The Relationship Between Abdominal Aortic Aneurysm (AAA) and Smoking

Abdominal aortic aneurysm (AAA) is the type of aneurysm we encounter most often in our clinic, and it has a strong relationship with tobacco use. In this article I will explain in whom AAA occurs and what role smoking plays in this disease.

In Whom Does Abdominal Aortic Aneurysm Occur?

AAA is seen more frequently in men over 65, in those with a history of smoking/tobacco use and in those with a family history of aneurysm; screening studies show that the frequency of AAA in men in this risk group is around 1-3%. For this reason we recommend a one-time ultrasound screening for men aged 65-75 who have used tobacco.

Pulsation and Pain in the Abdomen

Most AAAs cause no symptoms at all and are detected incidentally; some of our patients may describe a pulsating mass or a mild feeling of tightness in the abdominal area. Sudden and severe abdominal or back pain, however, may mean that the aneurysm has grown or has begun to rupture, and it requires urgent assessment.

The Effect of Smoking on Aneurysm Growth

Tobacco use is the strongest known modifiable risk factor in the development of AAA; large population studies show that a significant proportion of aneurysms of 4 centimetres and above are related to smoking. Quitting smoking is the most powerful intervention in the patient’s own hands, reducing both the growth rate of the aneurysm and the risk of rupture.

Frequently Asked Questions

Who is AAA screening recommended for? We recommend a one-time ultrasound screening for men aged 65-75 who have used cigarettes/tobacco; an individual assessment can also be made in women with a family history.

An AAA has been detected; do I need surgery straight away? Most of the time, no; regular follow-up is sufficient for small aneurysms, and the decision to operate is made according to the diameter and the growth rate.

If I quit smoking, will the aneurysm shrink? It will not shrink, but quitting markedly reduces the growth rate and the risk of rupture.

Conclusion

Abdominal aortic aneurysm is a disease seen frequently, especially in men who use tobacco, but it can be detected early with screening. Quitting smoking is the most important step that can change the course of this disease for the better.

If you are over 65 and have a history of cigarette/tobacco use, you can make an appointment for aortic screening.

References

1. US Preventive Services Task Force. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;322(22):2211-2218.