What are the other Names for this Condition? (Also known as/Synonyms)

• Abdominal Aneurysm of Aorta
• Aortic Aneurysm in the Abdomen
• Bulging of Abdominal Aorta

What is Abdominal Aortic Aneurysm? (Definition/Background Information)

• The aorta is the main artery coming directly out of the left ventricle of the heart, carrying oxygen-rich blood to vital organs through branch arteries
• The abdominal aorta, an inch in diameter, runs down the chest to the abdomen and is a major supplier of blood to the region. It carries blood to the belly, pelvis, and legs
• Due to various reasons, the lower part of the aorta may get weakened and dilate (swell locally, like a balloon). An aneurysm is an abnormal widening or bulge in an artery, caused by a weakening of the arterial wall
• This may lead to severe internal bleeding causing life-threatening situations if an aneurysm ruptures. The incidences of rupture depend on the size and growth rate of the dilatation; large, fast-growing Abdominal Aortic Aneurysms (AAAs) are more prone to causing severe health issues than small, slow-growing ones
• A pulsating sensation around the chest or lower back region, tenderness and pain in the abdomen, nausea, and vomiting, are some of the common signs and symptoms of Abdominal Aortic Aneurysm. Imaging procedures such as an abdominal ultrasound or a CT scan of the abdomen may establish the presence of an aneurysm
• The AAA treatment approach may vary from close monitoring of the development to adopting surgical procedures (if required), based on the growth rate
• The prognosis of AAA is generally good - if it is small, detected early, and timely medical intervention is provided. In case of a rupture, the prognosis is severely affected and the condition may prove to be fatal

Who gets Abdominal Aortic Aneurysm? (Age and Sex Distribution)

• Abdominal Aortic Aneurysms are generally observed in elderly adults. It peaks between the ages of 65-75 years
• However, a manifestation of this vascular condition becomes evident after the age of 50 years in men. In women, AAA seems to onset only a decade later
• A male predominance is observed in a 2:1 ratio (male-female). After the age of 80 years, though both men and women are equally affected (1:1 ratio)
• All racial and ethnic groups can be affected; some groups may be affected more than the other groups

What are the Risk Factors for Abdominal Aortic Aneurysm? (Predisposing Factors)

Some of the predisposing factors for Abdominal Aortic Aneurysm include the following. Most often, one or more risk factors may be present.

• Advancing age that reduces the aorta’s strength and elastic properties; individual’s over the age of 50-60 years have a higher rate of AAA occurrence
• Though women face a higher risk on account of aneurysm rupture than men, statistically men tend to develop more aortic aneurysms than women (among the same age group)
• Individuals belonging to Caucasian race seem to have a higher prevalence of the condition. However, individuals of all races and ethnicities are affected
• Use of tobacco and tobacco-based products (including duration of tobacco usage) such as cigarettes, bidis, hookah, pipes, smokeless tobacco, e-cigarettes; smoking, chewing or inhaling tobacco are high-risk factors
• A condition called atherosclerosis, where the arterial walls thicken (or the blood vessel walls get damaged), due to fat deposits or other related reasons
• Hypertension (elevated blood pressure): Damage to blood vessels increase due to high blood pressure, and this increases the probability of developing an aneurysm
• Chronic obstructive pulmonary disease (COPD)
• Leading a sedentary life, lacking physical activities or exercises
• Family history of the condition (genetic factors): The influence of family history (of an aneurysm) puts an individual more at risk than others. People in this category generally tend to develop aneurysms at a younger age, and there is also a greater risk of rupture
• Congenital conditions that involve or cause a weakening of the aorta, such as Marfan syndrome, Ehlers-Danlos syndrome, connective tissue disorders, and many other
• Mycotic aneurysm: This is caused by a fungal infection that weakens the aortic wall

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Abdominal Aortic Aneurysm? (Etiology)

In general, though the exact cause of an aneurysm is unknown, the occurrence of a bulge along the weakened area on an aortal wall in the abdomen may be caused due to any or all of the following factors. Abdominal Aortic Aneurysm causal factors may include:

• Use of tobacco: Consuming tobacco through cigarette smoking or by any other means indicate a risk of an aortic aneurysm. Smoking not only causes direct damage to the arteries, thereby forcing a faster rate of aneurysmal growth, but also leads to a condition called atherosclerosis (build-up of fatty deposits called plaque) and promotes high blood pressure levels
• High blood pressure: Each time, when blood is pumped out of the heart, the aortic walls are subjected to a pressure that causes it to expand and withdraw, leading to a constant stress in them. Hence, uncontrolled high blood pressure can damage and deteriorate the arteries, increasing the risk of an aortic aneurysm greatly
• Vasculitis: It can be a rare cause of Abdominal Aortic Aneurysm. This occurs when a section of the aortic wall gets infected and swollen, leading to the formation of an aneurysm

What are the Signs and Symptoms of Abdominal Aortic Aneurysm?

Aneurysms can occur in the upper or lower part (most common) of the aorta. The former is called thoracic aortic aneurysm and the latter, Abdominal Aortic Aneurysm. A rare manifestation is when it occurs between the upper and lower part, called thoracoabdominal aneurysm.

Detection is difficult in the case of small, slow-growing AAAs, which may not exhibit any symptoms. Most occur below the line of the kidneys. Some remain small, even though they tend to increase in size gradually (less than 0.5 inches a year) and do not rupture or leak.

Some of the common signs and symptoms due to Abdominal Aortic Aneurysms that would warrant a visit to the physician are:

• Pulsating sensation around the navel, lower back, chest or groin region, due to local compression of the aneurysm
• Feeling of pain or tenderness in the abdomen, chest, back (flank pain)
• Stiffness in the abdomen
• Other symptoms may include nausea, vomiting, problems with urination, feeling full after eating very less

There is an increased prevalence of rupture with those (aneurysms) that are large and those that expand quickly. If a rupture of AAA occurs, then the following signs and symptoms may be immediately observed. This is a medical emergency situation requiring immediate treatment.

• Sudden and severe/excruciating pain in the abdomen or lower back, radiating to the groin and legs
• Increased breathing and heart rate; shortness of breath, increased pulse rate
• Low blood pressure
• Dizziness, loss of consciousness (fainting/syncope)
• Paralysis
• Shock
• Intense sweating; sweaty palms and skin
• Nausea and vomiting
• Swollen legs
• Blue/purple skin and mucus discoloration

Besides rupture of the aneurysm, infrequently, blood clots may develop within an Abdominal Aortic Aneurysm (thrombosis) that can obstruct the blood flow, or travel to other vital organs (such as the brain, lungs, or heart), leading to serious complications.

How is Abdominal Aortic Aneurysm Diagnosed?

Frequently, AAAs are discovered during routine medical check-up or tests, which are ordered for various other reasons.  An ultrasound scan of the abdomen or heart, a CT scan of the abdomen, or an x-ray of the abdomen may lead to its incidental detection.

The following tests may be performed to diagnose an Abdominal Aortic Aneurysm:

• Physical examination with thorough evaluation of medical history:
  • The physician may ask a lot of questions related to the symptoms (their severity, frequency, if they subside or increase), family history, lifestyle, and personal habits
  • The physician may even feel a pulsating bulge during the physical examination of the abdomen region, indicating an aneurysm
• Abdominal X-ray: An abdominal x-ray (taken for other reasons) may indicate the presence of an AAA to a physician. This may serve as a first step in the detection of an aneurysm
• Abdominal ultrasound: This non-invasive procedure can help diagnose and confirm an aneurysm. In this exam, the patient is made to lie on his/her back, and a type of gel is applied to the abdomen. An instrument, called the transducer, is pressed against the abdomen and moved over it, to display images of the aorta on a monitor screen. The gel prevents air pockets from causing error, when the transducer is moved over the skin of the abdomen. An ultrasound technician can check for potential aneurysms by studying the images
• CT scan of abdomen: A computerized tomography (CT) scan is another painless method that provides multiple images of the insides of the body, to help radiologists diagnose problems in the human body. The CT scanner is a large box-like machine with a hole in the center. During the process of a scan, the technologist positions the patient to lie on his/her back on the CT examination table, which then slides in and out of the machine. The machine has a rotating ring, called a gantry that has an x-ray tube and electronic detectors located all around it. The radiation passing through the body is recorded, processed, and specialized equipment create 3-dimensional images that are then displayed on a computer screen
• MRI (magnetic resonance imaging) scan of abdomen: This is another non-invasive technique that uses a powerful magnetic field and radio frequency pulses, to produce detailed images of the internal body parts. The MRI machine is a large cylinder-shaped tube with a circular magnet in the center. The patient is made to lie on a moveable examination table that slides into the machine. A strong magnetic field, which is created by passing an electric current through wire coils, aligns atomic particles in the body cells. Other coils in the machine send and receive radio signals, which also pass through the body cells. These are processed by computers to give a series of images that a physician can analyze to detect possible aneurysms
• Vascular angiogram of the abdomen: A contrast dye is injected into the bloodstream. Photographs of the blood vessels are then taken to outline the size and shape of the blood vessels in the abdominal region

The healthcare provider may have to consider a differential diagnosis, considering the varied clinical signs and symptoms present, prior to arriving at a diagnosis of Abdominal Aortic Aneurysm.

Aneurysms are classified into the following groups, based on its size:

• Small aneurysm - size less than 1.6” or 4 cm in diameter
• Medium aneurysm - size 1.6-2.2” or 4.0-5.5 cm
• Large, fast-growing aneurysm - size over 2.2” or 5.5 cm; growth 0.5 cm (one-quarter inch) over 6 months

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Abdominal Aortic Aneurysm?

Tears in the aortic wall, or separation of layers of the aortic wall (called dissection) and bursting of an aneurysm pose major problems. The following complications may occur due to an Abdominal Aortic Aneurysm rupture:

• Often, uncontrolled hemorrhaging (internal bleeding) can occur and lead to fatal consequences
• Performing an emergency surgery on a ruptured Abdominal Aortic Aneurysm is often necessary. This procedure, unfortunately, has a risk of mortality and morbidity
• Depending on the location of the AAA rupture, the complications may also include:
  • Congestive heart failure
  • Kidney failure      
  • Peripheral ischemia, with reduced blood flow to the limbs
  • High heart rate disrupting normal heart function (tachycardia)
  • Gastrointestinal bleeding

Formation of blood clots around the aortic rupture due to bleeding, complicate an aneurysm further. These freely flowing blood clots have the potential to block other blood vessels cutting off blood supply to the legs, toes, kidneys or other abdominal organs

How is Abdominal Aortic Aneurysm Treated?

Generally, the choice of treatment for aneurysms depends on several factors that include:

• Size of the aneurysm
• Age of the patient
• Location and state of the aneurysm
• Kidney function
• Other health condition(s) that may adversely affect surgery or repair of the aneurysm

Some evidence suggests that the angiotensin receptor blocker losartan (Cozaar), prevent the formation of an aneurysm. Also, some antibiotics and statin medications slow the growth of small-sized aortic aneurysms.

Treatment of Abdominal Aortic Aneurysms depends on the detection stage (early or late) and the size of the aneurysms. Following are certain guidelines that apply in the treatment of AAAs:

• Small Abdominal Aortic Aneurysm
  • The physician may place the patient under observation if no symptoms are present. A periodic ultrasound exam every 6-12 months or so may have to be taken
  • Since the risk due to a surgery is far greater than a rupture from an aneurysm, surgery is not advised for small aneurysms  
  • However, if abdominal tenderness or back pain or any such symptoms begin to occur, then these have to be immediately conveyed to the attending physician
• Medium Abdominal Aortic Aneurysm:
  • After careful examination, it would depend on the physician to qualify the case for surgery, or to place the patient under observation
  • The risks and benefits of a surgery have to be clearly discussed and explained to the patient before a decision can be made 
• Large, fast-growing or leaking Abdominal Aortic Aneurysm:
  • These rapidly-growing or tender, painful aneurysms require surgery
  • There are 2 types of surgery that may be performed for Abdominal Aortic Aneurysm - open-abdominal surgery and endovascular surgery     
• Open-abdominal surgery for AAA:
  • Through an open-abdominal surgery, the damaged part of the aorta is repaired and replaced with a synthetic tube or graft, which is sewn into place
  • A complete recovery takes several months with this type of surgery     
• Endovascular surgery for AAA
  • A small incision is made near the groin region and a catheter (thin tube) is inserted through the femoral artery and advanced to the aneurysm site
  • This catheter carries a synthetic woven tube covered by a metal mesh support, which is placed at the site and secured by small hooks       
  • This reinforces the tender weakened section of an aneurysm and prevents any rupture
  • The biggest advantage of this technique is a relatively quicker recovery and earlier return to normal activity for the patient

How can Abdominal Aortic Aneurysm be Prevented?

Some of the preventative measures for Abdominal Aortic Aneurysms could include the following factors:

• Adopting a healthy lifestyle is the best approach to keeping one’s blood vessels healthy and preventing an aortic aneurysm. Regularly exercising, keeping stress and blood pressure under control, reducing cholesterol-rich or fatty foods, and a complete avoidance of tobacco, all go a long way in contributing to decreased risks of an aneurysm
• However, if some of the risk factors are indicated, then periodical screening is recommended. The physician may additionally recommend medications, for stress or high blood pressure
• An early detection of an aneurysm precedes an effective, easy, and faster treatment.  If there are worries or concerns about aneurysm risks, due to any of the susceptibility factors outlined (previously), or because of a strong family medical history, then periodic healthcare visits are encouraged

In case the diagnosis confirms an Abdominal Aortic Aneurysm, it is advised to seek information from the physician about its size and growth, the follow-up treatment, and what must you do to prevent further aggravation of the condition. Nevertheless, make changes to your regular lifestyle in a positive way by eating healthy foods, quitting smoking, and making yourself more physically active.

What is the Prognosis of Abdominal Aortic Aneurysm? (Outcomes/Resolutions)

• Early detection and proper treatment (surgery for large aneurysms) of Abdominal Aortic Aneurysm yields a better prognosis; no long-term complications may also be noted in such cases. However, this may be adversely affected by the presence of other underlying health issues, heart conditions, poor health status of the individual, and such other factors
• Large aneurysms are more prone to rupture than smaller aneurysms. A rupture of an aneurysm may lead to a poor prognosis if immediate/emergency medical support and treatment are not provided. In such cases, there is a 20% chance of survival (or may be even less), depending on timely medical attention and assistance provided
• If you fall into any of the risk categories mentioned above, then regular medical screenings are advised. Those with a family history of aortic aneurysms may have to take periodical ultrasound examinations to avert any potentially negative outcomes

Additional and Relevant Useful Information for Abdominal Aortic Aneurysm:

Abdominal Aortic Aneurysm (AAA) repair is a surgical procedure involving the removal or repair of an aortic aneurysm.

The following article link will help you understand Abdominal Aortic Aneurysm repair:

http://www.dovemed.com/common-procedures/procedures-surgical/abdominal-aortic-aneurysm-aaa-repair/

A routine physical exam may reveal an Abdominal Aortic Aneurysm and so, prior preparations are not usually needed. However, at the time of making an appointment, do confirm if any advance preparations are required, like dietary restrictions, fasting beforehand for ultrasound scan or echocardiogram, and so on.

Also, it is better to be prepared in advance for your appointment with the physician. Thus, certain specific information may be kept handy, by considering the following points:

• Note down any history of heart diseases or aneurysms in the family, as well as pertinent personal medical information
• List any symptoms that you are aware of, or you are experiencing; include those that may seem unconnected to an abdominal aneurysm too
• List of medication and drugs (also vitamins and supplements) that you are currently using for other health conditions (if any)
• Your physician might want to know and discuss your smoking habits (if any, present or past), exercise, and dietary routines

It is the recommendation of the ‘US Preventive Services Task Force’ that men between the ages 65-75 years should have a one-time abdominal ultrasound screening for Abdominal Aortic Aneurysm, if they have ever smoked before. Men, over 60 years of age with a family history of AAA, should also consider a medical examination for the same.