Abdominal aortic aneurysm (patient information)

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Overview
An aneurysm is a localized bulge or balloon in the wall of an artery, or in most cases in the aorta (the major blood vessel that supplies blood to the body). Abdominal aortic aneurysms occur in the part of the aorta running through the abdomen, if the aneurysm ruptures it can cause life-threatening bleeding. Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at high risk. Most small abdominal aortic aneurysms do not rupture, but the large aneurysms have a higher risk of a rupture. Ultrasound screening for abdominal aortic aneurysms is recommended for men who have ever smoked and are between the ages of 65 and 75. Medicines and surgery are the two main treatments for aneurysms.

What are the symptoms of abdominal aortic aneurysms?
Aneurysms develop slowly over many years and often have no symptoms. If an aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along the wall of the vessel (aortic dissection), symptoms may develop suddenly. As the aneurysm grows, some symptoms may be:
 * Pulsating feeling near the navel
 * Pain in the abdomen or back -- severe, sudden, persistent, or constant. The pain may radiate to the groin, buttocks, or legs.
 * Clammy skin
 * Nausea and vomiting
 * Shock
 * Rapid heart rate

What causes an abdominal aortic aneurysm?
The exact cause is unknown, but risk factors for developing an aortic aneurysm include: An abdominal aortic aneurysm can develop in anyone, but is most often seen in males over 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to rupture and break open.
 * Smoking
 * High blood pressure
 * High cholesterol
 * Male gender
 * Emphysema
 * Genetic factors
 * Obesity

Possible complications
When an abdominal aortic aneurysm ruptures, it is a true medical emergency. Aortic dissection occurs when the innermost lining of the artery tears and blood leaks into the wall of the artery. This most commonly occurs in the aorta within the chest. Complications include:
 * Arterial embolism
 * Heart attack
 * Hypovolemic shock
 * Kidney failure
 * Stroke

Treatment options
If you have bleeding inside your body from an aortic aneurysm, you will have open abdominal aortic aneurysm repair. If the aneurysm is small and there are no symptoms: Surgery is usually recommended for patients who have aneurysms bigger than 2 inches or 5.5 cm across and aneurysms that are growing quickly. The goal is to perform surgery before complications or symptoms develop. There are two approaches to surgery:
 * You and your doctor must decide whether the risk of having surgery is smaller than the risk of bleeding if you do not have surgery.
 * Your doctor may recommend checking the size of the aneurysm with a yearly ultrasound test, to see if the aneurysm is getting bigger.
 * In a traditional (open) repair, a large cut is made in your abdomen. The abnormal vessel is replaced with a graft made of man-made material, such as Dacron.
 * The other approach is called endovascular stent grafting. This procedure can be done without making a large cut in your abdomen, so you may get well faster. Endovascular repair is rarely done for a leaking or bleeding aneurysm.

What to expect(Outlook/Prognosis)
The outcome is usually good if an experienced surgeon repairs the aneurysm before it ruptures. However, less than 40% of patients survive a ruptured abdominal aneurysm.

When to seek urgent medical care?
Go to the emergency room or call 911 if you have pain in your belly or back that does not go away or is very bad.

Where to find medical care for an abdominal aortic aneurysm
Directions to Hospitals Treating Abdominal Aortic

Acknowledgements
The content on this page was first contributed by: C. Michael Gibson M.S., M.D.