abdominal aortic aneurysm
Detecting abdominal aortic aneurysms at an early stage
The risk of enlargement (known as aneurysm) of the abdominal aorta increases significantly from a certain age, and preventive early detection screening is therefore recommended from the age of 65. The preventive screening is carried out completely painlessly using an ultrasound device, and the diameter of the abdominal aorta is determined. This diameter can then be used to calculate the percentage risk of rupture.
Sometimes this screening examination may be useful at an earlier stage —for example, if there is a family history of this disease or if there is abdominal and back pain for which there is no other explanation.
Diagnosis & Therapy
Regular monitoring is advisable
An enlargement of the abdominal aorta is a dangerous condition in men with a transverse diameter of 5.0 cm or more and in women with a diameter of 4.5 cm or more, because if the abdominal aorta ruptures, there is an immediate risk of death. Since an aneurysm of the abdominal aorta often does not cause any pain even at these critical diameters, the abdominal aorta should be examined regularly from a certain age onwards. Even smaller bulges that have already been discovered below this critical diameter can be monitored for progressive growth.
It is important to always assess on a case-by-case basis whether the risk posed by an aneurysm justifies surgical intervention. The decision always depends on the individual case and the patient's overall condition. Many patients also find it burdensome to know that they have an aneurysm and want it removed.
If the decision is made to perform surgery, both a classic surgical procedure involving an abdominal incision and replacement of the dilated abdominal aorta with a polyester prosthesis (known as a tube or Y prosthesis) and interventional stent placement via two small incisions in the groin (known as EVAR = endovascular aortic repair) are possible options.
Stent placement is significantly less invasive and associated with fewer complications, but it is not suitable for every type of aneurysm.
In my practice, I take the time to conduct a comprehensive consultation and a detailed ultrasound examination, and I explain the advantages and disadvantages of surgical treatment of the abdominal aorta to you in detail.
Frequently asked questions about abdominal aortic aneurysms
An abdominal aortic aneurysm is a dilation of the abdominal aorta. By definition, a dilation of the abdominal aorta is considered to be a diameter of 1.7 cm in women and 2.0 cm in men. There are several reasons why an aneurysm can develop in the abdominal cavity: high blood pressure, smoking, elevated blood lipids, and diabetes mellitus can lead to damage to the wall of the abdominal aorta, resulting in an enlargement of the vessel diameter. However, abdominal aortic aneurysms are often genetic and are frequently inherited, particularly in the male line (father to son).
Testing for the presence of an abdominal aortic aneurysm is very simple: a painless ultrasound scan can usually determine the diameter of the abdominal aorta within a few seconds. If the abdominal aorta is dilated to more than 4 cm, imaging with, for example, computed tomography (CT) is recommended to determine the exact size, as ultrasound can sometimes underestimate the true diameter of the aneurysm. If an abdominal aortic aneurysm is present, an examination of the popliteal arteries should always be performed as well, as there is a connection between an abdominal aortic aneurysm and enlargement of the popliteal artery.
An aneurysm of the abdominal aorta with a diameter of less than 5 cm in men or less than 4.5 cm in women and no symptoms (abdominal or back pain) is initially treated conservatively. This means optimizing risk factors, in particular good blood pressure control and stopping smoking. However, its size should then be monitored regularly with ultrasound. If invasive treatment becomes necessary, the aneurysm is now usually sealed from the inside using a minimally invasive interventional procedure with a covered stent graft (known as EVAR = endovascular aortic repair). Access to the abdominal aorta is gained via the vessels in the groin. Traditional surgery involving an incision in the abdomen, open repair, and suturing of a prosthesis is now only necessary in very rare cases.
Statutory health insurance companies recommend screening for abdominal aortic aneurysms from the age of 65. However, if there is a family history of the condition, it is also advisable to undergo screening at a younger age, as aortic aneurysms are often genetically passed on to the next generation.
An abdominal aortic aneurysm is dangerous because it can rupture and cause life-threatening bleeding. The risk of aneurysm rupture increases with the diameter of the abdominal aorta. It is approximately 5 percent per year for men with a diameter of 5.0 cm or more and for women with a diameter of 4.5 cm or more. Treatment is therefore recommended above this diameter.
Impressions from practice
