DRHOOK- Triple threat: Aortic aneurysms can be deadly

the handsome doctor John Hong

AAA, C, 9-volt, Lithium batteries: Why are there so many different types? The problem with having so many different types of batteries is that you never have the one you need. 

Sure, that Energizer Bunny keeps going, and going, and going– but the commercial doesn't show you scrambling around to find the right type of battery for your flashlight during a power outage, TV remote during channel surfing, or keyboard while IM'ing your friends. 

AAA batteries are the worst because they seem to last only a week, and most products require AA batteries instead. Can we just do away with AAA?

I wish we could do away with AAA (Abdominal Aortic Aneurysm, AKA "Triple A") in the medical world. An aneurysm is a dilated blood vessel in a particular area. You know how a clown makes fun things with those skinny long balloons? Think of the long skinny balloon with only a small section blown up. That blown up area is basically what an aneurysm is in an artery. 

Aneurysms can occur in the brain arteries or any artery, but the abdominal aorta is the #1 type of aneurysm. It usually occurs around the level of the navel. So if you think you have a "navel orange" (meaning a beating mass just above the belly button), it could be an AAA. The abdominal aorta normally is 2.0cm in diameter; 3.0cm or larger is considered an aneurysm.

About 9,000-15,000 people a year die from AAA in this country, mostly men over 70 who smoke. If the AAA ruptures, it can cause rapid death from the bleeding. Only about 50 percent of people with an AAA rupture will make it alive to the ER, and of those who do make it, only half will survive. Ergo, the overall survival rate is 25 percent.

The problem with AAA is that, like so many other things, there are usually no symptoms until it ruptures. Rarely, the aneurysm will cause abdominal or back pain, but usually the severe pain doesn't occur until after the fact. Because blood pressure drops, folks with heart disease might start to have a heart attack!

Usually, the AAA is found incidentally on an abdominal ultrasound or CT scan. If the person is thin enough, someone might feel the pulsatile mass in the belly, which can be tender.

Who is at risk for AAA? Family history of AAA is a strong risk factor because there appears to be a gene that causes deterioration of the elastin and collagen of the arteries. (Yes, it's another thing you can blame your parents for. Being a parent sounds tough!) Smoking creates an enormous increase in risk for developing an AAA, as well making it grow faster.

Screening isn't recommended for most folks, but might be useful in men over 70 who smoke or who have a family history. Screening in women is more difficult because women's arteries tend to be smaller than men's. It's hard to figure exactly what to consider an aneurysm. However, women's aneurysms are more likely to rupture than men's.

In general, aneurysms 4.0-5.4cm are scanned every 6-12 months, and those 3.0-4.0cm are scanned every two years. 

Surgery within five years to insert a prosthetic graft occurs in over half the people with aneurysms 4.0-5.5cm. However, aneurysms that grow more than 0.5cm in six months are at high risk of rupture and might need intervention sooner rather than later. Of course, smoking cessation is key as well as management of cholesterol and blood pressure.

So if you want to be an Energizer Bunny and keep going and going– ask for anything but a AAA battery.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.