Abdominal Aortic Aneurysm

An aneurysm is a weakened or damaged part of an artery wall that bulges from the normal force of blood pumping through the body. An abdominal aortic aneurysm is an aneurysm that occurs in the lower part of the aorta, the main artery of the body.

ExitCare ImageThe major concern with an abdominal aortic aneurysm is that it can enlarge and burst (rupture) or blood can flow between the layers of the wall of the aorta through a tear (aortic dissection). Both of these conditions can cause bleeding inside the body and can be life threatening unless diagnosed and treated promptly.

CAUSES

The exact cause of an abdominal aortic aneurysm is unknown. Some contributing factors are:

  • A hardening of the arteries caused by the buildup of fat and other substances in the lining of a blood vessel (arteriosclerosis).

  • Inflammation of the walls of an artery (arteritis).  

  • Connective tissue diseases, such as Marfan syndrome.  

  • Abdominal trauma.  

  • An infection, such as syphilis or staphylococcus, in the wall of the aorta (infectious aortitis) caused by bacteria.

RISK FACTORS

Risk factors that contribute to an abdominal aortic aneurysm may include:

  • Age older than 60 years.  

  • High blood pressure (hypertension).

  • Male gender.

  • Ethnicity (white race).

  • Obesity.

  • Family history of aneurysm (first degree relatives only).

  • Tobacco use.

PREVENTION

The following healthy lifestyle habits may help decrease your risk of abdominal aortic aneurysm:

  • Quitting smoking. Smoking can raise your blood pressure and cause arteriosclerosis.

  • Limiting or avoiding alcohol.

  • Keeping your blood pressure, blood sugar level, and cholesterol levels within normal limits.

  • Decreasing your salt intake. In some people, too much salt can raise blood pressure and increase your risk of abdominal aortic aneurysm.

  • Eating a diet low in saturated fats and cholesterol.

  • Increasing your fiber intake by including whole grains, vegetables, and fruits in your diet. Eating these foods may help lower blood pressure.

  • Maintaining a healthy weight.

  • Staying physically active and exercising regularly.

SYMPTOMS

The symptoms of abdominal aortic aneurysm may vary depending on the size and rate of growth of the aneurysm. Most grow slowly and do not have any symptoms. When symptoms do occur, they may include:

  • Pain (abdomen, side, lower back, or groin). The pain may vary in intensity. A sudden onset of severe pain may indicate that the aneurysm has ruptured.

  • Feeling full after eating only small amounts of food.

  • Nausea or vomiting or both.

  • Feeling a pulsating lump in the abdomen.

  • Feeling faint or passing out.

DIAGNOSIS

Since most unruptured abdominal aortic aneurysms have no symptoms, they are often discovered during diagnostic exams for other conditions. An aneurysm may be found during the following procedures:

  • Ultrasonography (A one-time screening for abdominal aortic aneurysm by ultrasonography is also recommended for all men aged 65-75 years who have ever smoked). 

  • X-ray exams.

  • A computed tomography (CT).

  • Magnetic resonance imaging (MRI).

  • Angiography or arteriography.

TREATMENT

Treatment of an abdominal aortic aneurysm depends on the size of your aneurysm, your age, and risk factors for rupture. Medication to control blood pressure and pain may be used to manage aneurysms smaller than 6 cm. Regular monitoring for enlargement may be recommended by your caregiver if:

  • The aneurysm is 3–4 cm in size (an annual ultrasonography may be recommended).

  • The aneurysm is 4–4.5 cm in size (an ultrasonography every 6 months may be recommended).

  • The aneurysm is larger than 4.5 cm in size (your caregiver may ask that you be examined by a vascular surgeon).

If your aneurysm is larger than 6 cm, surgical repair may be recommended. There are two main methods for repair of an aneurysm:

  • Endovascular repair (a minimally invasive surgery). This is done most often.

  • Open repair. This method is used if an endovascular repair is not possible.