Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA or triple A) is a weakening in the wall of the aorta, which causes the aorta to bulge and expand. An abdominal aortic aneurysm may continue to expand from the pressure of blood flowing through it. Progressive expansion can lead to a rupture of the aorta that can cause severe internal bleeding, shock, or death.

Although less common, AAA poses another health risk called embolization. Embolization occurs when clots, that previously formed inside the aneurysm, break off and lodge in arteries of the leg or foot. These blockages cause severe pain and can even cause limb loss if not properly treated.

AAA can be treated, when diagnosed early. If an aneurysm were to rupture, it is still treatable; however, outcomes are significantly worse. Therefore, the key is early detection and monitoring by a vascular surgeon.

Symptoms of AAA

Often called the “silent killer,” AAA does not always present with symptoms. However, when symptoms do occur, they may include:
  • A pulsing sensation in the abdomen 
  • Pain in the abdomen, chest, lower back, or groin area 
  • Pain, sores, and/or discoloration on the toes or feet (very rare) 
  • A sudden onset of intense pain in the back and/or abdomen, which may indicate that the aneurysm is ready to rupture or has ruptured 
  • If the aneurysm ruptures, severe pain, weakness, and/or dizziness may be present and loss of consciousness is imminent. Seek immediate emergency medical attention. 
Symptoms of AAA may resemble other medical conditions, so it is important to contact your doctor if you think you may have an abdominal aortic aneurysm.

Causes & Risk Factors

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. The initial step of AAA is believed to be the inflammation of the aorta. This inflammation causes the aorta wall to weaken or break down. Atherosclerosis is also 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 of developing AAA:
  • Being older than 60 years 
  • Male (men are at greater risk of developing AAA than women) 
  • Family history/genetics (having an immediate relative who has had the disease) 
  • Hypertension (high blood pressure) 
  • History of smoking 
  • Diabetes

Tests Used to Diagnose AAA

If you are experiencing symptoms of AAA, seek a diagnosis as early as possible so that your risk of rupture will be significantly reduced. Cases of asymptomatic AAA are often diagnosed during routine physicals or when an imaging procedure for a different condition is performed.

If AAA is suspected, your doctor may order one or more of the following 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.

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

Treatments for AAA

Routine monitoring or “watch and wait
The management of AAA may include monitoring the aneurysm with routine ultrasounds or CT scans, modifying outstanding risk factors, such as quitting smoking or changing your diet, and prescribing medications that can control possible risk factors, such as high blood pressure and diabetes. It is important to realize that an AAA never resolves on its own. In fact, aneurysms can continue to increase in size over time. Preventing rupture of an aneurysm is the primary goal of treatment.

Surgical Aneurysm Repair or Open Aneurysm Repair
If your aneurysm is large or increasing in size, surgical aneurysm repair is a traditional surgical option. In this type of surgery, a graft made of a durable polymer is inserted to replace the diseased section of the aorta. Surgical aneurysm repair requires an incision in the abdomen and a hospital stay of four to seven days. This surgery has a long-term success rate of over 90 percent.

Endovascular Aneurysm Repair (EVAR) or Endovascular Stent Repair
EVAR is a minimally invasive procedure that requires only small incisions in the groin. Using a live X-ray screen for visual guidance and specially designed instruments, surgeons thread catheters through the blood vessels and then guide an endovascular stent graft into the aneurysm. An endovascular stent graft is a long tube made of thin, metal mesh and fabric that serves to strengthen the weakened portion of the aorta. Hospital stays following EVAR are typically two to three days. Frequent monitoring and occasional maintenance are required post-surgery to ensure correct functioning of the stent graft. The overall success of this type of surgery will depend on the shape, size, and location of the aneurysm and, therefore, is not recommended for all patients. A consultation with your vascular surgeon will help determine the best treatment for your AAA.

Abdominal Aortic Aneurysm - Dr. Sarac

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