Published:
August 10, 2022
Each year, about 200,000 people in the U.S. are diagnosed with an abdominal aortic aneurysm (AAA), a bulge in the lower part of the aorta—the main artery in your body. Anyone can have AAA, but if you are a male age 65 or older or have a history of smoking, you are at greater risk.
An aortic aneurysm occurs when part of the aortic wall becomes damaged or weakened, allowing it to bulge outward. If it ruptures, you are at risk for life-threatening bleeding.
That’s why it’s important to be aware of the symptoms and risk factors for AAA and understand when you need to seek emergency care.
What is the Aorta?
The aorta carries oxygen-rich blood away from your heart and delivers it to the vessels that supply blood to your brain, muscles and other parts of your body. It is a cane-shaped artery that begins in the upper chamber (left ventricle) of your heart and extends down through your chest and into your abdomen.
Aneurysms can develop anywhere in the aorta, including:
- The lower aorta in the abdomen (abdominal aortic aneurysm or AAA; the most common kind of aortic aneurysm)
- The upper aorta in the chest (thoracic aortic aneurysm or TAA)
- Both the abdomen and chest (thoracoabdominal aortic aneurysm)
What Are the Symptoms of AAA and How is it Diagnosed?
Abdominal aortic aneurysms typically develop slowly and at first, you may not notice any symptoms. If the aneurysm starts to expand, you may feel:
- Persistent abdominal or back pain that you can’t relieve by switching positions or taking pain medication
- A pulse near your belly button
Symptoms that an aortic aneurysm has torn or is bleeding may include:
- Sudden, intense and unrelenting abdominal or back pain (often described as a tearing sensation)
- Clammy skin
- Dizziness
- Fainting
- Low blood pressure
- Nausea and vomiting
- Rapid heart rate
- Shock
If you have sudden and severe pain, it is important to seek immediate medical help.
How is an Abdominal Aortic Aneurysm Treated?
Most aortic aneurysms develop in the abdomen. Depending on its size and how fast it is growing, your doctor may choose different treatment options:
- Surveillance (watchful waiting) using CT scans or ultrasound every 6–12 months
- Medications to control high cholesterol or high blood pressure
- Surgical repair—either endovascular (through a catheter in the groin) or open (through an incision in the abdomen)
What is an Endovascular Aneurysm Repair (EVAR)?
EVAR is a procedure performed by a vascular surgeon who starts by placing a needle into an artery in your groin. An incision is typically not necessary. The surgeon then inserts a long, flexible tube (catheter) over a wire and gently guides it through your arteries to the aneurysm.
Using tiny instruments and the catheter, the surgeon places a mesh tube (called an endograft or stent-graft) inside the aneurysm and fastens it in place to serve as a lining. This reinforces the weakened section of the aorta and relieves pressure on the aneurysm to prevent it from rupturing.
EVAR is a minimally-invasive procedure; it results in less pain, improved outcomes, and faster healing than traditional, open surgery. Most patients go home the following day and recover fully in about three weeks.
Other types of endovascular aneurysm repair include:
- TEVAR — Thoracic aortic endovascular repair, for an aneurysm of the upper aorta in the chest
- FEVAR — Fenestrated endovascular aneurysm repair, for AAAs located in the part of the aorta that carries blood to the kidneys. Fenestrations are small openings, like windows, in the EVAR graft. These allow for a repair of the aneurysm while still enabling blood flow to the kidneys.
What Are the Causes and Risk Factors for AAA?
If you have a family history of abdominal aortic aneurysm this may increase your risk for developing one. You’ll want to make your doctor aware of this. Other causes and risk factors include:
- High blood pressure
- High cholesterol or atherosclerosis (buildup of plaque in arteries)
- Aortic disease or inflamed blood vessels
- Traumatic injury (such as a car accident)
- Connective tissue disorders (such as Marfan syndrome)
- History of smoking
- Being age 65 and older
- Being male and white
What You Can Do to Reduce Your Risk for AAA
According to the American Heart Association, 75 percent of abdominal aortic aneurysms occur in people with a history of smoking. Quitting tobacco may help reduce your risk of developing AAA, along with partnering with your health-care provider to manage your cholesterol and blood pressure.
Abdominal aortic aneurysms are usually found during a physical exam or X-ray and confirmed by abdominal ultrasound or CT scan, or a CTA (computed tomographic angiogram). If you are between the ages of 65-75 and have certain risk factors, your doctor may recommend a one-time screening ultrasound for AAA.