Abdominal Aortic Aneurysm: Symptoms With and Without Rupture
Medically reviewed by Richard N. Fogoros, MD
Abdominal aortic aneurysm (AAA) is enlargement of the abdominal portion of the body's largest artery, the aorta. Aneurysms grow slowly over time, and with small ones there are often no symptoms at all. However, larger aneurysms and rapidly expanding aneurysms can cause symptoms, and even rupture (burst) or dissect (tear). AAA rupture and dissection are life-threatening situations that can cause severe low blood pressure, dizziness, rapid heart rate, and sudden, severe abdominal pain.
Read on to learn more about abdominal aortic aneurysm, its symptoms, diagnosis, and treatment options.
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Causes of Abdominal Aortic Aneurysm
Abdominal aortic aneurysms are caused by weakening of the aortic wall, causing bulging and enlargement in the affected area. Atherosclerosis, or build-up of plaque in the blood vessel wall, is commonly seen in aneurysms. Other risk factors for abdominal aortic aneurysm include:
Smoking- about 1 in 10 people who smoke develop abdominal aortic aneurysm
Age–abdominal aortic aneurysm is most common in those over 65 years
Genetics–up to 1 in 4 people with an abdominal aortic aneurysms have a family member affected
Connective tissue conditions, such as vascular Ehlers-Danlos and Loeys-Dietz syndromes
Inflammatory aortitis such as Takayasu arteritis and Giant Cell arteritis are rare but may cause aneurysm
Asymptomatic Abdominal Aortic Aneurysm
In many cases, aneurysms don't cause any symptoms, particularly if they are small. However, any aneurysm increases your risk of complications such as rupture or dissection (tearing in the artery wall). The larger the aneurysm, the higher the risk. For certain people with risk factors, screening tests for abdominal aortic aneurysms can help identify aneurysms early to allow for strategies and treatment to prevent life-threatening complications.
Emergency Symptoms of Ruptured Abdominal Aortic Aneurysm
Aneurysm rupture is a life-threatening complication of an abdominal aortic aneurysm. Symptoms of ruptured aorta include:
Sudden, severe pain in the abdomen, back, or legs
Lightheadedness, dizziness, or fainting
Fast heart rate
Feeling cold and clammy
Nausea and vomiting
If you have and known abdominal aortic aneurysm and experience these symptoms, seek medical attention immediately.
Screening and Diagnosis of Abdominal Aortic Aneurysm
Imaging tests are done to evaluate abdominal aortic aneurysms. These can be done for screening purposes, to look for an aneurysm in someone without symptoms who has certain risk factors, for diagnosis, to look for abdominal aortic aneurysm in someone with symptoms. The following imaging tests can identify abdominal aortic aneurysm:
Abdominal Aortic Aneurysm Screening
Not everyone needs screening tests to look for abdominal aortic aneurysm. However, screening is performed in people with certain risk factors for abdominal aortic aneurysms to help identify aneurysms. Specific recommendations for screening vary based on different guidelines. Ultrasound is the preferred test for screening since it's a quick, noninvasive, and inexpensive.
All men aged 65-75 years who have smoked should have an ultrasound to look for abdominal aortic aneurysm. The Society for Vascular Surgery also strongly recommends screening in women in this age group who have smoked.
Additionally, people who have first-degree relatives (such as a parent or sibling) with abdominal aortic aneurysm should also undergo screening. It's reasonable for people with multiple risk factors to undergo screening. Talk with your healthcare provider if you have risk factors to see if screening is indicated.
Diagnosis of Abdominal Aortic Aneurysm
Imaging is performed to diagnose an abdominal aortic aneurysm. This may be with an ultrasound of the aorta. Computed tomography (CT) scans are commonly performed in the diagnosis of abdominal pain as it may provide more detailed imaging of the abdomen and can identify various other problems. Sometimes an abdominal aortic aneurysm is discovered incidentally on imaging performed for other reasons.
Once an abdominal aortic aneurysm is identified, interval imaging tests using ultrasound, CT, or MRI are recommended depending on the size and rate of growth. Small aneurysms may have repeat imaging every three years, whereas larger or rapidly growing aneurysms need more frequent imaging every six months. Your healthcare provider can make an individualized plan.
Treatment of Abdominal Aortic Aneurysm
Treatment of an abdominal aortic aneurysm involves managing risk factors to delay the growth of the aneurysm. Some people may require procedures to address a large or rapidly growing aneurysm. Generally, an abdominal aortic aneurysm should be repaired when it is 5.0–5.5cm or larger. Repair is also recommended for any size aneurysm that is causing symptoms.
A ruptured abdominal aortic aneurysm is a medical emergency that requires repair of the aorta.
Risk Factor Management
The following preventive measures are recommended to delay growth and prevent complications:
Quitting smoking
Managing blood pressure
Controlling cholesterol- statin medications are recommended for those with atherosclerosis
Aspirin may also be recommended in those with aneurysms related to atherosclerosis to help prevent other complications like heart attack and stroke
Procedures
When aneurysms are large or rapidly growing, aorta repair is recommended. A ruptured aneurysm requires immediate attention and repair. There are two options for repair: open aneurysm repair or endovascular repair (EVAR) may be used, depending on the situation.
In both cases, a graft, or tube, is placed in the affected area of the abdominal aorta. Open aneurysm repair is a major surgery performed under general anesthesia. In open repair, a surgeon makes an incision in the abdomen to access the aorta. EVAR, on the other hand, involves the placement of catheters in the groin to access and deliver the graft.
A Look at Abdominal Aortic Aneurysm Recovery
Recovery after aneurysm repair varies depending on the type of surgery. After surgery, you will stay in the hospital for monitoring. Open repair is a major surgery with an abdominal incision, and it takes a few weeks to heal and return to normal activities. With endovascular repair, recovery is much quicker.
In either case, you will be monitored in the hospital for some time after surgery. Your surgeon will provide instructions on how to care for your surgical wound, as well as any activity restrictions, such as walking, lifting, and driving. Your surgeon may prescribe blood thinners to help keep your graft open. And you may need to take antibiotics before certain dental procedures to prevent graft infection.
Prevention of Abdominal Aortic Aneurysm
While it's not always possible to prevent an aortic aneurysm, we can minimize certain risk factors for abdominal aortic aneurysm. The following can help prevent cardiovascular disease in general and are good practices for everyone to incorporate, whether or not they have risk factors for abdominal aortic aneurysm:
Quit smoking and avoid secondhand smoke
Control blood pressure, cholesterol, and blood sugar
Get regular physical exercise
Talk to your healthcare provider about getting screened if you have risk factors like age >65, you've ever smoked, or have a family member with an aneurysm.
Summary
An abdominal aortic aneurysm is an area of aorta enlargement within the abdomen. Abdominal aortic aneurysms slowly grow over time and increase the risk of severe and life-threatening complications like rupture or dissection, especially when they become large. Many abdominal aortic aneurysms don't cause symptoms, especially when they're small.
Know the signs of an aortic emergency due to a ruptured or dissected abdominal aortic aneurysm, which includes sudden, severe pain in the abdomen, back, or legs, lightheadedness, and racing heart. Lower your risk of aneurysms and prevent them from enlarging by quitting smoking and controlling blood pressure and cholesterol.
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