Abdominal Aortic Aneurysm

Overview

An abdominal aortic aneurysm (AAA) is a bulge or swelling in the aorta, the main blood vessel that runs from the heart down through the chest and tummy.

An AAA can be dangerous if it is not spotted early on. It can get bigger over time and could burst (rupture), causing life-threatening bleeding. Screening for AAA can be offered to all men aged 65 and over. Women aged 70 or over, who have underlying risk factors such as high blood pressure, may also be advised to get a screening for AAA.

• The most common cause of an aneurysm is Arteriosclerosis. Smoking is a major risk factor.

Abdominal Aortic Aneurysms often do not cause symptoms. If they do, they may cause deep boring pain in the lower back or flank. Prominent abdominal pulsations may be present

• X-rays of the abdomen and other radiologic tests including ultrasound, CT, and MRI may be used in diagnosing and monitoring the aneurysm.
• Rupture of an aortic aneurysm is a major medical emergency and can be lethal.
• Repair of an aneurysm can be done by surgery or endovascular stenting.

Threatened rupture of abdominal aneurysms is a surgical emergency. Once an aneurysm ruptures, 50% of those with the aneurysm die before they reach the hospital. The longer it takes to get to the operating room, the higher the mortality.

Key facts

1. Aneurysms may cause a pulsing feeling in your belly
2. Aneurysms that are large or are growing need surgery to prevent them from bursting
3. If the aneurysm bursts, blood flows out and you have severe pain and low blood pressure
4. If the aneurysm bursts, you will die if you do not have surgery
5. Doctors often find an aneurysm during a regular exam or from an imaging test (such as an x-ray or CT scan) taken for another problem and found by accident

You are more likely to have an abdominal aortic aneurysm if:

• You are a man
• You are between the ages of 50 and 80
• Someone in your family had one
• You have high blood pressure
• You smoke. 

Symptoms

AAAs do not usually cause any obvious symptoms and are often only picked up during screening or tests carried out for another reason. Some people with an AAA have:

• a pulsing sensation in the tummy (like a heartbeat)
• tummy pain that does not go away
• lower back pain that does not go away

If an AAA ruptures, it can cause:

• sudden, severe pain in the tummy or lower back
• dizziness
• sweaty, pale, and clammy skin
• a fast heartbeat
• shortness of breath
• fainting or passing out

Diagnosis

The investigations used to diagnose and check the size of an AAA are CT Scan, MRI, and Ultrasound.

Causes

People at a higher risk of getting an AAA include all men aged 66 or over and women aged 70 or over who have one or more of the following risk factors:

• high blood pressure
• chronic obstructive pulmonary disease
• high blood cholesterol
• a family history of AAA
• cardiovascular diseases, such as heart disease or a history of stroke
• they smoke or have previously smoked

Speak to a doctor if you are worried you may be at risk of an AAA. They may suggest having a scan and making healthy lifestyle changes to reduce your risk of an AAA. 

Prevention

There are several things you can do to reduce your chances of getting an AAA or help stop one getting bigger. These include:

• stopping smoking – speak to your doctor about assistance to quit
• eating healthily – eat a balanced diet and cut down on fatty food
• exercising regularly – aim to do at least 150 minutes of exercise a week; read about how to get started with some common activities
• maintaining a healthy weight – use the healthy weight calculator to see if you need to lose weight, and find out how to lose weight safely
• cutting down on alcohol – read tips on cutting down and general advice about alcohol

If you have a condition that increases your risk of an AAA, such as high blood pressure, your Doctor may also recommend taking tablets to treat this.

Typical Treatments

The recommended treatment for an AAA depends on how big it is. Treatment is not always needed straight away if the risk of an AAA bursting is low. Treatment for a:

• small AAA (3cm to 4.4cm across) – ultrasound scans are recommended every year to check if it is getting bigger; you will be advised about healthy lifestyle changes to help stop it from growing
• medium AAA (4.5cm to 5.4cm) – ultrasound scans are recommended every 3 months to check if it is getting bigger; you will also be advised about healthy lifestyle changes
• large AAA (5.5cm or more) – surgery to stop it from getting bigger or bursting is usually recommended

Ask your doctor if you are not sure what size your AAA is.

Conclusion

AAAs are mostly asymptomatic and found incidentally. The incidence of AAA is higher in Caucasian men, individuals older than 60 years of age, and smokers. Diagnosis is usually reached using imaging modalities.

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