Aortic Aneurysm

What is an abdominal aortic aneurysm (AAA)?

When the wall of a blood vessel weakens, a balloon-like dilation called an aneurysm sometimes develops. This happens most often in the abdominal aorta, an essential blood vessel that supplies blood to your legs. Every year, 200,000 people in the U.S. are diagnosed with an abdominal aortic aneurysm (AAA). A ruptured AAA is the 15th leading cause of death in the country, and the 10th leading cause of death in men older than 55. 

What are the symptoms of an abdominal aortic aneurysm?

In most cases, abdominal aortic aneurysms cause no symptoms and are found when you are being evaluated for another medical condition. If you have a family history of AAA and feel sudden, severe pain in your abdomen or back, seek immediate care. These symptoms may signal that you have developed an AAA, possibly one in process of rupturing. A small percentage of patients with AAA have these symptoms when plaque or blood clots from elsewhere in the body collect in the feet and toes.

What causes an abdominal aortic aneurysm?

Many factors contribute to AAA formation.

  • Some type of inflammation that causes a weakening of the wall of the aortic artery.
  • Men older than 60, smokers,  and anyone with a first-generation relative who has developed an AAA are at highest risk for an abdominal aortic aneurysm.
  • Age (50+ for men, 60+ for women) and a history of atherosclerosis, high blood pressure, elevated cholesterol, heart or peripheral vascular disease and tobacco use are all associated with AAA formation.
  • Other potential factors associated with AAA formation include tears in the arterial wall, infections, and congenital connective tissue disorders.

How is an abdominal aortic aneurysm diagnosed?

Most AAAs cause no symptoms and are found incidentally, during an evaluation for another medical condition. If you are affected, your doctor will likely ask you to see a vascular surgeon.

An abdominal ultrasound is painless, cost-effective, safe and the most frequently utilized test to screen for and measure the size of an AAA.

Computed tomographic angiography (CTA) will assess aneurysm size, location and the extent of impact. This study requires exposure to radiation and injection of an intravenous contrast agent. However, a CTA provides valuable anatomic information and can help your vascular surgeon determine the optimal type of repair.

Treatment strategies

  • Small aneurysms: < 4 cms.-  These are watched with a yearly US
  • Medium aneurysms: 4-5 cms- Also watched with nan US but every 6 months
  • Marge aneurysms: > 5.5 cms for men, >5 cms. For women
    • Open surgery- Abdomial incision, 7-10 days in hospital, 1.5-3 month recovery, 95% success rate, office visits for follow up
    • Transfemoral stenting aortic stenting – 2 small groin incisions, done with x ray guidance, 95% success rates, life long yearly imaging to monitor position of stent with US or CT scan
Content reprinted with permission from the Society for Vascular Surgery® (SVS).

 

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