Abdominal aortic aneurysm Health Article

Definition

An abdominal aortic aneurysm is when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward.

Alternative Names

Aneurysm - aortic; AAA

Causes, incidence, and risk factors

The exact cause is unknown, but risk factors for developing an aortic aneurysm include:

• Smoking
• High blood pressure
• High cholesterol
• Male gender
• Emphysema
• Genetic factors
• Obesity

An abdominal aortic aneurysm can develop in anyone, but is most often seen in males over 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to rupture and break open.

Symptoms

Aneurysms develop slowly over many years and often have no symptoms. If an aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along the wall of the vessel (aortic dissection), symptoms may develop suddenly.

The symptoms of rupture include:

• Pain in the abdomen or back -- severe, sudden, persistent, or constant. The pain may radiate to the groin, buttocks, or legs.
• Clammy skin
• Nausea and vomiting
• Rapid heart rate
• Shock

Signs and tests

Your doctor will examine your abdomen. The exam also will include an evaluation of pulses and sensation in your legs. The doctor may find:

• Abdominal mass
• Stiff or rigid abdomen
• Pulsating sensation in the abdomen

You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem from special tests called ultrasound of the abdomen or CT scan of the abdomen.

Either of these tests may be done when you're having symptoms.

Treatment

If you have bleeding inside your body from an aortic aneurysm, you will have open abdominal aortic aneurysm repair.

If the aneurysm is small and there are no symptoms:

• You and your doctor must decide whether the risk of having surgery is smaller than the risk of bleeding if you do not have surgery.
• Your doctor may recommend checking the size of the aneurysm with a yearly ultrasound test, to see if the aneurysm is getting bigger.

Surgery is usually recommended for patients who have aneurysms bigger than 2 inches or 5.5 cm across and aneurysms that are growing quickly. The goal is to perform surgery before complications or symptoms develop.

There are two approaches to surgery:

• In a traditional (open) repair, a large cut is made in your abdomen. The abnormal vessel is replaced with a graft made of man-made material, such as Dacron.
• The other approach is called endovascular stent grafting. This procedure can be done without making a large cut in your abdomen, so you may get well faster. Endovascular repair is rarely done for a leaking or bleeding aneurysm.