Certain health conditions are low-risk, but if they occur, exact a high cost. Detection of one of these conditions during a physical is a powerful benefit of having regularly scheduled physical exams performed by a knowledgeable doctor. An abdominal aortic aneurysm (AAA) is a condition with low odds of occurring but potentially very high health costs if it goes unnoticed for a long time. In men over 60 years old, the occurrence of AAA ranges from 1.2% to 3.3% in population studies, and prevalence in women is about one-sixth that of men (1). So, the odds are low. However, people who develop an abdominal aortic aneurysm could experience a severe health condition that could result in debilitating repercussions or death if not treated promptly.
What is an Abdominal Aortic Aneurysm (AAA)?
An aneurysm involves the compromised integrity of a blood vessel wall that allows it to puff out like a balloon when blood pressure increases. Eventually, the balloon can be stretched so thin that it ruptures (or dissects), allowing blood to seep into places it should not be. An aortic balloon or abnormality can be repaired by surgery if caught early, increasing the patient's odds of a long life. Left undiscovered, an aortic aneurysm can become an aortic rupture, which is a very dangerous situation.
Typically these aneurysms happen in the largest artery in the body, the aorta (2). There are two types of aortic aneurysms, a thoracic aortic aneurysm which occurs in the arteries leading to the heart, and an abdominal aortic aneurysm, which occurs in the artery leading down the torso and splitting to go into each leg. The aorta can be thought of as the super highway for blood in the body, connecting the upper body around the heart to the trunk of the body. If you press about three inches above your belly button using three fingers, you may feel the pulse of blood going through your aorta. Feeling this pulse in the abdomen without touching this area is actually a warning sign.
One would think that thoracic aortic aneurysms (TAAs) near the heart would be more common than abdominal aortic aneurysms (AAA), but that's not the case. The heart can create tremendous pressure as it attempts to pump blood to the far reaches of the body. Nearby arteries receive blood under high pressure from the heart muscle contraction, so the artery walls must be strong- but flexible enough to expand with the increase in pressure. Yet, despite this wear-and-tear, thoracic aneurysms near the heart are less common than abdominal aortic aneurysms (2).
There is a close relationship between endothelial dysfunction (arterial lining health), atherosclerosis (cholesterol plaque buildup in the arteries) and AAA. When the arteries are hardened due to plaques sticking to and getting embedded in the artery wall, that particular area is less vulnerable to thinning and "ballooning out" because it is thicker and stiffer. However, when blood is under pressure from the pumping of the heart, the areas right beside the hardened, thickened atherosclerotic patches have to make up for the lack of flexibility of the hardened area. There is an increased pressure on the thinner parts of the walls when atherosclerosis makes other parts of the artery walls inflexible. Additionally, the mechanisms that allow the aneurysm in the first place compromise many places in the artery, weakening it.
People usually don't have noticeable symptoms that foretell an abdominal aortic aneurysm rupture or even the presence of an abdominal aortic aneurysm. Unless they are screened frequently and catch the condition early, most people will only find out they have an AAA after it has ruptured (3). Besides an outright rupture, a slow leak or a tear may cause some noticeable symptoms (4). More severe symptoms are usually noticed with a rupture. In the few people that will have symptoms, AAAs can cause the following (2-4):
Feeling your "heartbeat" in your abdomen
Deep, constant pain in the abdomen, back, chest, or groin
Sudden, severe onset of pain in the abdomen or back
A sudden spike in heart rate
The integrity of artery walls depends on many factors, including diet, genetics, exercise, blood pressure, and blood sugar status, among others. Researchers have not pinned down an exact cause of AAA. However, smoking or being a former smoker dramatically increases risk. The CDC indicates that having "a history of smoking accounts for about 75% of all abdominal aortic aneurysms” (2), and the Mayo Clinic considers smoking the "strongest risk factor for aortic aneurysms” (5).
Even so, there are a variety of characteristics that can increase the risk of developing AAA. Johns Hopkins lists the risk factors for atherosclerosis as the risk factors for AAA because atherosclerosis plays such an essential role in AAA (3). Risk factors include:
Being male (4 or 5 times greater risk for males than females)
Increasing age (60 years or greater) - a U.K. study proclaimed the risk goes up 40% every five years after the age of 65 years old (6)
AAA in the immediate family
Having an aneurysm in other places in the body
Being a smoker or former smoker
Having certain medical conditions, including atherosclerosis, high cholesterol, high blood pressure, diabetes, obesity, connective tissue disorders, congenital disabilities in the heart structures, high inflammation in the arteries of the head and neck, previous staph, salmonella, or syphilis infections, and previous physical trauma.
A famous saying is, "An ounce of prevention is worth a pound of cure." This folk wisdom is certainly true in the case of abdominal aortic aneurysms because the presence of AAA can end in severe consequences if left undiscovered.
1. Early detection through screening allows time to prevent a rupture. While it's technically not prevention because the AAA is being detected after it has progressed, determining its presence gives a patient time to take measures against a dangerous rupture. At TCIM, screenings during an Executive Physical are non-invasive and involve ultrasound to detect irregularities in the size of the abdominal aorta.
Multiple population studies show that AAA screening in males 65 years old or over correlated with a 35% reduction in death due to AAA, a 38% reduction in the rate of AAA ruptures, and a 43% reduction in emergency surgeries (7) due to AAAs.
2. Master self-care basics. See our "Five Pillars of Health" outlined in many of our articles. These actions form the basis of robust health.
3. Address endothelial disruption. Since endothelial disruption is a part of the disease process in AAA, anything that prevents endothelial disruption will also help AAA. Check out the prevention tips in this article, which include several nutrition tips (such as increasing antioxidants and using particular cooking oils) and trying oxygen therapies.
4. Explore nutritional supplements with a long tradition in herbal medicine for supporting the maintenance of veins. Scientific evidence is validating nutritional remedies, proving through research experiments that some nutraceutical remedies deliver results. In particular, remedies that address hemorrhoids and varicose veins, which are swollen blood vessels in different places in the body (8), may help fortify the walls of all blood vessels.
Horse chestnut (Aesculus hippocastanum): Several studies show that horse chestnut is vessel protective, often used to support hemorrhoids, stiffness of the arteries (9), and chronic venous insufficiency (10).
Butcher's broom (Ruscus aculeatus): Often used for hemorrhoids and varicose veins, this supplement improves vascular tone and blood flow through capillaries, and strengthens a particular type of connective tissue found in the walls of capillaries, veins, and arteries (11).
Diosmin: Diosmin is a non-medication flavonoid used to treat varicose veins and chronic venous insufficiency as well as provide cardiovascular protection. While all its mechanisms of action are not completely understood, it is known to be strongly antioxidant and anti-inflammatory (12).
5. Address smoking and get screening if you ever smoked. If you're a smoker, please get help to quit. If you haven't started smoking, don't engage in this highly addictive practice that damages bodily health, especially arteries. Temecula Center for Integrative Medicine (TCIM) can support your withdrawal from smoking and connect you with medically approved services and resources. Additionally, the U.S. Preventive Services Task Force recommends male smokers (or former smokers) in the age range of 65-75 receive screening for AAA (2).
Treatments of AAA can be a mix of monitoring, addressing underlying conditions that increase risk, taking medication, or undergoing surgery (3).
Small, slow-growing, asymptomatic AAAs may simply require monitoring rather than surgery. After assessing the level of safety, the doctor may decide to monitor the situation while supporting the patient in addressing high-risk factors such as diabetes, high cholesterol, high blood pressure, or smoking. The doctor helps determine if exercise would be beneficial or risky for the patient, considering the size of the aneurysm and the patient's health history.
If screening detects a large or rapidly growing AAA, the patient could be referred to a doctor who specializes in aneurysm repair surgery (3). Surgery may be necessary to reduce the risk of a rupture. Surgical repair typically involves placing a supportive structure around or inside the artery or replacing a section of the damaged artery with a graft (a synthetic graft or part of another vessel from the patient's own body) (3).
Depending on the doctor's evaluation, other treatments or complementary therapies may also be suggested. Integrative medicine has much to offer, combining conventional treatments with complementary therapies such as oxygen therapies, acupuncture, and delivering powerful antioxidants through IV therapy.
Achieving and maintaining vibrant health can be made easier by making small, consistent steps rather than massive efforts after a frightening health event. Catching a potentially serious condition in the early stages can buy you weeks, months, or even years to address it. At TCIM, we offer advanced testing techniques and excellent diagnostic skills during our Executive Physicals to save you time and effort. Regular physical examinations can prevent costly visits to the hospital, and the time and physical effort needed to recover, ensuring that you are maximally available to your family. We're aware that some people feel like they are "too far gone" for help, but we know that the human body is an amazing, resilient mechanism that always strives for health and can benefit from even the tiniest stepping stone. We're privileged to help you find that next stepping stone on your path to health.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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