Abdominal Aortic Aneurysm

The aorta is the largest artery (blood vessel) in the body and carries oxygen-rich blood away from the heart to all parts of the body. The part of the aorta that runs through the abdomen is the abdominal aorta. Abdominal aortic aneurysms occurs when an area of the aorta becomes very large or balloons out. The larger the aneurysm, the more likely it is to rupture which is a serious condition that can be life threatening. Each year about 11,000 people in the U.S. die of a ruptured abdominal aortic aneurysm. Causes The exact cause of an abdominal aortic aneurysm is unknown, but the condition is most often seen in males over age 60 who have one or more risk factors. Factors that can increase an individual’s risk of developing the an abdominal aortic aneurysm include:

  • Smoking
  • High blood pressure
  • Male gender
  • Genetic factors

The way to reduce the risk of an abdominal aortic aneurysm is to eat a heart-healthy diet, exercise, stop smoking if you smoke and reduce stress. Individuals with high blood pressure should take medications as directed. Those over the age of 65 who have ever smoked should have a screening ultrasound performed. Symptoms Aneurysms develop slowly over many years. Most people have no symptoms until the aneurysm begins to leak or expand. As the abdominal aortic aneurysm grows, some people may notice the following symptoms:

  • A pulsating feeling near the navel
  • Deep, persistent pain in your abdomen or on the side of your abdomen
  • Back pain

Symptoms often begin suddenly when the aneurysm grows quickly, the aneurysm tears the aortic wall and blood leaks out of the wall of the aorta . Symptoms of rupture include:

  • Pain in the abdomen or back. The pain may be severe, sudden, persistent, or constant. It may spread to the groin, buttocks, or legs.
  • Fainting
  • Clammy skin
  • Dizziness
  • Nausea and vomiting
  • Rapid heart rate
  • Shock

It is recommended that individuals experiencing pain in the belly or back that is very bad or does not go away, call 9-1-1 immediately. Diagnosis Abdominal aortic aneurysms are often found when a physician feels a mass or pulsating sensation during an examination for another reason.  If a physician suspects a patient has an abdominal aortic aneurysm, specialized tests will be used to confirm it. Tests may include:

  • Ultrasound of the abdomen to diagnose an aneurysm
  • CT scan to confirm the size of the aneurysm
  • CTA (computed tomographic angiogram) to help with surgical planning

Treatment The goal for treatment of aneurysms is to prevent rupture. There are two options for the treatment – medical monitoring and open/endovascular surgery. The recommended treatment option will depend on the size of the aneurysm. For patients with a small abdominal aortic aneurysm less than 5.5cm and no symptoms, the recommended treatment may be medical monitoring which includes regular tests to make sure your aneurysm isn't growing, and management of other medical conditions that could worsen the aneurysm. This option is typically recommended over surgery as the risk of surgery outweighs the risk of rupture for small aneurysms. For patients with large (larger 5.5cm, fast-growing, or leaking aneurysms, surgery is typically recommended before complications develop. There are two types of surgery to repair abdominal aortic aneurysms:

  • Open abdominal surgery to repair the aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic graft (tube), which is sewn into place. Patients can expect a month or more before full recovery.
  • Endovascular surgery in which doctors attach a— covers the aneurysm with a stent graft that's inserted through an artery in your leg and threaded up into your aorta. The stent -graft — a fabric tube supported by a metal mesh — is placed at the site of the aneurysm from inside the artery. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. Patients can typically expect a faster recovery time after this procedure than with open surgery, but endovascular surgery is not an option for all patients. Regular follow-up scans are required after the procedure to ensure the graft is not leaking.

For information about abdominal aortic aneurysm treatment at Tampa General Hospital’s Cardiovascular Center Aorta Program or to refer a patient, call (813) 394-5554 Monday through Friday, 8:00 a.m. - 4:30 p.m.  To transfer patients after business hours, call the TGH Transfer Center at 1-800-247-4472.

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