Aneurysms. They can strike fear in the healthiest of adults because of their reputation for bursting suddenly – and fatally.
An aneurysm is a weakening or bulging of an artery wall. Almost exclusive to adults over 40, aneurysms contribute to more than 25,000 deaths in the United States each year.
But contrary to common belief, there are steps you can take to prevent, identify, and manage aneurysms, keeping them from developing, or, if you already have one, from bursting.
Before we get there, though, let’s talk about the various places where aneurysms form.
Types of Aneurysms
There are three types of aneurysms: abdominal aortic, thoracic aortic, and cerebral.
Abdominal aortic aneurysms, sometimes known as “Triple A,” are the most common aneurysms of the aorta – the large blood vessel that carries blood away from your heart and through your body.
Given the aorta’s reach and size (it’s almost an inch wide in places), substantial internal bleeding occurs when blood pressure increases against the aorta’s walls, causing it to rupture. Sometimes mistaken for a heart attack, an abdominal aortic rupture can be characterized by chest and jaw pain, stabbing abdominal or back pain, fainting, difficulty breathing, and weakness on one side of the body.
Thoracic aortic aneurysms develop in the portion of the aorta that passes through the chest. Also like abdominal aortic aneurysms, thoracic aortic aneurysms are largely asymptomatic – so you’re unlikely to know that it’s lurking. However, some symptoms to look out for are back pain, hoarseness, shortness of breath, or tenderness or pain in the chest prior to a thoracic aneurysm’s rupture.
Cerebral aneurysms are weakened, bulging vessels above the aorta, in the brain. These are most common in people from ages 30 to 60. While cerebral aneurysms can be tiny and not cause any problems, larger ones can rupture causing bleeding in the brain and potentially becoming fatal.
How can I find out if I have one?
Most aneurysms are discovered during screenings for other conditions. However, if aneurysms run in your family, there are several ways to find out if you have one. Ultrasound is the recommended test when screening for abdominal aortic aneurysms. Chest x-rays pick up thoracic aortic aneurysms. MRIs or CT scans with angiography are the best bet for detecting aneurysms in the brain.
Prevention and Management
Some aneurysms are hereditary, but the large majority is due in some part to habits or conditions that contribute to high blood pressure including obesity and smoking. A healthy diet, exercise, and medication can keep aneurysms from spiraling out of control.
“A lot of aneurysm patients are on lipid-lowering medicines like statins,” explains Dr. Paul J. Foley, vascular surgeon at Hospital of the University of Pennsylvania. “There is some evidence to suggest that statins can not only improve cardio health, but can also stabilize smaller aneurysms, keeping them from growing.”
Treatment
If an aneurysm exists, surgery to prevent rupture is an option – but not a given.
Not all aneurysms need to be fixed,” explains Dr. Foley. “Many are small and should be followed, but aren’t necessarily candidates for preventative surgery.
Aneurysms are measured in centimeters, and are rated by their size.
The larger the aneurysm, the larger the risk of rupture,” Dr. Foley says. “The risk for rupture takes off dramatically around the 5.5 cm mark. If an aneurysm is smaller than 5.5 cm it can be followed closely and there’s a low risk of rupture.
In cases where preventative surgery makes sense, a minimally invasive aortic stent can be inserted into the aorta. Because of the risk of complication, preventative surgery for brain aneurysms is conducted even more carefully.
But Dr. Foley cautions patients against jumping solely to surgery as the go-to treatment.
We make the most impact by helping patients live overall healthy lives through changes that are more far-reaching than simply putting a stent in. I encourage patients to take advantage of programs we have here at Penn Medicine for smoking cessation, aggressively lowering blood pressure and cholesterol, and for managing diabetes. When patients adhere to these positive changes, they see all-over positive results and experience peace of mind.