What Is an Abdominal Aortic Aneurysm?

Definition

The large artery that leaves the heart and brings oxygen-rich blood to the rest of the body is called the aorta. When the walls of an artery become weakened, the artery can bulge outward and form an aneurysm. 

There are several types of aneurysms. When the aorta bulges in the chest area, it is called a thoracic aneurysm. When the aorta bulges in the abdominal area, it is called an abdominal aortic aneurysm (AAA). Abdominal aortic aneurysms (AAAs) occur in approximately 9% of Americans over 65 years of age. 

An abdominal aortic aneurysm is typically defined by an enlargement of 3.0 cm or larger. When AAAs are small, they are usually watched closely by your healthcare provider to make sure that they do not enlarge. When AAAs are large, or are rapidly growing in size, they may require treatment with a surgical procedure.

Causes

Smoking is responsible for over 75% of abdominal aortic aneurysms. Smoking can weaken the walls of the aorta and increase the risk of cholesterol deposits in the arteries, which can lead to aneurysm formation. Other reasons why you may be at risk for AAA include:

Male sex

• Age (65 and older)

• White ethnicity

• Genetics

• History of aneurysms in other places

Certain health conditions can also increase the risk of AAAs, including:

• Atherosclerosis (due to high cholesterol)

• Hypertension

• Vasculitis (blood vessel inflammation)

• Infection of the blood vessels

• Connective tissue diseases

• Trauma

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Symptoms

Abdominal aortic aneurysms don’t usually cause symptoms. In fact, symptoms are usually not felt at all until an aneurysm is large and/or rapidly enlarging. 

Symptoms of a large or rapidly enlarging AAA are:

• A “pulsation” near the naval area

• Abdominal pain

• Back/groin pain 

If you notice any of these symptoms, you should contact your healthcare provider immediately, so they can do a history and physical examination, and order testing to see if you have an AAA.

When an abdominal aortic aneurysm ruptures, or bursts, it is a medical emergency and you need to get  emergency care. Symptoms of a ruptured abdominal aortic aneurysm can include:

• Sudden, severe pain in your abdomen or back

• A feeling like you are going to pass out 

• Complete loss of consciousness

Diagnosis

Most people don’t know they have an AAA until a healthcare provider or an imaging test discovers it by accident.

Tests that can diagnose an AAA are:

• Abdominal ultrasound

• CT scan

• MRI

• Angiogram

In certain groups of people who are at higher risk for AAA, testing is recommended even if a person has never had symptoms. This is called screening. People who need screening for AAA are:

• Men 65 to 75 years of age who have ever smoked 

• Women over 65 years of age with a family history of AAA or who have ever smoked

Treatments

Treatment for abdominal aortic aneurysms (AAAs) depends on the size of the aneurysm and whether or not you feel any symptoms.

• In a person with no symptoms, if the AAA is less than 4 cm in diameter, a healthcare provider will examine the aneurysm with an ultrasound every 6 to 12 months to make sure it is not growing.

• In a person with no symptoms, if the AAA is 4.0 to 5.5 cm in diameter, treatment depends on several factors, including:

  • The size of the aneurysm

  • If the aneurysm is expanding

  • If there are symptoms

  • If there are aneurysms in other blood vessels

  • A person’s surgical risk

• In a person with no symptoms, if the aneurysm is larger than 5 to 5.5 cm, or if the aneurysm is growing more than 0.5 centimeters over a 6-month period of time, surgical treatment will likely be recommended.

• Symptomatic or ruptured aneurysms are usually sent for surgery.

Surgery

When surgery is needed for an AAA, people are referred to a specialized doctor called a vascular surgeon, who is an expert in repairing blood vessels. 

The best type of surgery to fix an aneurysm depends on the person’s age, the size of the aneurysm, and where the aneurysm is. 

The two ways to repair an AAA are:

• Endovascular repair: This involves making a small incision in the groin area to expose the femoral artery, and inserting catheters to deliver a folded tube, called a graft, into the artery. This approach is less invasive, requires a shorter hospital stay, and is safer for higher-risk patients.

• Open surgical repair: This involves making an incision in the abdominal wall, removing the damaged portion of the aorta, and replacing it with a flexible tube called a graft. Open repair is more invasive, usually requires a longer hospital stay, and can take a month or more to make a full recovery.

Living

If you have been diagnosed with an AAA, you can still live a fulfilling, normal life. Here are some helpful tips for healthy living with an AAA:

• Keep regular appointments with your healthcare providers, including getting regular testing to follow the size of aneurysm.

• Take steps to treat risk factors like high blood pressure and high cholesterol (including taking prescribed medication).

• Call your provider if you develop new abdominal or back pain.

• Do not smoke. If you smoke, try to cut down or quit.

• Avoid heavy lifting or exercises that involve straining, which can put pressure on the aneurysm. 

• Get regular aerobic exercise such as walking, cycling, or swimming.