Abdominal Aortic Aneurysm Screening

If an aneurysm is found during the screening, next steps will be determined by the size of the aneurysm.

For men, an aneurysm of 5.5 centimeters or larger must be surgically repaired. (For women, that threshold is 5 centimeters or larger.)

For men, if an aneurysm is found that is smaller than 5.5 cm, you will need to have follow-up imaging to monitor the aneurysm according to the following schedule:

• 5 – 5.5 cm: every 6 months
• 4 – 5 cm: every year
• 3 – 4 cm: every 3 years
• 2.5 – 3cm: every 10 years

Your aorta is the large artery that leaves your heart and carries oxygen rich blood to the rest of your body. As the blood flows from the heart through the aorta, it’s carried to other parts of the body like your intestines, spine and legs by smaller arteries that “branch” away from it.

When a patient develops an aortic aneurysm (a ballooning out of the walls of the aorta), many times these branches are affected. Aortic aneurysms are a dangerous weakening of the walls of the main artery in the abdomen that can have serious health consequences, including artery ruptures and internal bleeding.

• When the walls of the aorta become weakened they may begin to bulge outwards. This bulge is considered an aneurysm when it is more than 1.5 times the size of your normal aorta. An aneurysm can occur anywhere in the aorta.
• Thoracic Aortic Aneurysm (TAA): TAA occurs in the section of aorta that runs through the chest. This includes the ascending aorta, the part of the aorta closest to the heart, the aortic arch, and the descending aorta that leads down to the abdomen.
• Abdominal Aortic Aneurysm (AAA): The majority (greater than 75 percent) of aortic aneurysms occur in the abdomen. Most develop below the kidney arteries, however, they become more complex when they involve the kidney arteries and the arteries that supply blood to the intestines.

Many diseases and conditions can cause the aorta to widen or can cause a tear or dissection, increasing your risk for future life-threatening events. Conditions that can lead to aortic aneurysm and aortic dissection include:

• Atherosclerosis (hardening of the arteries)
• Hypertension (high blood pressure)
• Cigarette smoking
• Family history of aortic aneurysms
• Genetic connective tissue disorders (e.g., Marfan Syndrome or Ehler-Danlos Syndrome)
• Physical trauma to the chest or abdomen

There are many factors that determine when an aneurysm needs to be treated. The size and rate of growth of the aneurysm are the major factors. Aneurysms larger than 5.5 centimeters are considered for repair. In deciding whether or not to recommend repair, your surgeon will consider the size of your aneurysm, the location of your aneurysm, how fast it’s growing, how complicated it is to repair and your overall health. Surgery will only be recommended when your estimated risk of surgery is less than the estimated risk that your aneurysm will rupture.

According to the Society of Thoracic Surgeons, aortic aneurysms are the 13th leading cause of death in the United States. The potential for rupture increases as the aneurysm grows larger. Because of this, your surgeon may suggest “watchful waiting” with routine surveillance imaging in the form of CT scans or ultrasounds to closely monitor its size and characteristics. Or, if your aneurysm reaches a point where its size and characteristics become concerning, surgery may be recommended.