January 29, 2014
News Review From Harvard Medical School -- More Men May Benefit from Aneurysm Test
Older male smokers should receive a one-time test to see if they have a swelling of the aorta in the abdomen. And the newest advice says that some male nonsmokers may benefit, too. The advice comes from the U.S. Preventive Services Task Force. An enlarged section of artery is called an aneurysm. An abdominal aortic aneurysm (AAA) is most likely to occur in men who are current or past smokers. The task force recommends a one-time ultrasound scan for AAA for men ages 65 to 75 who have ever smoked. The latest update says that some men in the same age group who have never smoked also may benefit from a one-time ultrasound. They include men with a parent or sibling who had AAA or a personal history of aneurysm in another location. Those with heart or artery disease also might be at risk. Others who might benefit from screening include older men with diabetes, high blood pressure, high cholesterol or obesity. The task force said there is not enough evidence to recommend screening for women who smoke. The AAA risk for nonsmoking women is very low. HealthDay News wrote about the advice January 27.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
This new report includes minimal changes from earlier advice about screening for an abdominal aortic aneurysm (AAA, pronounced "triple A"). The U.S. Preventive Services Task Force says that men between the ages of 65 and 75 should have a one-time screening for AAA if they have ever smoked.
An aneurysm is a bulge in an artery caused by a weak spot in the artery wall. It is usually the result of fatty deposits that build up and damage the artery wall.
The aorta is the artery that comes directly out of the heart and runs down the back side of the abdomen. The part inside the belly is called the abdominal aorta. An abdominal aortic aneurysm happens when that part of the aorta enlarges.
Besides screening male smokers, the updated guidelines recommend doctors also consider a one-time screening for some male nonsmokers. Screening could benefit nonsmokers between the ages of 65 and 75 who have other factors that increase their risk of developing an aneurysm. Risk factors include:
- Having a parent, brother or sister with AAA
- A history of having an aneurysm in a different location
- Known atherosclerosis (hardening of the arteries caused by fatty buildup). An example would be coronary artery disease or narrow arteries in the neck or brain.
- High blood pressure
- High cholesterol
The test used to look for an abdominal aneurysm is an ultrasound. It's very safe. Harmless radio waves create a picture of the aorta within the belly. This provides a way to measure the width of the aorta.
The size of an aneurysm is directly related to the risk of rupture. The bigger it is, the greater the risk. Doctors want to find an aneurysm before it ruptures (bursts). That's because most aneurysms don't cause any symptoms until they rupture. But you don't want that to ever happen. Once an aneurysm breaks open, the risk of dying is high.
Regarding screening for women, the update states that ultrasound screening offers no benefit in female nonsmokers. For women age 65 to 75 who smoke, there is not enough evidence to determine if screening should be offered.
The U.S. Preventive Services Task Force has posted the updates on its website for comment before making the advice official.
What Changes Can I Make Now?
The one best way to help prevent AAA is to not smoke. You can also reduce your risk of developing an aortic aneurysm by:
- Being physically active and dedicating time each day to exercise
- Eating a healthy diet
- Keeping blood pressure in the normal range
- Lowering your LDL (bad) cholesterol if it is high
- Maintaining a healthy weight
An abdominal aorta found to be wider than 3.0 centimeters (a little more than 1 inch) is called a AAA. Once a AAA is discovered, you should have regular ultrasounds to see if it is getting bigger. For men, with a AAA size of:
- 3.0 to 3.9 centimeters, repeat ultrasound every 2 years
- 4.0 to 4.9 centimeters, repeat ultrasound every 12 months
- 5.0 to 5.4 centimeters, repeat ultrasound every 6 months
- 5.5 centimeters or larger, almost always surgery is needed to repair it
For women found to have a AAA, there is not enough information on how often you should repeat ultrasounds and when surgery is needed. If a woman patient has an aneurysm that reaches 4.5 centimeters, I refer her to a vascular surgeon. That doesn't mean a procedure always needs to be done right away. More frequent ultrasounds might be enough.
What Can I Expect Looking to the Future?
The risk of surgery to repair a large AAA that has not ruptured continues to decline. Today, most are treated with a minimally invasive procedure known as endovascular repair.
In this procedure, a new lining for the aorta is delivered through a tube inserted into a blood vessel. The procedure requires only two tiny slits or punctures in the abdomen. You stay in the hospital only one or two nights. And recovery is much quicker than with traditional surgery that required a large cut in the abdomen.