Answers to common question about abdominal aortic aneurysms

Dr. Sherene Shalhub

In this month’s “Ask a Doctor” feature, provided by Valley Medical Center, Dr. Sherene Shalhub answers common questions about abdominal aortic aneurysm.

Q. What is it?
A. The aorta is the largest artery in the body. It carries blood directly from the heart to all major parts of the body. When the aorta reaches the bottom of the rib cage and enters the abdomen it is called the abdominal aorta. A normal aorta is about 1 inch (or about 2 centimeters) in diameter. An abdominal aortic aneurysm (AAA) is a weakness in the wall of the aorta in the abdomen which causes bulging and acts like a balloon, swelling from the pressure of the blood. If it becomes severe, an aneurysm might rupture, potentially causing a person to bleed to death.
About 200,000 people in the United States are diagnosed with AAA each year. Of these, about 15,000 aneurysms rupture each year before treatment. Even with quick medical attention, such ruptures are commonly fatal. However, if diagnosed early, AAA is very treatable.

Q. Who gets it?
A. The cause of AAA is not always clear. There are risk factors such as a family history of aneurysms, smoking, and high blood pressure. Men at age 60 and older who are smokers or pervious smokers are at the greatest risk of developing the condition.

Q. What are the symptoms?
A. Most AAAs are asymptomatic, meaning they have no symptoms. When symptoms are present, they can include: A pulsing feeling in the abdomen or severe and sudden pain in the abdomen, lower back, legs or groin. If the abdominal aortic aneurysm does rupture, it can cause extreme pain and loss of consciousness. A ruptured abdominal aortic aneurysm is an emergency requiring immediate medical treatment.

Q. How is it found?
A. Since an AAA may not reveal itself with symptoms, it often is found in the course of a medical exam for an unrelated condition or if your physician sometimes feels a large pulsating mass in your abdomen during a routine physical examination. If your physician suspects that you may have AAA, he or she may recommend an abdominal ultrasound or a computed tomography (CT) scan.

Q. How is treated?
A. If your AAA is smaller than about 2 inches (roughly 5.0 to 5.5 centimeters), then vascular surgeons may recommend “watchful waiting.” This means you will be monitored with imaging studies every six to 12 months for signs of changes in the aneurysm size. If you smoke, it is recommended that you attempt to quit. If you have high blood pressure, your physician may prescribe blood pressure medication to lower the pressure on the weakened area of the aneurysm. The AAA will not “go away” by itself. If diagnosed with an AAA, it is extremely important to continue to follow up with your physician as directed because the aneurysm may get larger to a dangerous size over time.

If the AAA causes symptoms, or becomes larger than about 2 inches (roughly 5.0 to 5.5 centimeters), or is enlarging under observation, then your vascular surgeon will recommend you have a surgical procedure to fix it. Two surgical options exist: an open operation or an endovascular stent graft (EVAR). During an “open surgical aneurysm repair” your vascular surgeon makes an incision in your abdomen and replaces the weakened part of your aorta with a tube-like aortic graft made of a strong, durable, man-made plastic material. The EVAR procedure is less invasive, and typically only requires small incisions in the groin area to thread the catheters. During the procedure, your vascular surgeon will use live x-ray pictures viewed on a video screen to guide a fabric and metal tube, called an endovascular stent graft, to the site of the aneurysm to strengthen the aorta.
Talk to your health-care provider if you are concerned about the risk of an abdominal aortic aneurysm.