Abdominal Aortic Aneurysm

What is an abdominal aortic aneurysm?

The aorta is the main blood vessel that supplies blood to the chest, abdomen, pelvis and legs. When blood flows through the body, it does so under pressure. When there is a weakness in the walls of the aorta, the constant pressure can cause the vessel wall to balloon out. In medical terms this is called an aneurysm. Most abdominal aortic aneurysms are small and cause no symptoms so the patient is unaware that they have an abdominal aortic aneurysm. In the U.S., every year 15,000 people die from abdominal aortic aneurysms.

Abdominal aortic aneurysm risk factors:

• Smoking is a major risk factor for abdominal aortic aneurysm. Smokers die four times more often from a ruptured aneurysm than non-smokers.
• Men are four times as likely to have an abdominal aortic aneurysm than women.
• People with a family history of abdominal aortic aneurysm have an increased risk. Those with the highest risk are men over 60 who have one or more risk factors. Aneurysms run in families. If you have a first degree relative with an abdominal aortic aneurysm, you are at 12 times the risk for developing an abdominal aortic aneurysm.
• Atherosclerosis (hardening of the arteries).
• Abdominal aortic aneurysms affect about 8% of people over the age of 65.
• High Blood Pressure.

What causes abdominal aortic aneurysm?

It is occurs when there is a weakness in the aorta wall.  The cause of the weakness is unknown at this time.

Abdominal aortic aneurysm Symptoms

Abdominal aortic aneurysm is called a “silent killer” because often there are no symptoms. Abdominal aortic aneurysm develops gradually over years. Symptoms may appear suddenly when the aneurysm begins to grow larger, tear open or leak blood into the wall of the aorta. This is a life-threatening situation.

Most people have no symptoms, but if they do, they may include:

• A pain in the abdomen
• A pulsing sensation in the abdomen
• A stiff or rigid abdomen

This may indicate the aneurysm is growing and should be examined.

Symptoms of rupture include:

• Abdominal or back pain that is severe, sudden and persistent. The pain can spread to the groin, buttocks and legs
• Pale, clammy skin
• Dizziness
• Dry mouth or excessive thirst
• Nausea and vomiting
• Low blood pressure
• Shock- shaking, fainting, sweating, rapid heartbeat, and sudden weakness

Diagnosis of Abdominal Aortic Aneurysm

Physical exam may detect an aneurysm. An ultrasound of the abdomen is usually the test used when abdominal aortic aneurysm is suspected. A CT scan of the abdomen is used to establish the size of the aneurysm.

Treatment of an Abdominal Aortic Aneurysm

• If you have a ruptured aneurysm, emergency surgery is necessary.
• When the aneurysm is small, your doctor will monitor the aneurysm and decide whether the surgery is necessary.
• Only about 1 in 5 people survive a ruptured aneurysm. Early detection is critical.

Generally, abdominal aortic aneurysms are less than 5 cm (about 2 inches) in diameter, have a low risk of rupture, and should be watched.

Watchful waiting: When the aneurysm is small and not expanding quickly, it will be watched, medical problems will be carefully managed, and the size of the aneurysm will be checked by ultrasound every six months to one year. Lifestyle changes that control blood pressure can help. Daily exercise is beneficial. Quitting smoking is ideal.

Surgical repair: Generally, the size of the aneurysm determines the time for surgery. When the abdominal aortic aneurysm is larger than 5 cm in diameter, or rapidly expanding, treatment is necessary.

The larger the aneurysm the more likely it will tear or break open. This is called a rupture.  If the aneurysm is larger than 2 inches across and enlarging quickly, the goal of surgery is to repair it before complications can develop.

Surgical options:

1 – Open repair.  This surgery is done in an operating room under general anesthesia and can take from 2-4 hours. You will be sent to intensive care to recover after surgery. Recovery requires a hospital stay of 5-10 days. Full recovery may take 2-3 months. Many people who have the aneurysm repaired before rupture, will make a full recovery. Once the aneurysm ruptures, the chance of a full recovery is significantly reduced. Open repair may be done as an emergency procedure, when there is internal bleeding or when there is an immediate risk of rupture.

2 – Endovascular stent grafting. This minimally invasive procedure is performed under general anesthesia in a surgical suite or hospital. Guided by x-rays, small groin incisions are made to insert a stent graft to reinforce the artery wall, redirect blood flow (bypass the aneurysm) and reduce or stop pressure on the aorta wall. Older patients with medical conditions that prohibit them from open repair, can do well with this procedure. A hospital stay of 1-3 days is common.

Need more information on Abdominal Aortic Aneurysm? Visit the Society for Vascular Surgery’s Patient Resources section here.