The aorta is the main blood vessel that supplies blood to the chest, abdomen, pelvis and legs. When blood flows through the body, it does so under pressure. When there is a weakness in the walls of the aorta, the constant pressure can cause the vessel wall to balloon out. In medical terms this is called an aneurysm. Most abdominal aortic aneurysms are small and cause no symptoms so the patient is unaware that they have an abdominal aortic aneurysm. In the U.S., every year 15,000 people die from abdominal aortic aneurysms.
It is occurs when there is a weakness in the aorta wall. The cause of the weakness is unknown at this time.
Abdominal aortic aneurysm is called a “silent killer” because often there are no symptoms. Abdominal aortic aneurysm develops gradually over years. Symptoms may appear suddenly when the aneurysm begins to grow larger, tear open or leak blood into the wall of the aorta. This is a life-threatening situation.
Most people have no symptoms, but if they do, they may include:
This may indicate the aneurysm is growing and should be examined.
Symptoms of rupture include:
Physical exam may detect an aneurysm. An ultrasound of the abdomen is usually the test used when abdominal aortic aneurysm is suspected. A CT scan of the abdomen is used to establish the size of the aneurysm.
Generally, abdominal aortic aneurysms are less than 5 cm (about 2 inches) in diameter, have a low risk of rupture, and should be watched.
Watchful waiting: When the aneurysm is small and not expanding quickly, it will be watched, medical problems will be carefully managed, and the size of the aneurysm will be checked by ultrasound every six months to one year. Lifestyle changes that control blood pressure can help. Daily exercise is beneficial. Quitting smoking is ideal.
Surgical repair: Generally, the size of the aneurysm determines the time for surgery. When the abdominal aortic aneurysm is larger than 5 cm in diameter, or rapidly expanding, treatment is necessary.
The larger the aneurysm the more likely it will tear or break open. This is called a rupture. If the aneurysm is larger than 2 inches across and enlarging quickly, the goal of surgery is to repair it before complications can develop.
1 – Open repair. This surgery is done in an operating room under general anesthesia and can take from 2-4 hours. You will be sent to intensive care to recover after surgery. Recovery requires a hospital stay of 5-10 days. Full recovery may take 2-3 months. Many people who have the aneurysm repaired before rupture, will make a full recovery. Once the aneurysm ruptures, the chance of a full recovery is significantly reduced. Open repair may be done as an emergency procedure, when there is internal bleeding or when there is an immediate risk of rupture.
2 – Endovascular stent grafting. This minimally invasive procedure is performed under general anesthesia in a surgical suite or hospital. Guided by x-rays, small groin incisions are made to insert a stent graft to reinforce the artery wall, redirect blood flow (bypass the aneurysm) and reduce or stop pressure on the aorta wall. Older patients with medical conditions that prohibit them from open repair, can do well with this procedure. A hospital stay of 1-3 days is common.
Need more information on Abdominal Aortic Aneurysm? Visit the Society for Vascular Surgery’s Patient Resources section here.