About Abdominal Aortic Aneurysms
An aneurysm is a bulge or enlargement in the wall of an artery. Arteries are blood vessels responsible for carrying oxygen-rich blood from the heart to other organs of the body. An aneurysm occurs when the arterial wall weakens.
Most aneurysms happen in the aorta. The aorta is the main artery that carries blood away from your heart to the abdomen, pelvis and legs.
An abdominal aortic aneurysm (AAA) refers to the swelling or bulging of the arterial walls that is in your abdomen. AAAs do not always cause problems but a ruptured aneurysm can cause internal bleeding or even death when left untreated.
Your physician may order a screening test if they suspect an abdominal aortic aneurysm. The Detroit Medical Center provides this type of screening by using an abdominal ultrasound in the Vascular Lab. Those who require a screening commonly include:
- Males ages 65-70 with a history of smoking
- Females with a family history of abdominal aortic aneurysms
- Those with multiple risk factors – male gender, smoking, peripheral artery disease (PAD), high blood pressure, obesity, high cholesterol
According to Yevgeniy Rits, MD, vascular surgeon and chief of vascular surgery at DMC Harper University Hospital, abdominal aortic aneurysms over 5.5 cm need to be repaired. “The traditional method for repair is an open surgical operation in which the damaged portion of the aorta is replaced with an artificial vessel. This requires 5-7 days in the hospital. With the endovascular or minimally invasive approach, the DMC vascular surgeon uses x-ray guidance to place the artificial vessel inside the aorta to reinforce it. With the minimally invasive technique, patients can go home in 2-3 days with minimal discomfort. As experts in our field, DMC vascular surgeons perform both approaches based on the individual needs of the patient.”
What Are the Types of Abdominal Aortic Aneurysms?
AAAs are classified according to their size and the rate at which they are growing. These two factors give physicians an idea how the aneurysm affects the health of the patient afflicted with this condition.
- Small AAA (3 cm to 4.4 cm across) – these are slow-growing aneurysmsthat have a much lower risk of rupture. Regular ultrasound scans are recommended to monitor their growth.
- Medium AAA (4.5 cm to 5.4 cm) – these types of aneurysm require ultrasound scans every three months to check if they are getting bigger.
- Large AAA (5.5 cm or larger) – these fast-growing AAAs are much more likely to rupture that can lead to life-threatening complications. These types of AAAs need to be treated with surgery especially if they are causing symptoms or leaking blood.
What Are the Most Common Causes of Abdominal Aortic Aneurysms?
The exact cause of AAAs remain unknown. However, the following factors may increase your risk of developing this medical condition:
- Smoking – directly damages the arterial walls, making them more susceptible to bulging. Smoking also increases your risk of hypertension.
- Atherosclerosis – occurs when plaque builds up inside the arteries. Overtime, the plaque hardens, limiting the supply of oxygen-rich blood to the organs and to the rest of the body.
- Hypertension – high blood pressure can also weaken the walls of your aorta. This can cause an aneurysm to form.
- Vascular inflammation (vasculitis) – serious inflammation in the aorta and other arteries that can occasionally cause AAAs.
- Male sex – AAAs are more common in men and among white people than among black people.
- Infection or injury
- Genetic factors
Can You Feel an Abdominal Aortic Aneurysm?
Abdominal aortic aneurysm do not often show any obvious symptoms unless they rupture. They are usually discovered during screening or tests. If an individual does have symptoms, they can include the following:
- Throbbing or deep pain in the stomach like a heartbeat
- Pain spreading from your abdomen or back to the pelvis, buttocks, groin or legs
- A stomach pain that does not go away
- Clammy or sweaty skin
- Nausea and vomiting
- Increased heart rate
- Fainting or shock
Screening for Abdominal Aortic Aneurysm
AAAs that have not ruptured are picked up or diagnosed during ultrasounds or when your physician feels your stomach and finds the following during an examination:
- A lump (mass) in the abdomen
- Pulsating sensation in the abdomen
- Stiff or rigid abdomen
The following tests may be conducted if your doctor suspects that you may have an abdominal aortic aneurysm:
- Abdominal ultrasound
- Chest X-ray
- Computerized tomography (CT) scan of the abdomen to confirm the size of the aneurysm
- CT angiogram (CTA) to help with surgical planning
What Are the Risk Factors for Abdominal Aortic Aneurysm?
If you answer yes to one or a combination of the following descriptions below, then you have a higher chance of developing AAAs:
- Are you male?
- Are you obese or overweight?
- Are you over the age of 60?
- Do you have a family history of heart disease or a history of stroke?
- Do you have high blood pressure and between 35 and 60 years old?
- Do you have high cholesterol or fatty buildup in the blood vessels or atherosclerosis?
- Do you have an unhealthy and sedentary lifestyle?
- Have you had trauma to your abdomen or other damage to your midsection?
- Do you smoke or have previously smoked?
- Do you have chronic obstructive pulmonary disease?
How Can an Abdominal Aortic Aneurysm Be Treated?
Treatments depend on its size and exact location. If you are bleeding because of a ruptured AAA, you will need surgery right away. If the aneurysm is small and there are no symptoms, surgery is rarely done. Instead, your physician may choose to closely monitor your condition through ultrasound tests every six months.
Surgery is usually done when the aneurysm is medium-sized or is bigger than 2 inches or 5 centimeters across or is growing quickly to prevent complications from developing. The outcome is often good if the surgery is done before the aneurysm ruptures.
The two types of surgery are:
- Open repair – the more invasive form of surgery that is used for aneurysms that are very large or have already ruptured. This procedure involves making a large cut in the abdomen to replace the damaged areas of the aorta with a graft made of man-made material. This type of surgery has a longer recovery time.
- Endovascular stent grafting – is a less invasive form of surgery that can be done without making a large cut in the abdomen, making recovery time faster compared to an open repair surgery. It uses a graft to stabilize the weakened walls of the aorta. This safer approach is applicable to those with existing medical conditions or are an older adult.
How to Reduce the Risk of Developing Abdominal Aortic Aneurysm?
There are several ways to prevent AAAs or help stop it from getting bigger. You doctor might also prescribe medicines if you have a condition that raises your risk for AAAs like high blood pressure, cholesterol or diabetes. These heart-healthy habits include
- Maintaining a healthy weight
- Quitting smoking
- Cutting down on alcohol consumption
- Reducing stress
It is a medical emergency when an abdominal aortic ruptures. If you or someone you know has any of the symptoms mentioned in this article, seek medical attention or immediately call 911.
Centers for Disease Control and Prevention
National Heart, Lung, and Blood Institute
National Health Service UK