Abdominal Aortic Aneurysm

Most aortic aneurysms are AAAs.

These aneurysms are found more often now than in the past because of computed tomography (to-MOG-rah-fee) scans, or CT scans, done for other medical problems.

Small AAAs rarely rupture. However, AAAs can grow very large without causing symptoms. Routine checkups and treatment for an AAA can help prevent growth and rupture.

Prevention

The best way to prevent an aortic aneurysm is to avoid the factors that put you at higher risk for one. You can’t control all aortic aneurysm risk factors, but lifestyle changes can help you lower some risks.

For example, if you smoke, try to quit. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

Another important lifestyle change is following a healthy diet. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium, and added sugar.

Be as physically active as you can. Talk with your doctor about the amounts and types of physical activity that are safe for you.

Work with your doctor to control medical conditions such as high blood pressure and high blood cholesterol. Follow your treatment plans and take all of your medicines as your doctor prescribes.

SCREENING FOR ANEURYSMS

Although you may not be able to prevent an aneurysm, early diagnosis and treatment can help prevent rupture and dissection.

Aneurysms can develop and grow large before causing any signs or symptoms. Thus, people who are at high risk for aneurysms may benefit from early, routine screening.

Your doctor may recommend routine screening if you’re:

• A man between the ages of 65 and 75 who has ever smoked
• A man or woman between the ages of 65 and 75 who has a family history of aneurysms

If you’re at risk, but not in one of these high-risk groups, ask your doctor whether screening will benefit you.

Risk Factors

Certain factors put you at higher risk for an aortic aneurysm.

THESE FACTORS INCLUDE:

• Male gender. Men are more likely than women to have aortic aneurysms.
• Age. The risk for abdominal aortic aneurysms increases as you get older. These aneurysms are more likely to occur in people who are aged 65 or older.
• Smoking. Smoking can damage and weaken the walls of the aorta.
• A family history of aortic aneurysms. People who have family histories of aortic aneurysms are at higher risk for the condition, and they may have aneurysms before the age of 65.
• A history of aneurysms in the arteries of the legs.
• Certain diseases and conditions that weaken the walls of the aorta. Examples include high blood pressure and atherosclerosis.

Car accidents or trauma also can injure the arteries and increase the risk for aneurysms.

If you have any of these risk factors, talk with your doctor about whether you need screening for aneurysms.

Causes

The exact cause of the condition is unknown.

FACTORS THAT CAN INCREASE YOUR RISK OF DEVELOPING THE PROBLEM INCLUDE:

• Smoking
• High blood pressure
• Male gender
• Genetic factors

Symptoms

An abdominal aortic aneurysm is most often seen in males over age 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to break open. This can be life-threatening.

Most abdominal aortic aneurysms (AAAs) develop slowly over years. They often don’t cause signs or symptoms unless they rupture. If you have an AAA, your doctor may feel a throbbing mass while checking your abdomen.

WHEN SYMPTOMS ARE PRESENT, THEY CAN INCLUDE:

• A throbbing feeling in the abdomen
• Deep pain in your back or the side of your abdomen
• Steady, gnawing pain in your abdomen that lasts for hours or days

If an AAA ruptures, symptoms may include sudden, severe pain in your lower abdomen and back; nausea and vomiting; constipation and problems with urination; clammy, sweaty skin; light-headedness; and a rapid heart rate when standing up.

Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can’t get enough blood to work well. Shock can be fatal if it’s not treated right away.

Diagnosis

If you have an abdominal aortic aneurysm (AAA), your doctor may feel a throbbing mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed.

If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.

SPECIALISTS INVOLVED

Your primary care doctor may refer you to a cardiothoracic or vascular surgeon for diagnosis and treatment of an aortic aneurysm.

DIAGNOSTIC TESTS AND PROCEDURES

To diagnose and study an aneurysm, your doctor may recommend one or more of the following tests.

Ultrasound and echocardiography are simple, painless tests that use sound waves to create pictures of the structures inside your body. These tests can show the size of an aortic aneurysm, if one is found.

A computed tomography scan, or CT scan, is a painless test that uses x rays to take clear, detailed pictures of your organs.

Your doctor may recommend this test if he or she thinks you have an AAA or a thoracic aortic aneurysm (TAA). A CT scan can show the size and shape of an aneurysm. This test provides more detailed pictures than an ultrasound or echo.

Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test works well for detecting aneurysms and pinpointing their size and exact location.

Angiography is a test that uses dye and special x rays to show the insides of your arteries. This test shows the amount of damage and blockage in blood vessels.

Aortic angiography shows the inside of your aorta. The test may show the location and size of an aortic aneurysm.

Treatment

If you have bleeding inside your body from an aortic aneurysm, you will need abdominal aortic aneurysm repair.

IF THE ANEURYSM IS SMALL AND THERE ARE NO SYMPTOMS:

• Surgery is rarely done.
• You and your doctor must decide if the risk of having surgery is smaller than the risk of bleeding if you do not have surgery.
• Your doctor may want to check the size of the aneurysm with ultrasound tests every 6 months.

Most of the time, surgery is done if the aneurysm is bigger than 2 inches (5.5 cm) across or growing quickly. The goal is to do surgery before complications develop.

THERE ARE TWO TYPES OF SURGERY:

• Traditional (open) repair. A large cut is made in your abdomen. The abnormal vessel is replaced with a graft made of man-made material.
• Endovascular stent grafting. This procedure can be done without making a large cut in your abdomen, so you may recover more quickly. This may be a safer approach if you have certain other medical problems. Endovascular repair can sometimes be done for a leaking or bleeding aneurysm.

Recovery

If you have an aortic aneurysm, following your treatment plan and having ongoing medical care are important. Early diagnosis and treatment can help prevent rupture and dissection.

Your doctor may advise you to avoid heavy lifting or physical exertion. If your job requires heavy lifting, you may be advised to change jobs.

Also, try to avoid emotional crises. Strong emotions can cause blood pressure to rise, which increases the risk of rupture or dissection. Call your doctor if an emotional crisis occurs.

Your doctor may prescribe medicines to treat your aneurysm. Medicines can lower your blood pressure, relax your blood vessels, and lower the risk that the aneurysm will rupture. Take all of your medicines exactly as your doctor prescribes.

If you have a small aneurysm that isn’t causing pain, you may not need treatment. However, aneurysms can develop and grow large before causing any symptoms. Thus, people who are at high risk for aneurysms may benefit from early, routine screening.