An abdominal aortic aneurysm is a weakened and bulging area in the lower part of the aorta, the major blood vessel that supplies blood to the body. The aorta, about the thickness of a garden hose, runs from your heart through the center of your chest and abdomen. Because the aorta is the body’s main supplier of blood, a ruptured abdominal aortic aneurysm can cause life-threatening bleeding. Although you may never have symptoms, finding out you have an abdominal aortic aneurysm can be frightening.
Most small and slow-growing abdominal aortic aneurysms don’t rupture, but large, fast-growing abdominal aortic aneurysms may. Depending on the size and rate at which the aortic aneurysm is growing, treatment may vary from watchful waiting to emergency surgery. Once an abdominal aortic aneurysm is found, doctors will closely monitor it so that surgery can be planned if it’s necessary. Emergency surgery for a ruptured abdominal aneurysm can be risky.
Abdominal aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Some aortic aneurysms enlarge slowly, increasing less than half an inch (1.2 centimeters) a year. Others expand at a faster rate, which increases the risk of rupture. How quickly an aortic aneurysm may enlarge is difficult to predict.
As an aortic aneurysm enlarges, some people may notice:
When to see a doctor
You should see your doctor if you have any of the symptoms listed above.
Anyone age 60 and older who has risk factors for developing an aortic aneurysm should consider regular screening for the condition. Men ages 65 to 75 who have ever smoked cigarettes should have a one-time screening for abdominal aortic aneurysm using abdominal ultrasound. Men age 60 and older with a family history of abdominal aortic aneurysm should also consider screening.
If you have a family history of aortic aneurysm, your doctor may recommend regular ultrasound exams to screen for the condition.
Most aortic aneurysms occur in the part of your aorta that’s in your abdomen. Although the exact cause of abdominal aortic aneurysms is unknown, a number of factors may play a role, including:
Aneurysms can develop anywhere along the aorta, but when they occur in the upper part of the aorta, they are called thoracic aortic aneurysms. More commonly, aneurysms form in the lower part of your aorta, and are called abdominal aortic aneurysms. Rarely, an aneurysm can occur in between the upper and lower parts of your aorta. This type of aneurysm is called a thoracoabdominal aneurysm.
Abdominal aortic aneurysm risk factors include:
Tears in the wall of the aorta (dissection) and rupture of the aneurysm are the main complications of abdominal aortic aneurysm. A ruptured aortic aneurysm can lead to life-threatening internal bleeding. In general, the larger the aneurysm, the greater the risk of rupture.
Signs and symptoms that your aortic aneurysm has burst include:
Another complication of aortic aneurysms is the risk of blood clots. Small blood clots can develop in the area of the aortic aneurysm. 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.
If you think you may have an abdominal aortic aneurysm, or are worried about your aneurysm risk because of a strong family history, make an appointment with your family doctor. If an aneurysm is found early, your treatment may be easier and more effective.
Since many abdominal aortic aneurysms are found during a routine physical exam, or while your doctor is looking for another condition, there are no special preparations necessary. If you’re being screened for an aortic aneurysm, your doctor will likely ask if anyone in your family has ever had an aortic aneurysm, so have that information ready.
Because appointments can be brief and there’s often a lot of ground to cover, it’s a good idea to be prepared for your appointment. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For an abdominal aortic aneurysm, some basic questions to ask your doctor include:
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
What you can do in the meantime
It’s never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense to keep your blood vessels healthy and prevent an abdominal aortic aneurysm from developing or worsening.
If you’re diagnosed with an abdominal aortic aneurysm, you should ask about the size of your aneurysm, whether your doctor has noticed any changes, and how frequently you should visit your doctor for follow-up appointments.
Most abdominal aortic aneurysms are found during an examination for another reason. For example, during a routine exam, your doctor may feel a pulsating bulge in your abdomen, though it’s unlikely your doctor will be able to hear signs of an aneurysm through a stethoscope. Aortic aneurysms are often found during routine medical tests, such as a chest X-ray or ultrasound of the heart or abdomen, sometimes ordered for a different reason.
If your doctor suspects that you have an aortic aneurysm, specialized tests can confirm it. These tests might include:
Regular screening for people at risk of abdominal aortic aneurysms
The U.S. Preventive Services Task Force recommends that men ages 65 to 75 who have ever smoked should have a one-time screening for abdominal aortic aneurysm using abdominal ultrasound. Men age 60 and older with a family history of abdominal aortic aneurysm should also consider screening.
Here are the general guidelines for treating abdominal aortic aneurysms:
Open-abdominal surgeryto repair an abdominal aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place, through an open-abdominal approach. With this type of surgery, it will likely take you several months to fully recover.
Endovascular surgeryis a less invasive procedure sometimes used to repair an aneurysm. Doctors attach a synthetic graft to the end of a thin tube (catheter) that’s inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm.
Recovery time for people who have endovascular surgery is shorter than for people who have open-abdominal surgery — about one or two weeks compared with six weeks for open surgery.
The options for treatment of your aneurysm will depend on a variety of factors, including location of the aneurysm, your age, kidney function and other conditions that may increase your risk for surgery or endovascular repair.
Statin medications and some antibiotics may slow the growth of small aortic aneurysms. There’s also some evidence that the angiotensin receptor blocker losartan (Cozaar) may prevent aneurysm formation.
The best approach to prevent an aortic aneurysm is to keep your blood vessels as healthy as possible. That means taking these steps:
If you have some risk factors for aortic aneurysm, talk to your doctor. If you are at risk, your doctor may recommend additional measures, including medications to lower your blood pressure and relieve stress on weakened arteries. You may also want to consider screening ultrasounds every few years.