Prevention of Aortic Aneurysms

Aortic aneurysm rupture is a medical crisis. About 80 percent of those who experience a ruptured aortic aneurysm do not survive.

Prevention of aortic aneurysms is based on lifestyle modification. And prevention of aortic aneurysm rupture requires screening and, possibly, surgical intervention to repair the aneurysm. 

Lifestyle Modification

Risk factors, such as family history and gender, cannot be controlled. However, some of the other risk factors for aortic aneurysm and aortic aneurysm rupture can be modified in ways that reduce your risk of developing an aortic aneurysm or of experiencing a rupture of the aneurysm if you already have one.

An aortic aneurysm, a bulge in the aorta, can form due to longstanding vascular disease (blood vessel disease). Vascular disease is characterized by weakness, inflammation, and atherosclerosis (stiffening and hardening) of the blood vessels, including the aorta. Certain lifestyle modifications can decrease your chances of developing these problems: 

  • Quit smoking: Smoking is a leading risk factor for aortic aneurysm development. If you smoke, you are at high risk of developing vascular disease. The longer you continue to smoke, the worse your vascular disease will become. Medications intended to reduce the severity of vascular disease are not powerful enough to counteract the effects of smoking if you continue to smoke. 
  • Maintain a healthy diet: Your diet has an impact on your risk of atherosclerosis, which makes you susceptible to developing an aortic aneurysm. A diet that is high in trans fats, fats that are found commonly in deep-fried food, put you at high risk of developing vascular disease. 
  • Exercise regularly: Exercise has been shown to lower the harmful fats in your body and to raise the level of healthy fats. This reduces your risk of developing the vascular disease that predisposes you to aortic aneurysms. 
  • Control stress: Stress is a factor that contributes to hypertension which, in turn, leads to vascular disease. While stress is not always a major factor in vascular disease, for some people it exacerbates the disease, causing a profoundly negative impact on health. Stress control strategies vary widely, but can be quite effective, and include reading, mindfulness, meditation, spiritual practice, socialization, and cognitive restructuring. 

    If you have already had an aortic aneurysm, preventing it from rupturing is of vital importance. At-home lifestyle modifications cannot actually prevent an aneurysm from rupturing. However, the most important thing you can do to prevent an aortic aneurysm from rupturing is to get routine medical care. Most aortic aneurysms do not cause symptoms, so screening and regular medical check-ups provide you with an opportunity for diagnosis at an early stage. 

    Medication

    If you have medical conditions, such as high blood pressure and atherosclerosis, that predispose you to aortic aneurysms, treatment of these conditions can reduce your chances of developing an aortic aneurysm.

    There are a variety of anti-hypertensive medications which are used to reduce high blood pressure. There are a number of factors, in addition to your blood pressure, that your doctor considers when selecting the right anti-hypertensive medication for you, including your heart and kidney function.

    Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors—cardiac medications that affect the ability of the blood vessels to dilate (widen)—have been shown to slow dangerous dilatation of the aorta. This can potentially avert the rupture of an aortic aneurysm. Statins, a class of medications used to lower cholesterol, also appear to reduce the growth of aortic aneurysms slightly.

    Additionally, research suggests that certain antibiotics, such as doxycycline, may inhibit aneurysm growth. While antibiotics have many benefits, using them for a prolonged period of time can put you at risk of antibiotic resistance which makes it difficult for you to be effectively treated for a bacterial infection if you develop one. A number of small, preliminary studies have produced encouraging results in terms of the effect of antibiotic use on aortic aneurysms, but larger studies are still needed.

    Screening and Observation

    An estimated 300,000 Americans have undetected aortic aneurysms, which are often small in size and may not cause any symptoms. Screening tests may be recommended based on risk factors. 

    Typically, small aneurysms are only discovered during a physical examination or during an imaging test for another condition. The U.S. Preventative Services Task Force recommends ultrasound screening for men who are between the ages of 65 to 75 who have ever smoked. Selective screening, which is based on an individualized medical history and physical examination, is recommended for men who have never smoked and for all women. 

    If you have a small aortic aneurysm, or if you have a larger aneurysm but your medical condition makes surgery a high risk, then your medical team may decide that it is best to carefully observe your aortic aneurysm. Your doctors may schedule you for regular physical examinations to check on your symptoms and to monitor whether your aortic aneurysm can be detected by physical examination.

    You may also need to have periodic ultrasounds to follow any growth or change in the shape or appearance of your aortic aneurysm as well as to check for leaking. If you develop any symptoms during the time when your aortic aneurysm is being medically monitored, you should contact your doctor immediately. 

    Rupture Prevention

    Surgical or endovascular repair of aortic aneurysms that have not ruptured is often necessary to reduce the risk of rupture. It is recommended that aortic aneurysms that are larger than 5 to 5.5 cm in diameter or that show evidence of growth, should be repaired. The reason for this is that there is a greater risk of rupture when an aneurysm is larger in size. 

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