Patient Basics: Abdominal Aortic Aneurysm

Originally published by Harvard Health.

What Is It?

An abdominal aortic aneurysm is an abnormal swelling in the aorta. It can be fatal.

The aorta is the body’s largest artery. It carries oxygen-rich blood from the heart to smaller arteries in the body.

An abdominal aneurysm occurs in the abdominal aorta. This is the part of the aorta between the bottom of the chest and the pelvis.

An abdominal aortic aneurysm usually causes a balloon-like swelling. The wall of the aorta bulges out.

Normally, the aorta is about one inch (2.5 centimeters) in diameter. The size increases very gradually as people age. If the abdominal aorta becomes larger than 3 centimeters, this is called an abdominal aortic aneurysm.

Most aortic aneurysms are related to atherosclerosis. In atherosclerosis, fatty deposits build up along the inside walls of blood vessels.

Symptoms

Most aortic aneurysms don’t cause any symptoms. They often are discovered during routine physical exams. Or they are found on X-rays for unrelated illnesses.

When symptoms develop, they can include:

• Pain in the:
  • Abdomen
  • Back
  • Fleshy part of the sides, between the bottom of the ribs and hips
• A feeling of fullness after eating a small meal
• Nausea and vomiting
• A pulsating mass in the abdomen

Rarely, floating blood clots form near the aneurysm. These clots can break away. They can block blood vessels elsewhere in the body.

Sometimes an undiscovered abdominal aneurysm ruptures without warning. The patient collapses and dies from massive bleeding inside the abdomen.

Diagnosis

Your doctor will ask about your family history of heart disease. He or she will want to know about any sudden and, perhaps, unexplained, deaths in the family.

Your doctor will ask if you smoke. The doctor will check for high cholesterol, high blood pressure and diabetes.

Your doctor may suspect an aortic aneurysm based on the physical examination. Your doctor may hear abnormal blood flow in your abdomen. Or, your doctor may see and feel a pulsating mass in your abdomen.

In most people an abdominal aortic aneurysm is found on an imaging study for an unrelated illness. Aortic aneurysms can be seen on many different imaging studies. These include x-rays and ultrasound.

Ultrasound is a very accurate test for abdominal aortic aneurysm. And it doesn’t expose the patient to radiation.

Expected Duration

Once an abdominal aortic aneurysm develops, it is a lifelong condition. Most grow larger with time.

Prevention

You may be able to reduce your risk of an aortic aneurysm. You can do this by controlling your risk factors for atherosclerosis.

• If you smoke, quit now
• If you have high cholesterol:

• Eat a diet low in fats and cholesterol
• If necessary, take cholesterol-lowering medication

If you have high blood pressure:

• Maintain a healthy weight or reduce caloric intake if you are over weight
• Decrease salt intake
• Eat a diet rich in fruits and vegetables
• Take medication to control your blood pressure as needed

• If you have diabetes:

• Monitor your blood sugar frequently
• Follow a healthy diet
• Keep your blood pressure in the normal range
• Aim for an LDL cholesterol less than 100 mg/dL, using medication if necessary

Also, exercise regularly and maintain an ideal weight.

Men aged 65 to 75 who have ever smoked should have a one-time screening ultrasound.

Treatment

Treatment depends mostly on the size of the aneurysm. The larger the aneurysm, the more likely it is to burst (rupture).

Surgery is almost always recommended for an aneurysm that is leaking. Surgery generally is recommended for aneurysms larger than 5.5 centimeters in diameter.

An aneurysm larger than 6.5 centimeters almost always requires emergency surgery to repair the problem. This is true even if the patient has no symptoms. Emergency surgery for a ruptured aneurysm is riskier than a scheduled aneurysm repair.

Smaller aneurysms may be monitored with frequent ultrasound tests. These tests are done to see if the aneurysm is getting larger.

Surgeons have two options to repair abdominal aortic aneurysms. The traditional method is abdominal surgery. It involves:

• Temporarily clamping the aorta
• Repairing the blood vessel by cutting away the damaged section
• Replacing the aneurysm with a plastic patch

A newer surgical method is called endovascular surgery. Small cuts are made in the groin. A special tube called a stent is threaded through the artery to the site of the aneurysm. The stent can stop the artery wall from expanding and weakening.

The choice of procedure depends on:

• Location of the aneurysm
• Appearance of the aneurysm
• Patient’s health

Endovascular repair is less invasive. This makes it a better option for older and frailer patients.

Younger and healthier patients may be better candidates for abdominal surgery.

When To Call a Professional

Contact your doctor if you notice a pulsating mass in your abdomen but otherwise feel well.

If you have abdominal, back or flank pain along with a pulsating mass, this is an emergency. It requires immediate attention.

Prognosis

The outlook for an untreated abdominal aortic aneurysm depends on its size. A larger aneurysm has a higher chance of rupturing. As the size of the aneurysm decreases, so does the risk of rupture.

With successful surgical repair, the prognosis is good.

Additional Info

American Heart Association (AHA)
7272 Greenville Ave.
Dallas, TX 75231
Toll-Free: 1-800-242-8721
http://www.americanheart.org/

National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: 301-592-8573
TTY: 240-629-3255
http://www.nhlbi.nih.gov/