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Newswise — Herbert Shaw would rather do almost anything than see a doctor. But when he started having trouble digesting food last spring, he knew he needed medical attention. A doctor ordered a CT scan and discovered a grapefruit-sized bulge in Shaw’s aorta. Shaw, 75, was diagnosed with an aortic aneurysm, a bulge or ballooning in the body’s main blood vessel.

A former pack-a-day smoker, Shaw fits the profile of someone at risk for an aneurysm, even though he quit smoking more than two decades ago. That’s because current and former smokers are significantly more likely to develop an aortic aneurysm than nonsmokers. High blood pressure and family history are also risk factors.

The danger can go hidden because aneurysms don’t typically cause symptoms, although they can sometimes lead to indigestion, as was the case for Shaw, or more subtle issues. If an aneurysm keeps growing, it can burst—most people in whom this happens die from internal bleeding. That’s why vascular surgeons urge people like Shaw to get imaging tests that can help physicians find an aneurysm.

“If you have a family history of an aortic aneurysm, or you are a smoker, you should be screened,” said Cedars-Sinai vascular surgeon .

Chou explained that people at risk can see a primary care doctor, a cardiologist or a vascular surgeon for an imaging test such as an ultrasound or CT scan. Studies report that among people who get screened, about 3%-8% are diagnosed with abdominal aortic aneurysm.

An electrician and handyman who likes to stay active, Shaw had choices to make to prevent life-threatening rupture: minimally invasive catheter-based surgery or open surgery through an incision?

When Shaw met Chou, he learned his best option for his condition and lifestyle was an open surgery, where Chou and team would create an incision in the abdomen, sew a tube to the healthy parts of the aorta, and remove the aneurysm.

For people who have a smaller aortic aneurysm, a vascular surgeon will recommend an annual CT scan to see if it grows.

“Some aneurysms do not grow for many years,” said Chou, who is also assistant professor of Vascular Surgery in the at Cedars-Sinai. “Some people may never need surgery or any sort of repair, only routine monitoring.” She added that research is underway to help physicians understand why some aneurysms grow and some stay the same.

If an aneurysm reaches a certain size—about 5 ½ centimeters in men and 5 centimeters in women—a vascular surgeon typically recommends surgery.

Some patients may benefit from a minimally invasive surgery, during which a catheter is threaded through an incision in a patient’s groin until it reaches the aneurysm. The surgeon positions a tube in the area of the aneurysm and relines the aorta and aneurysm to divert blood flow into the relined aorta and away from the aneurysm. This option is usually recommended for patients who are older, frail, and generally wouldn’t recover well from an open surgery.  Some people also choose this option because they prefer a less invasive approach and are willing to undergo annual follow-ups to make sure the relining remains intact.

Shaw felt confident in Chou’s recommendation for an open surgery

“I live on a ranch,” he said. “I toss around bales of hay and 50-pound bags of horse feed. I need to be totally well. Anything other than a completely replaced artery was not acceptable because of my lifestyle.”

Chou said the most important part of the process is for patients to understand what the aneurysm is and how it affects their life.

“There are pros and cons to open surgery, minimally invasive surgery, and watching and waiting,” she said. “Our utmost priority is ensuring that each patient is comfortable with their decision. What we want people to know is that they need to be screened, and we will take the next steps together.”

After almost a week of recovery in the hospital and four weeks of recovery with light activity at home, Shaw returned to horseback riding on his ranch in Santa Maria, California.

“This could have ruptured at any time,” he said. “I was a walking time bomb. Now I’m totally healthy.”

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Photo Captions (from top to bottom):

• Elizabeth Chou, MD. Photo by Cedars-Sinai.
• Herbert Shaw leads an active life on his ranch. Photo courtesy of Herbert Shaw.