Aneurysms: Know the Risks

There are at least 60,000 miles of blood vessels in the human body. Oxygen-rich blood is pumped from the heart into the aorta, the mother of all arteries. Branching out from this crucial blood supply, the arterial network delivers oxygen to all parts of the body. So when the aorta springs a leak, you have a big problem.

If the arterial wall weakens and bulges, it creates an aneurysm. And if the aneurysm ruptures, blood flow is interrupted. About 13,000 Americans die each year from aortic aneurysms, according to the National Heart Lung and Blood Institute, making it the 13th leading cause of death in the United States.

Aneurysms can form in the upper part of the aorta (thoracic) or the lower part (abdominal). “Abdominal aortic aneurysms are much more common, and they’re treatable,” says Dr. Gordon Knight, a cardiothoracic surgeon at Des Peres Hospital. When aortic aneur - ysms are detected before they burst, they can be reinforced to help prevent rupture.

Most aortic aneurysm repairs are performed with minimally invasive techniques, known as endovascular surgery. Knight uses this approach for at least 80 percent of the abdominal aortic aneurysm repairs he performs. The procedure involves inserting a catheter into the groin and threading it through the artery to the site of the aneurysm. The surgeon then deploys and fastens a small fabric mesh tube, known as a stent graft, to the interior wall of aorta, which stabilizes the artery.

That’s all well and good for those who are lucky enough to discover an aneurysm before it ruptures. However, most aneurysms are asymptomatic. “A lot of them are picked up incidentally from people who fall and have X-rays on their back due to back pain or from other screening tests,” Gordon says.

Yet physicians don’t recommend that everyone run out to get screened. The Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services, recommends a one-time screening test for men between the ages of 65 and 75 who have ever smoked cigarettes. Other men and women should talk with their physician about screening if they are especially concerned or have had a first-degree relative diagnosed with an aneurysm.

The aorta is not the only location where a life-threatening aneurysm can occur. About 3 million Americans develop a brain aneurysm, and about 30,000 of those rupture each year, causing bleeding into the brain. Like aortic aneurysms, many brain aneurysms are diagnosed when the patient undergoes tests for headaches or other neurological problems, says Dr. Armond Levy, a neurosurgeon with the SSM Neurosciences Institute at St. Clare Health Center.

“I probably operate on about 40 aneurysms a year, some endovascular and some through traditional open craniotomy surgical approaches,” he says. He estimates that about half of the aneurysms he treats have not ruptured prior to surgery.

Like an aortic aneurysm rupture, brain aneurysms that burst are life-threatening emergencies. Patients often report a sudden onset of the most severe headache ever experienced. Aortic aneurysm ruptures similarly present with sudden, severe abdominal and back pain. Internal bleeding can result quickly in loss of consciousness and shock, and medical intervention is needed immediately.

Still, “it’s not worthwhile to blindly screen everybody,” Levy reiterates. “It’s not even worthwhile to screen people just because they have headaches. And there’s been some controversy (about screening) in the medical field.” Many aneurysms never rupture, and there are risks associated with the preventive surgical procedures, he points out.

Screening recommendations may become a topic for broader debate in the medical community as new types of genome screening become more widely available. Preliminary research shows that a new process, called whole exome sequencing, can identify rare gene mutations that may increase brain aneurysm risk.

Until such innovations become more standard, however, risk is best assessed and screening recommended on an individual basis after discussion between patient and physician.