Ex-smokers should be screened for abdominal aortic aneurysms

Dear Mayo Clinic, My 70 year old father-in-law smoked for over 30 years. I’ve read that men who have smoked in the past should be screened for an abdominal aortic aneurysm. What does this screening include? What to do if he is diagnosed with an aneurysm?

answers: A number of factors can increase the risk of developing an abdominal aortic aneurysm. One of the most important is tobacco use. In addition to the direct harmful effects that smoking has on the arteries, smoking contributes to the buildup of fatty deposits in the arteries and to high blood pressure. Smoking can also cause an aneurysm to grow faster by damaging the wall of the aorta.

Other risk factors include a family history of abdominal aortic aneurysms, being male, and having atherosclerosis, which is a condition in which fat and other substances build up in the lining of your blood vessels. The risk of an abdominal aortic aneurysm also increases with age.

Given his smoking history and age, you are right that your father-in-law should be evaluated for an abdominal aortic aneurysm.

Recommended screening usually includes a physical exam and an abdominal ultrasound. In some cases, other imaging tests may also be necessary. If an abdominal aortic aneurysm is found, treatment depends on the size of the aneurysm, its growth rate, and whether it’s causing symptoms.

The aorta is a large garden hose-sized blood vessel that runs from your heart through the middle of your chest and abdomen. Two types of aortic aneurysms can occur in the vessel wall. An abdominal aortic aneurysm is a bulge in the aorta just above the area of ​​your belly button that forms due to weakness in the blood vessel wall. A thoracic aneurysm can also occur along the part of the vessel that runs through the chest cavity. The greatest risk of such an aneurysm is that it could rupture. Because it provides the body with much of its blood supply, a rupture in the abdominal aorta can lead to life-threatening internal bleeding.

Because of the various risk factors, many health organizations, including the Mayo Clinic, recommend that men ages 65 to 75 who are or have been smokers be screened for an abdominal aortic aneurysm. Men and women who have a family history of the disease may need to start screening earlier. Currently, data on screening women with a prior history of smoking are inconclusive for screening for abdominal aortic aneurysms.

Screening is important because in most cases, aneurysms grow slowly and cause no noticeable signs or symptoms until they rupture. Although rare, an abdominal aortic aneurysm that has not ruptured can trigger persistent back pain; deep, constant abdominal pain; or a throbbing sensation near the belly button.

Symptoms of a ruptured abdominal aortic aneurysm include sudden back pain, abdominal pain, or fainting. If your father-in-law experiences any of these symptoms, it’s important that he gets emergency medical care right away.

If a screening test finds an aneurysm, surgery to repair the aneurysm is usually recommended if the aneurysm is 5.5 centimeters or larger, if it is growing rapidly, or if it is causing pain or showing signs of blood clots forming. If an aneurysm is small, growing slowly, and not causing bothersome symptoms, a doctor may recommend monitoring it regularly without immediate treatment.

Although an abdominal aortic aneurysm is a potentially serious health condition, the outlook is good if these aneurysms are caught early. Even large aneurysms can often be successfully repaired.

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