Q: What causes abdominal aortic aneurysms?
The exact development of abdominal aortic aneurysms is unclear and remains the focus of on-going research at the Center for Aortic Disease. It occurs due to the weakness in the wall of the artery and is predominantly seen in males older than 60. The risk factors for the development of the AAA include smoking, high blood pressure, male gender, atherosclerosis or hardening of the arteries, and genetic factors.
Q: How is an abdominal aortic aneurysm diagnosed?
Abdominal aortic aneurysms often have no symptoms and are usually detected incidentally during other tests. It can also present as a lump (mass) in the abdomen, a pulsating sensation in the abdomen, or as a stiff or rigid abdomen that is usually detected during a routine examination.
An ultrasound scan is done when an abdominal aortic aneurysm with no symptoms is first suspected. A CT scan is used to confirm the size of an aneurysm.
Q: Why does this make people sick?
Abdominal aortic aneurysms develop slowly over years, often with no symptoms. Most people will not have any symptoms until the aneurysm is very large or until it begins to leak. When people continue to have poor control of risk factors, such as smoking and high blood pressure, it can expand rapidly. The risk of tearing also increases as the aneurysm grows.
Some of the symptoms from the tearing open of the aorta are sudden, severe pain in the abdomen or back, clammy skin, dizziness, nausea and vomiting, passing out, and rapid heart rate. The leak of blood (a rupture) can often result in very low blood pressure or death if not immediately treated at a hospital.
Q: How are abdominal aortic aneurysms treated?
Treatment for abdominal aortic aneurysms are determined by the size of the aneurysm, the presence and severity of symptoms, and the risk of surgery. If you have bleeding inside your body from the aortic aneurysm, you will need surgery right away.
Regular monitoring: Smaller aneurysms do not require surgery, but close observation is necessary to monitor its growth. Your doctor may want to check the size of the aneurysm with ultrasound tests every six months to determine the risk of bleeding from the aneurysm.
Surgery: Surgery is done when the aneurysm is bigger than two inches (5.5 cm) across or is growing rapidly. The goal is to do the surgery before complications develop.
- Conventional Surgery: A procedure known as open abdominal aortic repair is done under general anesthesia. A vascular surgeon will perform this by making a large incision in the abdomen and then use special surgical tools to stop the blood flow in the aorta above and below the aneurysm. The section of the aorta with the aneurysm is then replaced with an artificial graft (a durable fabric tube). The graft is sewn in place with fine stitches and the incision is then closed. Patients are monitored in the intensive care unit (ICU) after the surgery and will require a hospital stay of at least 7-14 days.
- Endovascular treatment: A procedure known as endovascular abdominal aortic repair (EVAR) is performed under general anesthesia. A vascular surgeon will perform this by making an incision in the groin, followed by inserting and deploying a fabric covered metal or plastic tube (a stent) at the site of the aneurysm. This stent will provide a new pathway for the blood flow at the site of the aneurysm. It will also prevent further expansion of the aneurysm and will keep the aorta from rupturing. Patients are closely monitored after surgery and usually have shorter hospital stays than with an open repair. This technique requires continued monitoring with CT scans every 6-12 months following discharge from the hospital to look for problems with the stent graft. However, not everyone is a candidate for the endovascular treatment.
Q: What is the long-term outcome for patients with abdominal aortic aneurysms?
The long-term outcome for patients with abdominal aortic aneurysms depends on good control of other medical problems such as smoking and tobacco use, high levels of bad cholesterol, heart disease, and high blood pressure. Development of another aneurysm after your operation (elsewhere in the abdomen or in the chest) is not uncommon in people who have been treated for a thoracic aortic aneurysm. For this reason, in addition to stopping smoking, taking your prescribed medication, and staying healthy, regular follow-up imaging studies must be performed according to your vascular surgeon’s recommendations.
The outcome is often good if you have the surgery to repair the aneurysm before it ruptures. When an abdominal aortic aneurysm begins to tear or rupture, it is a medical emergency. Only 1 in 5 people survive a ruptured abdominal aortic aneurysm.