Abdominal aortic aneurysm

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An abdominal aortic aneurysm is an enlarged area in the lower part of the major vessel that supplies blood to the body (aorta). The aorta runs from your heart through the center of your chest and abdomen.                               

The aorta is the largest blood vessel in the body, so a ruptured abdominal aortic aneurysm can cause life-threatening bleeding.

Depending on the size of the aneurysm and how fast it's growing, treatment varies from watchful waiting to emergency surgery.

Symptoms

Abdominal aortic aneurysms often grow slowly without symptoms, making them difficult to detect. Some aneurysms never rupture. Many start small and stay small; others expand over time, some quickly.

If you have an enlarging abdominal aortic aneurysm, you might notice:

• Deep, constant pain in your abdomen or on the side of your abdomen
• Back pain
• A pulse near your bellybutton

When to see a doctor

If you have pain, especially if pain is sudden and severe, seek immediate medical help

Causes

Aneurysms can develop anywhere along the aorta, but most aortic aneurysms occur in the part of your aorta that's in your abdomen. A number of factors can play a role in developing an aortic aneurysm, including:

• Hardening of the arteries (atherosclerosis). Atherosclerosis occurs when fat and other substances build up on the lining of a blood vessel.
• High blood pressure. High blood pressure can damage and weaken the aorta's walls.
• Blood vessel diseases. These are diseases that cause blood vessels to become inflamed.
• Infection in the aorta. Rarely, a bacterial or fungal infection might cause an abdominal aortic aneurysms.
• Trauma. For example, being in a car accident can cause an abdominal aortic aneurysms.

Risk factors

Abdominal aortic aneurysm risk factors include:

• Tobacco use. Smoking is the strongest risk factor. It can weaken the aortic walls, increasing the risk not only of developing an aortic aneurysm, but of rupture. The longer and more you smoke or chew tobacco, the greater the chances of developing an aortic aneurysm.
• Age. These aneurysms occur most often in people age 65 and older.
• Being male. Men develop abdominal aortic aneurysms much more often than women do.
• Being white. People who are white are at higher risk of abdominal aortic aneurysms.
• Family history. Having a family history of abdominal aortic aneurysms increases your risk of having the condition.
• Other aneurysms. Having an aneurysm in another large blood vessel, such as the artery behind the knee or the aorta in the chest, might increase your risk of an abdominal aortic aneurysm.

Complications

Tears in one or more of the layers of the wall of the aorta (aortic dissection) or a ruptured aneurysm are the main complications. A rupture can cause life-threatening internal bleeding. In general, the larger the aneurysm and the faster it grows, the greater the risk of rupture.

Signs and symptoms that your aortic aneurysm has ruptured can include:

• Sudden, intense and persistent abdominal or back pain, which can be described as a tearing sensation
• Low blood pressure
• Fast pulse

Aortic aneurysms also put you at risk of developing blood clots in the area. If a blood clot breaks loose from the inside wall of an aneurysm and blocks a blood vessel elsewhere in your body, it can cause pain or block the blood flow to the legs, toes, kidneys or abdominal organs.

Prevention

To prevent an aortic aneurysm or keep an aortic aneurysm from worsening, do the following:

• Don't use tobacco products. Quit smoking or chewing tobacco and avoid secondhand smoke.
• Eat a healthy diet. Focus on eating a variety of fruits and vegetables, whole grains, poultry, fish and low-fat dairy products. Avoid saturated fat, trans fats and limit salt.
• Keep your blood pressure and cholesterol under control. If your doctor has prescribed medications, take them as instructed.
• Get regular exercise. Try to get at least 150 minutes a week of moderate aerobic activity. If you haven't been active, start slowly and build up. Talk to your doctor about what kinds of activities are right for you.

If you're at risk of an aortic aneurysm, your doctor might recommend other measures, such as medications to lower your blood pressure and relieve stress on weakened arteries.

Diagnosis

Abdominal aortic aneurysms are often found during an examination for another reason or during routine medical tests, such as an ultrasound of the heart or abdomen.

To diagnose an abdominal aortic aneurysm, doctors will review your medical and family history and do a physical exam. If your doctor suspects that you have an aortic aneurysm, specialized tests, such as the following, can confirm it.

• Abdominal ultrasound. This test is most commonly used to diagnose abdominal aortic aneurysms. You lie on a table while a technician moves a wand (transducer) around your abdomen. Ultrasound uses sound waves to send images to a computer screen.

• CT scan. This painless test can provide your doctor with clear images of your aorta, and it can detect the size and shape of an aneurysm.

  During a CT scan, you lie on a table inside a doughnut-shaped machine. CT scanning generates X-rays to produce cross-sectional images of your body. You might have contrast dye injected into your blood vessels that makes your arteries more visible on the CT pictures (CT angiography).

• MRI. In this test, you lie on a movable table that slides into a machine. An MRI uses a magnetic field and pulses of radio wave energy to make pictures of your body. You might have a dye injected into your blood vessels to make them more visible (magnetic resonance angiography).

Screening for abdominal aortic aneurysm

Being male and smoking significantly increase the risk of abdominal aortic aneurysm. Screening recommendations vary, but in general:

• Men ages 65 to 75 who have ever smoked cigarettes should have a one-time screening using abdominal ultrasound.
• For men ages 65 to 75 who have never smoked, your doctor will decide on the need for an abdominal ultrasound, usually based on other risk factors, such as a family history of aneurysm.

There isn't enough evidence to determine whether women ages 65 to 75 who ever smoked cigarettes or have a family history of abdominal aortic aneurysm would benefit from abdominal aortic aneurysm screening. Ask your doctor if you need to have an ultrasound screening based on your risk factors. Women who have never smoked generally don't need to be screened for the condition.