An aneurysm is a balloon-like bulge in an artery. Arteries are blood vessels that carry oxygen-rich blood to your body.
Arteries have thick walls to withstand normal blood pressure. However, certain medical problems, genetic conditions, and trauma can damage or injure artery walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm.
An aneurysm that occurs in the abdominal portion of the aorta is called an abdominal aortic aneurysm (AAA).
These aneurysms are found more often now than in the past because of computed tomography scans, or CT scans, done for other medical problems, also because of the increasing life-expectancy and the development of easy and low-cost diagnostic tools like ultrasound .
Most aortic aneurysms are AAAs. Other aortic aneurysms are thoracic aneurysms
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| Thoracic and abdominal aortic aneurysms |
What Causes an Aneurysm?
The force of blood pushing against the walls of an artery combined with damage or injury to the artery’s walls can cause an aneurysm.
Many conditions and factors can damage and weaken the walls of the aorta and cause aortic aneurysms. Examples include aging, smoking, high blood pressure, and atherosclerosis.
Atherosclerosis is the hardening and narrowing of the arteries due to the buildup of a waxy substance called plaque (plak).
Rarely, infections—such as untreated syphilis (a sexually transmitted infection)—can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that inflame the blood vessels, such as vasculitis (vas-kyu-LI-tis).
A family history of aneurysms also may play a role in causing aortic aneurysms.
Who Is at Risk for an abdominal aortic aneurysm?
Certain factors put you at higher risk for an aortic aneurysm. These factors include:
- Male gender. Men are more likely than women to have aortic aneurysms.
- Age. The risk for abdominal aortic aneurysms increases as you get older. These aneurysms are more likely to occur in people who are aged 65 or older.
- Smoking. Smoking can damage and weaken the walls of the aorta.
- A family history of aortic aneurysms. People who have family histories of aortic aneurysms are at higher risk for the condition, and they may have aneurysms before the age of 65.
- A history of aneurysms in the arteries of the legs.
- Certain diseases and conditions that weaken the walls of the aorta. Examples include high blood pressure and atherosclerosis.
- Car accidents or trauma also can injure the arteries and increase the risk for aneurysms.
Symptoms of abdominal aortic aneurysm
Most abdominal aortic aneurysms (AAAs) develop slowly over years. They often don't cause signs or symptoms unless they rupture. If you have an AAA, your doctor may feel a throbbing mass while checking your abdomen.
When symptoms are present, they can include:
- A throbbing feeling in the abdomen
- Deep pain in your back or the side of your abdomen
- Steady, gnawing pain in your abdomen that lasts for hours or days
If an AAA ruptures, symptoms may include sudden, severe pain in your lower abdomen and back; nausea (feeling sick to your stomach) and vomiting; constipation and problems with urination; clammy, sweaty skin; light-headedness; and a rapid heart rate when standing up.
Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work well. Shock can be fatal if it’s not treated right away.
Small AAAs rarely rupture. However, AAAs can grow very large without causing symptoms. Routine checkups and treatment for an AAA can help prevent growth and rupture.
Diagnosis
If you have an aortic aneurysm but no symptoms, your doctor may find it by chance during a routine physical exam. More often, doctors find aneurysms during tests done for other reasons, such as chest or abdominal pain.
If you have an abdominal aortic aneurysm (AAA), your doctor may feel a throbbing mass in your abdomen. A rapidly growing aneurysm about to rupture (burst) can be tender and very painful when pressed. If you're overweight or obese, it may be hard for your doctor to feel even a large AAA.
If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.
Your primary care doctor may refer you to a cardiothoracic or vascular surgeon for diagnosis and treatment of an aortic aneurysm.
A cardiothoracic surgeon does surgery on the heart, lungs, and other organs and structures in the chest, including the aorta. A vascular surgeon does surgery on the aorta and other blood vessels, except those of the heart and brain.
To diagnose and study an aneurysm, your doctor may recommend one or more of the following tests.
- Ultrasound and Echocardiography: Ultrasound and echocardiography (echo) are simple, painless tests that use sound waves to create pictures of the structures inside your body. These tests can show the size of an aortic aneurysm, if one is found.
- Computed Tomography Scan: A computed tomography scan, or CT scan, is a painless test that uses x rays to take clear, detailed pictures of your organs. During the test, your doctor will inject dye into a vein in your arm. The dye makes your arteries, including your aorta, visible on the CT scan pictures.Your doctor may recommend this test if he or she thinks you have an AAA or a thoracic aortic aneurysm (TAA). A CT scan can show the size and shape of an aneurysm. This test provides more detailed pictures than an ultrasound or echo.
- Magnetic Resonance Imaging: Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test works well for detecting aneurysms and pinpointing their size and exact location.
- Angiography: Angiography is a test that uses dye and special x rays to show the insides of your arteries. This test shows the amount of damage and blockage in blood vessels. Aortic angiography shows the inside of your aorta. The test may show the location and size of an aortic aneurysm.
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| CT scan 3D Abdominal aortic aneurysm |
Treatments:
Aortic aneurysms are treated with medicines and surgery. Small aneurysms that are found early and aren’t causing symptoms may not need treatment. Other aneurysms need to be treated.
The goals of treatment may include:
- Preventing the aneurysm from growing
- Preventing or reversing damage to other body structures
- Preventing or treating a rupture or dissection
- Allowing you to continue doing your normal daily activities
How often you need testing (for example, every few months or every year) is based on the size of the aneurysm and how fast it's growing. The larger it is and the faster it's growing, the more often you may need to be checked.
Medicines
If you have an aortic aneurysm, your doctor may prescribe medicines before surgery or instead of surgery. Medicines are used to lower blood pressure, relax blood vessels, and lower the risk that the aneurysm will rupture (burst). Beta blockers and calcium channel blockers are the medicines most commonly used.
Surgery
Your doctor may recommend surgery if your aneurysm is growing quickly or is at risk of rupture or dissection.
The two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair.
- Open Abdominal Repair:
The standard and most common type of surgery for aortic aneurysms is open abdominal repair. This surgery involves a major incision (cut) in the abdomen.
General anesthesia is used during this procedure
During the surgery, the aneurysm is removed. Then, the section of aorta is replaced with a graft made of material such as Dacron® or Teflon.® The surgery takes 3 to 6 hours; you’ll remain in the hospital for 5 to 8 days.
If needed, repair of the aortic heart valve also may be done during open abdominal surgery. It often takes a month to recover from open abdominal surgery and return to full activity. Most patients make a full recovery.
- Endovascular Repair:
Endovascular aneurysm repair has been a revolutionary development in the treatment of abdominal aortic aneurysms (AAAs). The advent of endovascular technology and the increasing experience and expertise of endovascular specialists have had a profound impact on the management of aortic aneurysms and resulted in improved perioperative outcomes and late results comparable with conventional open surgical repair.
In endovascular repair, the aneurysm isn't removed. Instead, a graft is inserted into the aorta to strengthen it. Surgeons do this type of surgery using catheters (tubes) inserted into the arteries; it doesn't require surgically opening the chest or abdomen. General anesthesia is used during this procedure.
The surgeon first inserts a catheter into an artery in the groin (upper thigh) and threads it to the aneurysm. Then, using an x ray to see the artery, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm.
The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta. This helps prevent the aneurysm from rupturing.
Endovascular Repair
The
illustration shows the placement of a stent graft in an aortic
aneurysm. In figure A, a catheter is inserted into an artery in the
groin (upper thigh). The catheter is threaded to the abdominal aorta,
and the stent graft is released from the catheter. In figure B, the
stent graft allows blood to flow through the aneurysm.
The
recovery time for endovascular repair is less than the recovery time for
open abdominal or open chest repair. However, doctors can’t repair all
aortic aneurysms with endovascular repair. The location or size of an
aneurysm may prevent the use of a stent graft.