Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is a bulge or ballooning in the lower part of the aorta,the major blood vessel that supplies blood to the lower body. Over time, the vessel wall can weaken and enlarge, increasing the risk of rupture, which can be life-threatening.

AAAs often develop slowly and silently, without symptoms, and are commonly discovered during imaging done for other reasons. Small aneurysms may go unnoticed, but larger ones can cause life-threatening internal bleeding. Early detection through screening and routine monitoring is key to preventing serious complications.

AAAs are typically grouped based on size.

• Small AAA – 3.0-3.9 cm in diameter
• Medium AAA – Between 4 and 5.4 centimeters
• Large AAA – 5.5 centimeters or more

An abdominal aortic aneurysm often develops slowly over time. Several factors increase the likelihood of developing an AAA:

• Atherosclerosis – Buildup of fat and plaque damages the aortic wall
• Inflammation – Chronic inflammation can degrade the structural integrity of the vessel
• Genetic conditions – Such as Marfan syndrome or Ehlers-Danlos syndrome, which affect connective tissue
• Older Age – Most common in people over 65
• Sex – Men are 4–6 times more likely than women to develop an AAA
• Tobacco Use – Strongly linked to increased risk
• Family History – Having a first-degree relative with AAA increases your risk
• High Blood Pressure – Increases stress on artery walls.

Small AAAs are often asymptomatic and may go undetected for years. However, as the aneurysm enlarges, symptoms can develop, including:

• Deep, constant pain in the abdomen or lower back
• Pulsating sensation near the navel
• Abdominal fullness or pressure
• Back or flank pain that may radiate
• Pain that worsens over time or doesn't respond to typical treatments

Ruptured AAA is a medical emergency and may present with:

• Sudden, severe abdominal or back pain
• Low blood pressure (hypotension)
• Rapid heart rate
• Loss of consciousness

Prompt medical attention is critical if rupture is suspected.

AAAs are typically diagnosed through imaging, often incidentally or via screening in at-risk populations. Common diagnostic tools include:

• Abdominal Ultrasound – A non-invasive imaging tool that uses high-frequency sound waves to visualize internal organs and blood vessels. It is the primary screening method for abdominal aortic aneurysms, often recommended for men over 65 with a history of smoking.
• CT Scan or MRI – Advanced imaging techniques that provide detailed views of the aorta and surrounding structures. These are often used to confirm the diagnosis, assess the size and extent of the aneurysm, and guide surgical planning, especially when intervention is being considered.
• Abdominal Aortic Angiography – An invasive imaging technique that involves injecting contrast dye into the bloodstream to visualize the aorta using X-ray. This is reserved for select cases during endovascular repair or when other imaging is inconclusive.

Treatment depends on aneurysm size, growth rate, and presence of symptoms:

• Monitoring: For smaller AAAs (3.0–4.9 cm), management typically involves regular imaging surveillance, lifestyle modifications to reduce risk factors, and strict blood pressure control through both lifestyle changes and medical therapy. These measures help slow aneurysm growth and reduce the risk of rupture.
• Surgical intervention: Often reserved for larger aneurysms (typically >5.0 cm in women and >5.5 cm in men), those with a rapid growth rate (usually >0.5 cm in 6 months), or those that are symptomatic.
• Endovascular Repair (EVAR) – A minimally invasive procedure in which a stent graft is inserted through the femoral artery to reinforce the weakened section of the aorta and prevent rupture.
• Open Surgical Repair – Involves making an abdominal incision to remove the weakened portion of the aorta and replace it with a synthetic graft. This approach is more invasive but offers durable, long-term results.

Speak with your healthcare provider to determine which treatment option is right for you.

• Compression of nearby structures – Large aneurysms may press on surrounding organs, causing pain or urinary symptoms
• Infection (mycotic aneurysm) – Rare, but can occur if the aneurysm becomes infected

Untreated or rapidly growing AAAs can lead to serious and potentially life-threatening outcomes, including:

• Rupture – Sudden tearing of the aneurysm wall, causing massive internal bleeding; a medical emergency with a high risk of death
• Aortic dissection – A tear in the inner layer of the aorta, allowing blood to flow between the layers of the vessel wall
• Blood Clots – Blood clots within the aneurysm may break off and block blood flow to legs or other organs.
• Compression of nearby structures – Larger aneurysms may press on surrounding organs or blood vessels, potentially causing pain, urinary symptoms, or disrupted blood flow to nearby tissues.
• Infection or Inflammation of AAA – Rare, but serious.

You can lower your risk of AAA by:

• Quitting smoking
• Managing blood pressure and cholesterol
• Exercising regularly
• Eating a heart-healthy diet
• Getting screened if you’re over 65 or have a family history