Abdominal Aortic Aneurysm (AAA)

Basic Facts

  • An aneurysm is an enlarged portion of a weak area of an artery. Over time, blood flow can cause the weak area to bulge like a balloon.
  • An abdominal aortic aneurysm (AAA) is an enlargement in the aorta, the main blood vessel that carries blood away from the heart. 
  • The risk for complications increases with the size of the aneurysm. In general, larger aneurysms should be considered for treatment while smaller aneurysms should be monitored carefully for any enlargement.

 

Larger aneurysms, more than two inches (5 cm) in diameter, are more likely to burst, resulting in internal bleeding that is fatal unless treated immediately. Only about half of patients with a ruptured AAA who get to a hospital survive.

A ruptured aneurysm normally causes severe abdominal and/or lower back pain and is life threatening, requiring immediate medical attention. 

Most people with AAA do not feel any symptoms, though some may experience:

  • A rhythmic, pulsating feeling in the abdomen, similar to a heartbeat, or
  • Deep or severe pain in the abdomen or lower back.
  • Men older than age 60,
  • Hypertension (high blood pressure),
  • Smoking,
  • Atherosclerosis,
  • Excessive alcohol use,
  • People with other large artery aneurysms, 
  • Family history of AAA in a 1st degree relative
  • Rarely, it can be caused by trauma, connective tissue disease, or infections.

 

Only about 10 percent of AAAs can be diagnosed during a physical examination. Most AAAs are noted on one of the following tests, sometimes being done for other reasons;

  • Abdominal ultrasonography, which uses sound waves to produces images of blood vessels in the abdomen, 
  • Computed tomography (CT) scans, which uses radiation to produce detailed views of the blood vessels, and 
  • Magnetic resonance imaging (MRI), which uses magnetic and radio wave energy to take detailed pictures of blood vessels to show location and severity of aneurysms.

Control high blood pressure to limit stress on the aneurysm over time, beta blockers are the preferred first-line medication.

AAA smaller than 5 cm (2 inches) are lower risk, do not cause symptoms. The goal is to control blood pressure and monitor every 6-12 months via one of the above imaging tests.

AAA larger than 5 cm (2 inches) are at higher risk of complication and may require interventions such as:

  • Endovascular stent graft- A minimally invasive procedure performed at the hospital. A tube is inserted into the aorta, through a small incision in the groin, allowing for placement of a synthetic tube supported by metal. This graft relieves pressure on the aneurysm wall, and the aneurysm may eventually shrink. 
  • Open aneurysm repair- A surgical repair that involves opening the abdomen and replacing the weakened area of the aorta with a fabric tube.