Abdominal Aortic Aneurysm

What is an Abdominal Aortic Aneurysm?

An abdominal aortic aneurysm (AAA or triple A) is a weakened area in the wall of the aorta, which causes the aorta to bulge in the area of weakness and widen by 50 percent.

The most common location where an arterial aneurysm forms is in the abdominal aorta, especially in the area below the kidneys. 

The types of an aneurysm are fusiform or saccular, each named because of their shape. A fusiform aneurysm bulges out on both sides of the aorta while a saccular aneurysm bulges only on one side. 
With each heartbeat, the walls of the aorta expand and then come back as blood is pumped through it. This continuing pressure on a weak wall in the area of an aneurysm can cause the wall to rupture. It may also lead to dissection, which is the separation of the layers of the aortic wall. Either condition may cause life-threatening hemorrhaging. 

At Yale Vascular Surgery, we offer the widest range of treatment and management options for abdominal aortic aneurysms. In addition to being well-versed with the traditional or classic techniques and surgeries, many additional procedures offered by our innovative surgeons are at the leading edge of vascular surgery. Our multidisciplinary vascular team works collectively to create personalized treatment plans that provide the best options for each patient, reflecting his or her specific condition and individual needs.

Causes of Abdominal Aortic Aneurysm

There are many factors that may cause the wall of the abdominal aorta to weaken, but the exact cause of an abdominal aortic aneurysm is not yet known.

Symptoms of Abdominal Aortic Aneurysm

Abdominal aortic aneurysms may or may not have symptoms. In fact, only about one in four cases produce symptoms, which is why many refer to the disease as a silent killer. An asymptomatic abdominal aortic aneurysm may suddenly rupture, causing life-threatening hemorrhaging.

When symptoms are present, pain is the most common. Pain generally presents in the abdomen, chest, lower back, or groin area. If you experience pain, either dull or acute, it may indicate that the aneurysm may be ready to rupture. You should seek emergency medical attention if you have a sudden onset of severe pain in the back and/or abdomen.

An abdominal aortic aneurysm may also produce a pulsing sensation in the abdomen.

Complete symptoms of this disease may resemble other medical conditions, so it is important to contact your doctor if you think you may have an abdominal aortic aneurysm.

Risk Factors of Abdominal Aortic Aneurysm

At Yale Vascular Surgery, we emphasize patient education, risk-factor reduction, and management. Knowing your risk factors for any disease can help to guide you to the appropriate actions, including changing certain behaviors and being clinically monitored for the disease.

Atherosclerosis is thought to play an important role in developing an abdominal aortic aneurysm. Atherosclerosis is the hardening of the arteries due to the buildup of plaque, which consists of cholesterol, calcium, fibrous tissue, and other debris, on the artery walls. Additionally, the following factors are associated with an increased risk in developing aneurysmal disease: 
  • Age: patients older than 60 are at an increased risk 
  • Gender: males have a four to five times greater risk of developing the disease 
  • Family history 
  • Genetics
  • Hyperlipidemia: patients with elevated levels of fats in the blood
  • Hypertension (high blood pressure)
  • Smoking
  • Diabetes
Other conditions that may contribute to developing an abdominal aneurysm include:
  • Genetic disorders of connective tissue, such as Marfan syndrome, Ehlers-Danlos syndrome, Turner's syndrome, and polycystic kidney disease
  • Congenital syndromes, such as bicuspid aortic valve, that affect the aorta 
  • Giant cell arteritis (a disease that causes inflammation of the arteries in the head and neck) 
  • Trauma
  • Infections that may affect the aorta, such as syphilis, salmonella, or staphylococcus. 
It is important to understand that having one or more risk factors does not mean that you will develop the disease. The information should be used only as a guideline. 

Diagnosing Abdominal Aortic Aneurysm

If you think you have an aneurysm, it is important to get a diagnosis so that you can begin treatment and management of the disease to prevent rupturing.

Yale Vascular Surgery uses the most innovative techniques to diagnose vascular conditions so that you can receive a timely and accurate diagnosis. In addition to using diagnostic procedures, our surgeons take the time to discuss your medical history and perform a physical examination.

Below describes the most common diagnostic procedures: 

Computed Tomography (CT) Scan
A CT scan is an imaging procedure combining X-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of the blood vessels. 

Magnetic Resonance Imaging (MRI)
An MRI is an imaging procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of the blood vessels within the body.

Ultrasound
An ultrasound uses high-frequency sound waves and a computer to create images of blood vessels and to assess the blood flow within the vessels. 

Arteriogram (Angiogram)
An arteriogram is an X-ray image of the blood vessels. A dye is injected into the artery through a thin, flexible tube. This dye makes the blood vessels visible on the X-ray.

Treatment of Abdominal Aortic Aneurysm

Aneurysms can continue to increase in size, which can contribute to the weakening of the aortic wall. Treatment may include management of the disease and/or surgery. Preventing rupture of an aneurysm is the primary goal of treatment.

At Yale Vascular Surgery, our team includes nationally renowned surgeons who are dedicated to helping patients affected by vascular disease and who have continually excelled in caring for patients with abdominal aortic aneurysms. They will help determine the best-possible comprehensive treatment by using the latest technology and compassionate care.

Should you require surgery, our surgeons will review your surgical plan with you, in detail, so that you know what to expect before, during, and after the surgery.

Each patient’s specific treatment is determined by a number of factors, including:
  • Age
  • Overall health and medical history
  • Extent of the disease
  • Signs and symptoms
  • Patient’s tolerance of medications, procedures, or therapies
  • Expectations for the course of the disease
  • Patient’s preference
Management of an Aneurysm
The management of an abdominal aortic aneurysm may include monitoring the aneurysm with routine ultrasounds, modifying outstanding risk factors, such as quitting smoking or changing your diet, and medications that can control possible risk factors, such as high blood pressure and diabetes.

Surgery for an Aneurysm
When surgery is necessary, the two primary options include endovascular aneurysm repair (EVAR) and open surgery. 

Endovascular Aneurysm Repair (EVAR), or Endovascular Stent Repair
EVAR is a minimally invasive procedure that requires only small incisions in the groin. Using an X-ray for visual guidance and specially designed instruments, surgeons repair the aortic wall with a stent-graft. The stent-graft is inserted through the femoral artery and moved into the aorta to the aneurysm. 

A stent-graft uses a stent, which is a long cylinder-like tube made of thin, metal mesh framework and a graft, which is made of different materials. The stent is used to hold the graft open and in place. 

Abdominal Aortic Aneurysm Open Repair
During open surgery, the graft is sewn to the aorta without the use of a stent. Open surgery requires an incision in the abdomen for direct access to the aneurysm.