Abdominal Aortic Aneurysm

What is an Abdominal Aortic Aneurysm?

Your aorta is the main artery in your body. This large artery is like a superhighway that supplies blood to your entire body. The aorta, which is shaped like a candy cane, begins in the left ventricle (upper chamber) of your heart. It curves in your chest and extends all the way down into your abdomen.

When the walls of your aorta become damaged or weakened, it can balloon outward. This bulge is an aneurysm. The three types of aortic aneurysms include:

• Abdominal aortic aneurysm (AAA), an aneurysm in the lower part of the aorta
• Thoracic aortic aneurysm, an aneurysm in the top of the aorta
• Thoracoabdominal aneurysm, a complex aneurysm that involves branches of the abdominal aorta that supply blood to the liver, intestines and kidneys

If an aneurysm ruptures or bursts, it can result in rapid blood loss that can be life-threatening. While a ruptured aneurysm is extremely dangerous, most abdominal aortic aneurysms are discovered before they reach that point. AAAs occur most often in people aged 60 and older.

Causes of an Abdominal Aortic Aneurysm

The most significant risk factor for AAA is having a family history of this type of aneurysm. If someone in your family has had AAA and you have severe pain in your back or abdomen that comes on suddenly, get care immediately.

Other risk factors for abdominal aortic aneurysm include having:

• Atherosclerosis, the buildup of plaque (fatty deposits) in artery walls
• Tears in the wall of the aorta (aortic dissection)
• Infections in or near the aorta
• Connective tissue disorders, such as Marfan syndrome
• History of smoking
• Long-standing high blood pressure

Screening for an Abdominal Aortic Aneurysm

Health care providers can screen you for an existing abdominal aortic aneurysm or to assess your likelihood of developing AAA. The screening is a simple, noninvasive ultrasound exam. Ultrasound uses sound waves to show images of your organs and blood vessels.

One-time screening is recommended for men ages 65 to 75 who smoke or have ever smoked. If you are a man ages 65 to 75 who has never smoked, your health care provider may recommend screening based on your personal history and other risk factors. Experts don't recommend routine screening for women at this time.

Symptoms of an Abdominal Aortic Aneurysm

Aneurysms develop slowly over the course of several years. Most people don't experience symptoms. You may be unaware that you have an abdominal aortic aneurysm.

An aneurysm that expands rapidly, tears open or leaks blood can cause symptoms. One notable symptom is pain in your abdomen or back that you can't relieve by switching positions or taking pain medication. The pain may be sudden, severe and constant and may spread to the legs, groin or buttocks.

You may also experience:

• Clammy skin
• Dizziness
• Fainting
• Low blood pressure
• Nausea and vomiting
• Rapid heart rate
• Shock

Diagnosing an Abdominal Aortic Aneurysm

Doctors usually find abdominal aortic aneurysms during a physical examination or on an X-ray. To understand more about the aneurysm, your doctor will examine your abdomen and feel the pulses in your legs.

You may have one or more of the following tests to confirm the diagnosis:

• Ultrasound of the abdomen: Uses sound waves to produce images of the aorta
• CT scan of the abdomen: A series of X-rays that produces 3D images that can show an aneurysm's size and extent
• CTA (computed tomographic angiogram): Imaging that uses contrast (dye) to show details about an aneurysm that can help surgeons plan your treatment

Treatment at Penn

When you choose Penn Medicine, you will work with a highly specialized team of vascular surgeons who helped pioneer treatments for abdominal aortic aneurysms. Your treatment may include:

Active surveillance

If a small aneurysm is not causing symptoms, your doctor may advise surveillance, also called watchful waiting. You may have CT scans or ultrasound every six to 12 months to monitor the aneurysm. In the meantime, your doctor may recommend that you:

• Stop smoking
• Lower blood pressure
• Reduce high cholesterol levels

Medications

If you have high cholesterol or high blood pressure, your doctor may prescribe or change medications to help control these conditions. Controlling blood pressure can help prevent further weakening of the wall of the aorta.

Surgery

If the aneurysm is bigger than 2.5 inches (the size of a plum), Penn doctors generally recommend surgery. Surgical options may include:

• Endovascular aneurysm repair: We perform many aortic aneurysm repairs endovascularly (through a vein), using minimally invasive procedures without a large incision. Our team uses advanced techniques to repair aneurysms that involve complex structures in the abdomen. Learn more about endovascular aneurysm repair.
• Traditional open surgery: For some people, open surgery is the most effective option to repair the aneurysm. We routinely perform this procedure and have a high level of expertise. Open surgery involves an incision in your abdomen. Our skilled surgeons remove the damaged portion of the aneurysm and replace it with a synthetic tube (stent graft).

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Penn Programs & Services for Abdominal Aortic Aneurysm