Abdominal aortic aneurysm

Overview

An abdominal aortic aneurysm is an enlarged area in the lower part of the major vessel that supplies blood to the body (aorta). The aorta runs from your heart through the center of your chest and abdomen.

The aorta is the largest blood vessel in the body, so a ruptured abdominal aortic aneurysm can cause life-threatening bleeding.

Depending on the size of the aneurysm and how fast it's growing, treatment varies from watchful waiting to emergency surgery.

Abdominal aortic aneurysm

An abdominal aortic aneurysm occurs when a lower portion of your body's main artery (aorta) becomes weakened and bulges.

Symptoms

Abdominal aortic aneurysms often grow slowly without symptoms, making them difficult to detect. Some aneurysms never rupture. Many start small and stay small; others expand over time, some quickly.

If you have an enlarging abdominal aortic aneurysm, you might notice:

  • Deep, constant pain in your abdomen or on the side of your abdomen
  • Back pain
  • A pulse near your bellybutton

When to see a doctor

If you have pain, especially if pain is sudden and severe, seek immediate medical help.

Causes

Aneurysms can develop anywhere along the aorta, but most aortic aneurysms occur in the part of your aorta that's in your abdomen. A number of factors can play a role in developing an aortic aneurysm, including:

  • Hardening of the arteries (atherosclerosis). Atherosclerosis occurs when fat and other substances build up on the lining of a blood vessel.
  • High blood pressure. High blood pressure can damage and weaken the aorta's walls.
  • Blood vessel diseases. These are diseases that cause blood vessels to become inflamed.
  • Infection in the aorta. Rarely, a bacterial or fungal infection might cause an abdominal aortic aneurysms.
  • Trauma. For example, being in a car accident can cause an abdominal aortic aneurysms.

Risk factors

Abdominal aortic aneurysm risk factors include:

  • Tobacco use. Smoking is the strongest risk factor. It can weaken the aortic walls, increasing the risk not only of developing an aortic aneurysm, but of rupture. The longer and more you smoke or chew tobacco, the greater the chances of developing an aortic aneurysm.
  • Age. These aneurysms occur most often in people age 65 and older.
  • Being male. Men develop abdominal aortic aneurysms much more often than women do.
  • Being white. People who are white are at higher risk of abdominal aortic aneurysms.
  • Family history. Having a family history of abdominal aortic aneurysms increases your risk of having the condition.
  • Other aneurysms. Having an aneurysm in another large blood vessel, such as the artery behind the knee or the aorta in the chest, might increase your risk of an abdominal aortic aneurysm.

Complications

Tears in one or more of the layers of the wall of the aorta (aortic dissection) or a ruptured aneurysm are the main complications. A rupture can cause life-threatening internal bleeding. In general, the larger the aneurysm and the faster it grows, the greater the risk of rupture.

Signs and symptoms that your aortic aneurysm has ruptured can include:

  • Sudden, intense and persistent abdominal or back pain, which can be described as a tearing sensation
  • Low blood pressure
  • Fast pulse

Aortic aneurysms also put you at risk of developing blood clots in the area. If a blood clot breaks loose from the inside wall of an aneurysm and blocks a blood vessel elsewhere in your body, it can cause pain or block the blood flow to the legs, toes, kidneys or abdominal organs.

Prevention

To prevent an aortic aneurysm or keep an aortic aneurysm from worsening, do the following:

  • Don't use tobacco products. Quit smoking or chewing tobacco and avoid secondhand smoke.
  • Eat a healthy diet. Focus on eating a variety of fruits and vegetables, whole grains, poultry, fish and low-fat dairy products. Avoid saturated fat, trans fats and limit salt.
  • Keep your blood pressure and cholesterol under control. If your doctor has prescribed medications, take them as instructed.
  • Get regular exercise. Try to get at least 150 minutes a week of moderate aerobic activity. If you haven't been active, start slowly and build up. Talk to your doctor about what kinds of activities are right for you.

If you're at risk of an aortic aneurysm, your doctor might recommend other measures, such as medications to lower your blood pressure and relieve stress on weakened arteries.

Diagnosis

Abdominal aortic aneurysms are often found during an examination for another reason or during routine medical tests, such as an ultrasound of the heart or abdomen.

To diagnose an abdominal aortic aneurysm, doctors will review your medical and family history and do a physical exam. If your doctor suspects that you have an aortic aneurysm, specialized tests, such as the following, can confirm it.

  • Abdominal ultrasound. This test is most commonly used to diagnose abdominal aortic aneurysms. You lie on a table while a technician moves a wand (transducer) around your abdomen. Ultrasound uses sound waves to send images to a computer screen.
  • CT scan. This painless test can provide your doctor with clear images of your aorta, and it can detect the size and shape of an aneurysm.

    During a CT scan, you lie on a table inside a doughnut-shaped machine. CT scanning generates X-rays to produce cross-sectional images of your body. You might have contrast dye injected into your blood vessels that makes your arteries more visible on the CT pictures (CT angiography).

  • MRI. In this test, you lie on a movable table that slides into a machine. An MRI uses a magnetic field and pulses of radio wave energy to make pictures of your body. You might have a dye injected into your blood vessels to make them more visible (magnetic resonance angiography).

Screening for abdominal aortic aneurysm

Being male and smoking significantly increase the risk of abdominal aortic aneurysm. Screening recommendations vary, but in general:

  • Men ages 65 to 75 who have ever smoked cigarettes should have a one-time screening using abdominal ultrasound.
  • For men ages 65 to 75 who have never smoked, your doctor will decide on the need for an abdominal ultrasound, usually based on other risk factors, such as a family history of aneurysm.

There isn't enough evidence to determine whether women ages 65 to 75 who ever smoked cigarettes or have a family history of abdominal aortic aneurysm would benefit from abdominal aortic aneurysm screening. Ask your doctor if you need to have an ultrasound screening based on your risk factors. Women who have never smoked generally don't need to be screened for the condition.

Treatment

The goal of treatment — either medical monitoring or surgery — is to prevent your aneurysm from rupturing. Which treatment you have depends on the size of the aortic aneurysm and how fast it's growing.

Medical monitoring

Your doctor might recommend this option if your abdominal aortic aneurysm is small and you don't have symptoms. You'll have regular appointments to check if your aneurysm is growing, and treatment to manage other medical conditions, such as high blood pressure, that could worsen your aneurysm.

It's likely you'll need regular imaging tests to check on the size of your aneurysm. Expect to have an abdominal ultrasound at least six months after your aneurysm is diagnosed and at regular follow-up exams.

Surgery

Repair is generally recommended if your aneurysm is 1.9 to 2.2 inches (4.8 to 5.6 centimeters) or larger or if it's growing quickly. Also, your doctor might recommend surgery if you have symptoms such as stomach pain or you have a leaking, tender or painful aneurysm.

Depending on several factors, including location and size of the aneurysm, your age, and other conditions you have, repair options might include:

  • Open abdominal surgery. This involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. Full recovery is likely to take a month or more.
  • Endovascular repair. This less invasive procedure is used more often. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded into your aorta.

    The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm, expanded and fastened in place. It reinforces the weakened section of the aorta to prevent rupture of the aneurysm.

    Endovascular surgery isn't an option for about 30 percent of people with an aneurysm. After endovascular surgery, you'll need regular imaging tests to ensure that the repair isn't leaking.

Long-term survival rates are similar for both endovascular surgery and open surgery.

Lifestyle and home remedies

For an abdominal aortic aneurysm, your doctor will likely suggest that you avoid heavy lifting and vigorous physical activity so as not to increase blood pressure excessively, which can put more pressure on your aneurysm.

Stress can raise your blood pressure, so try to avoid conflict and stressful situations. If you're going through a particularly emotional time in your life, let your doctor know because your medications might need to be adjusted to keep your blood pressure levels from going too high.

Preparing for an appointment

If you're concerned about having an abdominal aortic aneurysm, make an appointment with your family doctor.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. Before an ultrasound or echocardiogram, for example, you might need to fast.

Make a list of:

  • Your symptoms, including any that may seem unrelated to an abdominal aortic aneurysm, and when they began
  • Key personal information, including a family history of heart disease or aneurysms
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor

For an abdominal aortic aneurysm, questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What tests will I need?
  • What treatments are available, and which do you think would be the best treatment for me?
  • Do I need regular screenings, and if so, how often?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • Do your symptoms come and go, or do you always feel them?
  • How severe are your symptoms?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Have you ever smoked?

Last Updated Mar 15, 2019


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