Abdominal aortic aneurysm

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 the heart through the center of the 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.

Symptoms

Abdominal aortic aneurysms often grow slowly without noticeable symptoms, making them difficult to detect. Some aneurysms never rupture. Many start small and stay small. Others grow larger over time, sometimes quickly.

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

• Deep, constant pain in the belly area or side of the belly (abdomen)
• Back pain
• A pulse near the 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 the aorta that's in the belly area (abdomen). Several things can play a role in the development of an abdominal 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 injured 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 for aortic aneurysms. Smoking can weaken the walls of the aorta, increasing the risk of aortic aneurysm and aneurysm rupture. The longer and more you smoke or chew tobacco, the greater the chances of developing an aortic aneurysm. Doctors recommend a one-time abdominal ultrasound to screen for an abdominal aortic aneurysm in men ages 65 to 75 who are current or former cigarette smokers.
• Age. Abdominal aortic 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 the 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 (thoracic aortic aneurysm), might increase the risk of an abdominal aortic aneurysm.

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.

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 an 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 increase the 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 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 smoke or use tobacco products. Quit smoking or chewing tobacco and avoid secondhand smoke. If you need help quitting, talk to your doctor about medications and therapies that may help.
• Eat a healthy diet. Focus on eating a variety of fruits and vegetables, whole grains, poultry, fish, and low-fat dairy products. Avoid saturated and 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.

Diagnosis

Abdominal aortic aneurysms are often found when a physical exam is done for another reason or during routine medical tests, such as an ultrasound of the heart or abdomen.

To diagnose an abdominal aortic aneurysm, a doctor will examine you and review your medical and family history. If your doctor thinks that you may have an aortic aneurysm, imaging tests are done to confirm the diagnosis.

Tests to diagnose an abdominal aortic aneurysm include:

• Abdominal ultrasound. This is the most common test to diagnose abdominal aortic aneurysms. An abdominal ultrasound is a painless test that uses sound waves to show how blood flows through the structures in the belly area, including the aorta.

  During an abdominal ultrasound, a technician gently presses an ultrasound wand (transducer) against the belly area, moving it back and forth. The device sends signals to a computer, which creates images.

• Abdominal CT scan. This painless test uses X-rays to create cross-sectional images of the structures inside the belly area. It's used to create clear images of the aorta. An abdominal CT scan can also detect the size and shape of an aneurysm.

  During a CT scan, you lie on a table that slides into a doughnut-shaped machine. Sometimes, dye (contrast material) is given through a vein to make your blood vessels show up more clearly on the images.

• Abdominal MRI. This imaging test uses a magnetic field and computer-generated radio waves to create detailed images of the structures inside your belly area. Sometimes, dye (contrast material) is given through a vein to make your blood vessels more visible.

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, a doctor will decide on the need for an abdominal ultrasound 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 abdominal aortic aneurysm treatment is to prevent an aneurysm from rupturing. Treatment may involve careful monitoring or surgery. Which treatment you have depends on the size of the aortic aneurysm and how fast it's growing.

Medical monitoring

A doctor might recommend this option, also called watchful waiting, if the abdominal aortic aneurysm is small and isn't causing symptoms. Monitoring requires regular doctor's checkups and imaging tests to determine if the aneurysm is growing and to manage other conditions, such as high blood pressure, that could worsen the aneurysm.

Typically, a person who has a small, symptomless abdominal aortic aneurysm needs an abdominal ultrasound at least six months after diagnosis and at regular follow-up appointments.

Surgery and other procedures

Surgery to repair an abdominal aortic aneurysm is generally recommended if the aneurysm is 1.9 to 2.2 inches (4.8 to 5.6 centimeters) or larger, or if it's growing quickly.

Also, a doctor might recommend abdominal aortic aneurysm repair surgery if you have symptoms such as stomach pain or you have a leaking, tender or painful aneurysm.

The type of surgery performed depends on the size and location of the aneurysm, your age, and your overall health. Abdominal aortic aneurysm surgery options may include:

• Endovascular repair. This procedure is used most often to repair an abdominal aortic aneurysm. A surgeon inserts a thin, flexible tube (catheter) through an artery in the leg and gently guides it to the aorta. A metal mesh tube (graft) on the end of the catheter is placed at the site of the aneurysm, expanded and fastened in place. The graft strengthens the weakened section of the aorta to prevent rupture of the aneurysm.

  Endovascular surgery isn't an option for everyone with an abdominal aortic aneurysm. You and your doctor will discuss the best repair option for you. After endovascular surgery, you'll need regular imaging tests to ensure that the grafted area isn't leaking.

• Open abdominal surgery. This involves removing the damaged part of the aorta and replacing it with a graft, which is sewn into place. Full recovery may take a month or more.

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

Lifestyle and home remedies

For an abdominal aortic aneurysm, a doctor will likely suggest avoiding heavy lifting and vigorous physical activity to prevent extreme increases in blood pressure, which can put more pressure on an aneurysm.

Emotional stress can raise blood pressure, so try to avoid conflict and stressful situations. If you're feeling stressed or anxious, let your doctor know so that together you can come up with the best treatment plan.

Preparing for an appointment

If you are at risk of an abdominal aortic aneurysm or having signs and symptoms of the condition, make an appointment with your family doctor. If you're having severe pain, seek emergency medical help.

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 certain tests, you might need to avoid drinking or eating for a short time.

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 how much you take and when
• 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?

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