It’s funny how sometimes the biggest things show up in the quietest ways. I remember a gentleman, let’s call him Mr. Davies, who came in for his regular check-up. He was in his late 60s, always active, and just mentioned a bit of a dull ache in his lower back he’d been having. “Probably just overdid it in the garden, Doc,” he said with a wave of his hand. But during the exam, I felt a little something – a faint, unusual pulsing in his belly. That little “something” led us to discover he had an abdominal aortic aneurysm, often called AAA. He’d never heard of it. And that’s the thing about AAA; it’s often a silent condition, which makes understanding it so important.
So, what exactly is an abdominal aortic aneurysm? Imagine your aorta – it’s the largest artery in your body, like a major highway carrying blood from your heart down through your chest and into your abdomen (your belly). Normally, the walls of your aorta are strong and flexible. But, sometimes, a section of this artery wall in your abdomen can weaken and start to bulge outwards. Think of it like a weak spot developing on the side of a garden hose. This bulge is what we call an abdominal aortic aneurysm. We generally diagnose an AAA if a part of the aorta expands to at least 1.5 times its normal diameter, which often means the bulge is about 3 centimeters (cm) wide or more.
Why Does This Happen? The Sneaky Causes of AAA
It’s rarely just one thing that leads to an abdominal aortic aneurysm. It’s usually a combination of factors that weaken that aortic wall over time.
Getting older, unfortunately, plays a role. And smoking? That’s a really big one. I can’t stress this enough – tobacco use is a major culprit because it damages the proteins that give the aorta its strength and elasticity.
Another common factor is atherosclerosis. That’s the medical term for the buildup of fatty deposits, or plaques, inside your arteries. This buildup can cause inflammation and damage, making the artery wall weaker and more prone to bulging.
Sometimes, it just runs in the family. If a close blood relative – like a parent, sibling, or child – has had an AAA, your own risk is higher. This connection seems to be particularly strong among male siblings. About 10% to 20% of people who have a first-degree relative with an AAA also develop one.
Other things that can increase the risk include:
- High blood pressure (hypertension)
- Having other forms of artery disease, such as coronary artery disease (affecting the heart) or peripheral artery disease (affecting the legs)
- Certain less common inherited conditions that affect the body’s connective tissues.
Who’s More Likely to Get an AAA? Understanding the Risks
We see abdominal aortic aneurysms more frequently in certain groups of people. It’s good to be aware of these, not to cause alarm, but so you can have informed conversations with your doctor.
- Age: The risk definitely goes up as we get older. It’s most common in men over 50 and women over 65.
- Sex: Men are about four times more likely to develop an AAA than women.
- Tobacco Use: This is a huge factor. Having smoked at least 100 cigarettes in your lifetime significantly increases your risk. The more you’ve smoked, the higher that risk.
- Family History: As I mentioned, if a close relative had an AAA, your chances are higher.
- While men develop AAAs more often, it’s worth noting that when women do get them, the aneurysms may have a higher chance of rupturing even at slightly smaller sizes. They also seem to have a stronger familial link in women.
In the U.S., about 1.4% of adults between 50 and 84 have an AAA, which is around 1.1 million people. And while aneurysms can technically form anywhere along the aorta, about 75% of them are abdominal.
Spotting the Signs: When an AAA Isn’t So Silent
Here’s the tricky part: most of the time, an abdominal aortic aneurysm doesn’t cause any symptoms at all. It can grow slowly and silently for years. Many people only find out they have one by chance, perhaps during an imaging test done for a completely different reason.
However, if an AAA gets larger or is close to rupturing (bursting), you might start to notice:
- A steady, deep pain in your belly or your lower back.
- Pain that radiates to your leg, groin, or pelvic area.
- A pulsing sensation in your abdomen, almost like feeling your heartbeat in your stomach.
A ruptured AAA is a life-threatening medical emergency. The symptoms usually come on very suddenly and can include:
- Severe, intense pain in your abdomen, lower back, or legs.
- Sudden shortness of breath.
- A rapid heartbeat.
- A sudden drop in blood pressure, leading to dizziness or fainting.
- Nausea or vomiting.
- Clammy, sweaty skin.
If you or someone you know experiences these sudden, severe symptoms, please call 911 or your local emergency number immediately. Every second counts.
How We Find Out: Diagnosing an Abdominal Aortic Aneurysm
Because they’re often silent, we sometimes discover an abdominal aortic aneurysm incidentally. But if we have a reason to suspect one, or if you fall into a high-risk group, we have reliable ways to check.
The most common initial test is an abdominal duplex ultrasound. This is a simple, painless imaging test that uses sound waves to create pictures of your aorta. It can show us if there’s a bulge and measure its size. It’s very similar to the ultrasounds used during pregnancy.
Sometimes, we might recommend a Computed Tomography Angiogram (CTA scan). This is a more detailed type of X-ray that involves injecting a contrast dye into your bloodstream. The dye helps your blood vessels show up clearly on the scan, giving us a precise look at the aorta and any aneurysm.
Screening for AAA
For certain individuals, especially men aged 65 to 75 who have ever smoked, a one-time ultrasound screening for AAA is recommended. It’s a quick, non-invasive check that can be a lifesaver. If you have a strong family history of AAA, we might discuss screening with you even if you don’t meet those exact criteria. It’s always a good topic to bring up with your doctor.
What We Do About It: Managing an Abdominal Aortic Aneurysm
So, we’ve found an abdominal aortic aneurysm. What’s next? Well, the approach really depends on how big the aneurysm is and whether it’s causing any symptoms. The main goal is to prevent it from rupturing.
Surveillance (Watchful Waiting)
If the aneurysm is relatively small – generally less than 5.5 centimeters (cm) in diameter for men, or less than 5.0 cm for women – and it’s not causing any symptoms, we often recommend surveillance. This doesn’t mean we ignore it! It means we keep a very close eye on it with regular imaging tests, usually an ultrasound or sometimes a CT scan. These check-ups might be every six to 12 months, or more frequently if the aneurysm is approaching a size where treatment might be needed.
During this surveillance period, we’ll also work closely with you on important lifestyle modifications:
- Quitting all tobacco products: This is absolutely the most critical step.
- Adopting a heart-healthy diet.
- Engaging in regular exercise (we can help you figure out what’s safe and appropriate for you).
- Taking prescribed medications to manage conditions like high blood pressure or high cholesterol.
It’s important to understand that these lifestyle changes and medications won’t make the aneurysm shrink (currently, there’s no medication that can do that). However, they can help slow down its rate of growth and reduce your risk of other cardiovascular problems. Researchers are always looking into new ways to manage small AAAs.
When Surgery is the Best Option
We’ll start talking about surgery for your AAA if:
- The aneurysm reaches a certain size (typically 5.5 cm for men, or 5.0 cm for women, though some specialized centers might advise surgery at smaller sizes depending on your overall health and risk profile).
- The aneurysm is causing symptoms, regardless of its size.
- The aneurysm is growing rapidly.
- The aneurysm has ruptured. This is an emergency situation requiring immediate surgery.
There are two main surgical approaches to repair an abdominal aortic aneurysm:
- Traditional Open Aneurysm Repair: This is a major operation where a surgeon makes an incision in your abdomen. The weakened, bulging section of the aorta is then replaced with a synthetic tube called a graft.
- Endovascular Aneurysm Repair (EVAR): This is a less invasive procedure. The surgeon makes small incisions, usually in your groin, and guides a catheter (a thin, flexible tube) through your arteries to the site of the aneurysm. A special device called a stent graft (a fabric tube supported by a metal mesh) is then deployed inside the aneurysm. This stent graft reinforces the aorta from within, allowing blood to flow through it and taking pressure off the weakened aortic wall.
Often, if your anatomy is suitable, EVAR is the preferred method for elective (non-emergency) repair because it usually involves a shorter hospital stay and a quicker recovery. However, EVAR does require lifelong surveillance with regular imaging scans (often yearly) to ensure the graft is functioning correctly and there are no complications like an endoleak (where blood still seeps into the aneurysm sac). In some cases, due to a person’s specific anatomy or other health factors, open surgery might be the safer or more durable option.
This is a big decision, and if surgery is recommended, we will carefully discuss all the benefits and risks of each approach as they apply to your specific situation. We’ll make this choice together.
The Big Worry: Aneurysm Rupture
The most serious complication of an abdominal aortic aneurysm is rupture. This is when the weakened wall of the aorta tears or bursts, leading to massive internal bleeding. Sadly, a ruptured AAA is often fatal, causing an estimated 150,000 to 200,000 deaths worldwide each year. This is precisely why early detection, careful monitoring, and timely treatment are so incredibly important. The larger an aneurysm grows, the higher the risk of it rupturing.
Looking Ahead: What’s the Outlook?
If you’re diagnosed with an abdominal aortic aneurysm, your long-term outlook depends on several things: the size of the aneurysm, whether it’s detected and treated before it causes a major problem like rupture, and your overall health.
With good medical care, regular follow-up, and appropriate treatment when needed, many people with AAA live long and full lives. Working closely with your healthcare team is key.
Can We Prevent an Abdominal Aortic Aneurysm?
While there’s no guaranteed way to prevent an abdominal aortic aneurysm from developing, especially if you have risk factors like older age or a strong family history, there’s a lot you can do to lower your overall risk and support the health of your arteries.
If you know that a close biological relative (parent, sibling, child) had an AAA, please tell your doctor. We may recommend an ultrasound screening for you.
And for everyone, these steps are always beneficial for your cardiovascular health:
- If you smoke or use any tobacco products, please seek help to quit. It’s the single most impactful thing you can do.
- Strive for regular physical activity that’s appropriate for your fitness level.
- Follow a heart-healthy eating plan – think lots of fruits, vegetables, whole grains, and lean proteins, and less saturated fat, salt, and sugar.
- Work with your doctor to manage your blood pressure, cholesterol, and blood sugar levels.
- If you choose to drink alcohol, do so in moderation.
Living Well with an AAA: Your Part in Your Care
If you have an abdominal aortic aneurysm, even a small one that we’re just monitoring, it’s so important to be an active participant in your own care.
- Attend all your scheduled medical appointments and follow-up imaging tests. These are really vital.
- Commit to those healthy lifestyle changes we talked about. Every little bit helps.
- Take any medications prescribed by your doctor exactly as directed.
- After an aneurysm repair surgery (either open or EVAR), some people may need to take antibiotics before certain dental or medical procedures to prevent infection. Always check with us if you’re unsure about this.
When to Call Your Doctor (or 911)
You should always feel comfortable reaching out to us if you:
- Notice any new symptoms, or if existing symptoms like back or belly pain change or worsen.
- Experience any side effects from your medications.
- Simply have questions or concerns about your condition or treatment plan. That’s what we’re here for!
And please, always remember: if you experience those sudden, severe symptoms that could indicate an aneurysm rupture – like intense pain, dizziness, or a racing heart – call 911 or your local emergency number without delay.
Take-Home Message: Key Things to Remember About Abdominal Aortic Aneurysm
Here are the main points I hope you’ll take away about abdominal aortic aneurysm (AAA):
- An AAA is a bulge or swelling in the aorta, the main artery carrying blood from your heart through your abdomen.
- It often develops silently, without symptoms, until it becomes large or, critically, ruptures – which is a life-threatening emergency.
- Major risk factors include a history of smoking, being an older male, and having a family history of AAA.
- Screening with a simple, painless ultrasound can detect an AAA, especially in at-risk individuals (like men aged 65-75 who have smoked).
- Treatment depends on the aneurysm’s size: smaller AAAs are carefully monitored (“surveillance”), while larger or symptomatic ones often require surgical repair (either open surgery or the less invasive EVAR) to prevent rupture.
- Lifestyle changes, especially quitting smoking and managing blood pressure and cholesterol, are crucial.
- Don’t ignore persistent, unexplained pain in your abdomen or back, or a new pulsing sensation in your belly – talk to your doctor.
Learning you have an **abdominal aortic aneurysm** can feel quite daunting, and I completely understand that. But please know that with good monitoring and timely treatment, we can manage this condition effectively. You’re not alone in this, and we’re here to support you every step of the way.