When the wall of a blood vessel weakens, a balloon-like dilation called an aneurysm sometimes develops. This happens most often in the abdominal aorta, an essential blood vessel that supplies blood to your legs. Every year, 200,000 people in the U.S. are diagnosed with an abdominal aortic aneurysm (AAA). A ruptured AAA is the 15th leading cause of death in the country, and the 10th leading cause of death in men older than 55. Aneurysms run in families. If a first- degree relative has had an AAA, you are 12 times more likely to develop one.
In most cases, abdominal aortic aneurysms cause no symptoms and are found when you are being evaluated for another medical condition. However, it’s possible for some patients to experience back pain, a deep pain on the side of their abdomen or a throbbing sensation near their navel. Doctors don’t really know what causes an abdominal aortic aneurysm, although they suspect a few things might play a role:
- A genetic predisposition – anyone with a first-generation relative who has developed an AAA are at highest risk.
- Age – (50+ for men 60+ for women) and a history of atherosclerosis, high blood pressure, elevated cholesterol, heart and peripheral vascular disease or smoking
- Inflammation or tears in the arterial wall, infections, and congenital connective tissue disorders.
NOTE: If you have a family history of AAA and feel sudden, severe pain in your abdomen or back, seek immediate care. These symptoms may signal that you have developed an AAA, possibly one in process of rupturing.
If an abdominal aortic aneurysm is suspected your doctor will perform an abdominal ultrasound. This noninvasive test can effectively screen for and measure the size of an AAA. A computed tomographic angiography (CTA) can also assess aneurysm size, location and the extent of impact. A CTA provides valuable anatomic information and can help your vascular surgeon determine the optimal type of repair.
Treatment depends on the size of the aneurysm. Small AAAs (less than 5 cm in diameter) have a very low risk of rupturing, but should be watched.
- It’s important to have an ultrasound test every 6–12 months to monitor for aneurysm growth and risk of rupture.
- Lifestyle changes that help control blood pressure and medication may help you.
- If you smoke, ask your vascular surgeon to help you find a smoking cessation program that will work for you.
- Daily exercise is also beneficial
Larger AAAs (more than 5.0 cm in diameter), rapidly enlarging AAAs and those causing symptoms are usually repaired.
There are two main types of surgery for aortic aneurysms. Open abdominal or open chest repair and endovascular repair. In open surgery the vascular surgeon accesses the affected portion of the aortic artery through an incision in your abdomen. Your surgeon replaces the weakened section of your aorta with a tube, or “graft,” made of a special fabric.
Most patients stay in the hospital 4–10 days. Recovery time may be up to 3 months. Endovascular aneurysm repair (EVAR) is a less invasive treatment. During the procedure two small groin incisions are made. Guided by x-ray imaging, the vascular surgeon introduces a tiny device into the artery. The device is used to reinforce the artery wall and exclude the aneurysm. Most patients stay in the hospital 1–3 days. Recovery time is shorter than with open surgery.