Aortic Aneurysms

Diagnosis

While technology has improved the ease of diagnosis of AAA, an “old-fashioned” history and physical examination are critical in the assessment and diagnosis of this problem. Abdominal aortic aneurysms do tend to “run in families”–hence, genetics are important. Interestingly, when there is a female in the family that has had an AAA, this tends to be more familial than a male relative. Patients with chronic lung disease (COPD) seem to be at higher risk for rupture of an AAA than others and those with a history of smoking also seem to be at risk. Hypertension (high blood pressure) is another independent risk factor for aneurysms. A careful examination of the abdomen can identify an AAA in thinner patients. Unfortunately, in patients who have a more rotund abdomen, the physical examination is less reliable as the aneurysm may be impossible to feel—even by the trained physician. Many AAAs are found incidentally when tests are performed for other reasons. It is not uncommon for patients to have an x-ray for back pain or a CT Scan for an unrelated reason (for example, looking for prostate disease or trying to determine the cause of abdominal pain) and the radiologist will find an AAA. It is very uncommon for an aneurysm itself to cause pain (unless it has ruptured) and thus the surprise when it is found during a test looking for something else.

The Noninvasive Vascular Laboratory is one of the most reliable and safest places to diagnose and follow an abdominal aortic aneurysm. Using ultrasound, the AAA can be seen and measured. Ultrasound does not use radiation and is safe and accurate when performed by an experienced Registered Vascular Technologist such as those at The Cardiovascular Care Group. It is important for the test to be done in an accredited laboratory, as the size of the AAA is critical in determining the management. Quite frequently, an AAA can be safely watched over time to see if it is growing and at what rate it is expanding ( if at all.) Since a few millimeters can make a difference, repeating the test at predetermined intervals by the same laboratory is extremely important. Vascular Laboratories specialize in this examination and should be utilized for this purpose. Other test, such as CT Scans and Magnetic Resonance Imaging (MRI) also allow for the diagnosis of AAA. These tests, however, require radiation (CT scan) and the use of contrast (dye) that makes them more invasive than an ultrasound. However, they are invaluable once the decision has been made to proceed with surgery as they provide information that is important in the decision-making process that might not be available with the use of ultrasound technology.