AneurysmScreening

Clinical, diagnostic ultrasound is the first line method to diagnose many diseases of the circulatory system. Ultrasound generates images, usually in two dimensions, on a computer screen of structures within the body by sending out high frequency soundwaves and analyzing the resultant echo. Frequencies are typically between 2.5 million and 10 million cycles per second (Hertz or Hz). The pictures shown here are from real patients taken within the past year by me as ordered by a physician, physicians assistant, or family nurse practitioner.

Ultrasound is the first line test (in the ideal environment) ordered to diagnose abdominal aortic aneurysm (AAA). Typical reasons may be usual abdominal pain that radiates between the shoulder blades, a spinal x-ray that may be suggestive of an abnormally large aorta, a physical exam wherein the physician may appreciate an abnormal pulsitile aorta, and family history of aneurysm. Family history is powerful, but not all powerful. Generally, aortic aneurysms in first degree family members (Father, Mother, Brother, Sister) are more significant that aneurysm in ones Uncles or Aunts.

Those at risk for development of abdominal (and even thoracic) aneurysm include hypertensives, diabetics, smokers, those significantly overweight, and heart disease patients. Also, AAA typically only develop in those older than 55 years, although I have seen significant aneurysms in younger patients (unusual). In my experience more men that women develop AAA. If you smoke, stop. The damage inflicted upon the vascular system is remarkable and impressive. If you are at risk as defined above and do not smoke, you are less likely to develop AAA.

A normal abdominal aorta is an average person of average build should not exceed 3.0 cm. Any aorta measuring greater than 3.0 cm. is defined as an aneurysm. The walls of the aorta stretch and become weak over time. The widening may be symmetrical or asymmetrial, up 'high' (proximal) near the rib cage, in the middle portion of the aorta at the level of the stomach (mid), or 'down' (distally) near the belly button. It seems as though most AAA develop in the mid portion, at or just below where the arteries that supply the kidneys branch off of the aorta. Generally, AAA will increase in size about up to .5 cm. per year until such time that if the diameter reaches 5.0 cm. or greater, a surgical evaluation for resection of the aorta may be considered. The key thing is discovery of the AAA at its earliest and smallest, then disengaging from risks or lifestyles that may increase the risk for further progression. If one is overweight, lose weight. If one smokes, stop. If one is hypertensive, treat it. If family history, make sure your first degree relations are tested.

Better medical institutions today enage in endograft repair of AAA. A Dacron or similar synthetic tube is inserted inside the dilated aorta. The native aorta is left in the body and the aneurysm is thus repaired without the need for potentially complicated traditional excision, removal, and reconnecting of the good parts of the remaining aorta with a synthetic tube.

Others tests that may be appropriate in the setting of abdominal aortic aneurysm include a transthoracic echocardiogram, carotid duplex exam, ankle/brachial index, and careful monitoring of blood pressure. The power of ultrasound in diagnosing this and other circulatory abnormalities can not be overstated. Ultrasound imaging, even brief 'screening ultrasounds' in the hands of a trained sonographer (whether physician or not) can identify a AAA and other life threatening abnormalities under one (1) minute. Please look for other information on this topic.

All my best, and am happy to engage in any questions or comments.