it directly impacts the occurrence and size of an AAA. It increases the risk of medium-to-large size aneurysms by at least fivefold. One study found that smoking was responsible for 78 percent of aortic aneurysms larger than 4 cm. For those who smoke, this is a wake-up call.
Increasing your fruit intake can have a significant impact. The results of two prospective (forward-looking) study populations, Cohort of Swedish Men and the Swedish Mammography Cohort Study, showed that consumption of greater than two servings of fruit a day decreased the risk of a AAA by 25 percent.
If you do have an AAA, this same amount of fruit also decreased the risk of AAA rupture by 43 percent. This study involved over 80,000 men and women, ages 46 to 84, with a follow-up of 13 years.
The authors believe that fruit’s impact may have to do with its antioxidant properties; it may reduce the oxidative stress that can cause these types of aneurysms.
So, what have we learned? Screening for AAA may be very important, especially as we age and if we have a family history. To reduce your risk, lifestyle changes, including smoking cessation and increased fruit intake, are no-brainers.