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Abdominal Aortic Aneurysm – Causes, Symptoms & Treatment
An abdominal aortic aneurysm is an abnormal enlargement of the main abdominal artery. It often causes no symptoms but can be life-threatening if it ruptures.
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An abdominal aortic aneurysm is an abnormal enlargement of the main abdominal artery. It often causes no symptoms but can be life-threatening if it ruptures.
What Is an Abdominal Aortic Aneurysm?
An abdominal aortic aneurysm (AAA) is an abnormal, balloon-like bulging of the abdominal aorta – the largest artery in the human body running through the abdomen. An aneurysm is diagnosed when the diameter of the aorta exceeds 3 cm (about 1.2 inches), which represents an enlargement of more than 50 percent compared to the normal vessel size. A ruptured abdominal aortic aneurysm is a life-threatening emergency with a very high mortality rate if not treated immediately.
Causes and Risk Factors
Most abdominal aortic aneurysms develop due to degenerative weakening of the arterial wall. The main risk factors include:
- Atherosclerosis (hardening of the arteries): The most common underlying cause, involving plaque buildup that weakens the vessel wall.
- Smoking: The most significant preventable risk factor.
- High blood pressure (hypertension): Increased pressure against the artery wall promotes expansion.
- Older age: Risk increases significantly after the age of 65.
- Male sex: Men are approximately 4 to 6 times more likely to develop AAA than women.
- Family history: A genetic predisposition is well established.
- Chronic inflammation or rare connective tissue disorders such as Marfan syndrome.
Symptoms
Most abdominal aortic aneurysms are silent for a long time and are often discovered incidentally during an ultrasound for another reason. When symptoms do occur, they may include:
- A dull, persistent pain in the abdomen or lower back
- A pulsating sensation in the abdomen
- Pain radiating into the groin, back, or legs
A rupture or impending rupture causes sudden, severe, tearing pain in the abdomen and back, accompanied by dizziness, a drop in blood pressure, and possible loss of consciousness. This is a medical emergency requiring immediate surgery.
Diagnosis
AAA is diagnosed using imaging techniques:
- Ultrasound (sonography): A fast, safe, and cost-effective first-line imaging method; also used for population screening.
- Computed tomography (CT) scan with contrast dye: Provides detailed information on size, shape, and anatomy – essential before surgery.
- Magnetic resonance imaging (MRI): An alternative to CT, particularly useful for patients with contrast dye intolerance.
In many countries, including the United States and the United Kingdom, a one-time ultrasound screening for AAA is recommended for men aged 65 and older, and for women with significant risk factors.
Treatment
Conservative Management (Watchful Waiting)
Small aneurysms under 5 cm in diameter are typically monitored with regular ultrasound scans every 6 to 12 months. At the same time, risk factors are actively managed: blood pressure control, smoking cessation, cholesterol reduction, and regular physical activity.
Surgical Treatment
Surgery is recommended when the aneurysm reaches 5 cm or more in diameter, grows rapidly, or causes symptoms. Two main approaches are available:
- Open surgical repair: The surgeon replaces the weakened section of the aorta with an artificial graft (prosthesis). This is a major operation but offers long-term durability.
- Endovascular aneurysm repair (EVAR): A stent-graft is inserted through the groin arteries using minimally invasive techniques to seal off the aneurysm from the inside. This approach involves a faster recovery but requires ongoing follow-up imaging.
Prognosis
When detected early and managed appropriately, the prognosis for patients with AAA is generally favorable. However, the mortality rate of a ruptured aortic aneurysm exceeds 80 percent. Regular screening and follow-up examinations are therefore critical, especially for high-risk individuals.
References
- Wanhainen A. et al. – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery, 2019.
- U.S. Preventive Services Task Force – Abdominal Aortic Aneurysm: Screening. JAMA, 2019. Available at: www.uspreventiveservicestaskforce.org
- Lederle F. A. – The natural history of abdominal aortic aneurysm. Acta Chirurgica Belgica, 2009.
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