An aortic aneurysm is a weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. As blood flows through the aorta, the weak area bulges like a balloon and can burst if the balloon gets too big.
A small aneurysm may require no immediate treatment other than "watchful waiting" - checking the aneurysm regularly to be certain it does not grow. If an aneurysm reaches a certain size, however, there is a danger that it will burst and bleed uncontrollably (hemorrhage). In these cases treatment is necessary.
Treatment of an abdominal aortic aneurysm may require surgery. For some patients, however, a new, non-surgical treatment called "stent-graft repair" can be performed by an interventional radiologist. This site gives an overview of treatment options, and specific information about stent-graft repair, the new, interventional radiology treatment that does not require surgery.
Q: What is an aneurysm?
A: An aneurysm is a weak area in the wall of a blood vessel that bulges like a balloon when blood flows through the vessel. Aneurysms can occur throughout the body, and sometimes they are harmless. But sometimes they are life-threatening. Aneurysm occurs most commonly in the brain (cerebral aneurysm) or the aorta, the main blood vessel that supplies blood to the body. An aortic aneurysm may be in the chest cavity (thoracic aortic aneurysm), but it is most commonly seen in the abdomen (abdominal aortic aneurysm).
Q: What is an abdominal aortic aneurysm (AAA)?
A: An abdominal aortic aneurysm (AAA) is a weak area in the wall of the abdominal aorta - the artery that carries blood from the heart to the rest of the body. The aorta is the body’s largest blood vessel; when an area is weak, it may bulge like a balloon when blood flows through it. The most common site for an aortic aneurysm to occur is below where the aorta divides to supply blood to the kidneys and above where it divides to supply blood to the pelvis and legs. An aneurysm that occurs in this location is called an abdominal aortic aneurysm. The normal diameter of the aorta is about 1 inch or less. Small aneurysms - less than 2 inches (5 centimeters) rarely rupture and may pose little risk to the patient. If the aneurysm grows larger, however, the risk of rupture and life-threatening bleeding (hemorrhage) increases. In most cases, physicians recommend treating aneurysms that are 5.5 centimeters or greater in diameter.
Q: How Common is AAA?
A: Abdominal aortic aneurysms occur in from 5 percent to 7 percent of people over the age of 60 in the United States. Males are at least four times more likely to have AAA than females, and some studies have shown the rate in males to be even higher. According to one study, the incidence of AAA has increased three-fold over the past 40 years, making it the 13th leading cause of death in the U.S.The condition accounts for nearly 15,000 deaths each year.
Approximately one in every 250 people over the age of 50 will die of a ruptured AAA. Fortunately, when AAA is diagnosed early it can be successfully treated and rupture is prevented. Depending on the individual, treatment may require surgery. Often, however, the aneurysm can be repaired with a new, interventional radiology technique that does not require open surgery.
Q: What are the symptoms of AAA?
A: AAA is often a silent disease. Many patients do not experience any symptoms, particularly when the aneurysm is small. If there are symptoms, the most common ones are:
- intense abdominal pain that may be constant or come and go.
- pain in the lower back that may radiate to the buttocks, groin or legs
- the feeling of a "heart beat" or pulse in the abdomen.
- Sometimes, the aneurysm can be felt as a soft mass in the abdomen.
If an aneurysm expands rapidly, tears open, or bursts, or if blood leaks along the wall of the blood vessel (aortic dissection), more severe symptoms may develop suddenly. A ruptured aneurysm is life-threatening and requires immediate emergency care.
Symptoms of a ruptured aneurysm may include:
- severe pain that begins suddenly
- rapid pulse
- dry mouth/skin and excessive thirst
- nausea and vomiting
- lightheadedness or fainting
- excessive sweating or clammy skin
Q: Who is at Risk for AAA?
A: The most common cause of an aortic aneurysm is atherosclerosis (often called "hardening of the arteries"). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that weakens or damages the walls of the blood vessels and makes them more vulnerable to an aneurysm. Other risk factors are high blood pressure, smoking and a family history of AAA. Less frequently, aneurysms may be caused by connective tissue diseases, inflammation of the blood vessels (vasculitis) and some congenital disorders. Aortic aneurysms most frequently occur in white males between the ages of 50 and 60.
Q: How do I know if I have an AAA?
A: A careful physical examination can detect as many as 70 percent to 80 percent of abdominal aortic aneurysms. By placing a stethoscope on the abdomen, the doctor often can hear the sounds of abnormal blood flow through the roughened surface of the aorta. The doctor also may be able to feel the aneurysm by pressing gently on the abdomen. If your physician suspects that you have an AAA, further diagnostic tests will be performed.
Q: How is AAA diagnosed?
A:There are a number of imaging exams that can be used to "see" and diagnose an abdominal aortic aneurysm. Your doctor may recommend one or more of the following tests: