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Abdominal Aortic Aneurysm

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Written by Andrew Le, MD.
Last updated June 21, 2024

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Causes and Risk Factors of Abdominal Aortic Aneurysm

While the exact cause of AAAs isn't always clear, certain factors can increase your likelihood of developing one.

  • Age: AAAs are most common in adults over 65.8,9
  • Sex: Men are also more likely than women to develop an AAA.8,9
  • Smoking: Smoking is one of the biggest risk factors for AAAs. The chemicals in tobacco smoke can damage the aortic wall, making it easier for an aneurysm to form.1,2
  • Genetics: Having a close family member with an AAA also increases your risk.8,9
  • Other medical conditions: Conditions like high blood pressure and high cholesterol can weaken the aortic wall over time, making an aneurysm more likely.8,9
  • Certain genetic disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, are also associated with a higher AAA risk.8,9

Symptoms and Diagnosis of Abdominal Aortic Aneurysm

In many cases, AAAs don't cause any noticeable symptoms until they become very large or rupture.11,12 However, some people with larger AAAs may experience:

  • A pulsing sensation in their abdomen, similar to a heartbeat13,14
  • Deep, constant abdominal or back pain15,18
  • Nausea or vomiting11
  • Clammy skin or lightheadedness11

If an AAA ruptures, it can cause sudden, severe abdominal or back pain, dizziness, rapid heart rate, and cold, sweaty skin.11,13 This is a life-threatening emergency that requires immediate medical attention.

Because AAAs often have no symptoms, they're usually found during routine physical exams or imaging tests done for other reasons.13,15 The most common test used to diagnose an AAA is an abdominal ultrasound, which uses sound waves to create pictures of the aorta.13,15 Other imaging tests like CT scans or MRIs may also be used to get more detailed images.

Experts recommend that men aged 65 to 75 who have ever smoked get a one-time ultrasound screening for AAA.12,15 It may be a good idea to get screened if you have a family history of AAA or other risk factors.12,15

After an AAA is found, its size is used to help predict the risk of rupture. Smaller aneurysms (less than 5.5 cm wide) have a low risk of rupturing and are often watched closely with regular ultrasounds.16,17 Larger AAAs or those that are growing quickly may need surgery to prevent a rupture.

If an AAA does rupture, emergency surgery is needed to repair the aorta and stop the bleeding.10,14 It is very important to monitor your AAA as only about 20% of people survive a ruptured AAA.13,15

Treatment Options for Abdominal Aortic Aneurysm

Treatment for an AAA depends on its size and how fast it's growing. The goal is to prevent the aneurysm from rupturing, which can be deadly.

Small AAAs that aren't causing symptoms or growing quickly are often monitored regularly with imaging tests.23 Healthcare providers may prescribe medications to control risk factors for rupture like high blood pressure and high cholesterol.23

However, once an AAA reaches about 5.5 cm wide in men or 5.0 cm wide in women, the risk of rupture increases significantly, and surgery is usually recommended.22,23

There are two main surgical options for repairing AAAs:

  1. Open surgical repair involves making a large incision in the abdomen to access the aorta directly. The aneurysm is cut out and replaced with a synthetic graft.24,25 This is a major operation with a longer recovery time, but it's been used successfully for many years.
  2. Endovascular aneurysm repair (EVAR) is a less invasive approach. A small incision is made in the groin, and a stent graft (a mesh tube supported by a metal framework) is threaded through the arteries to the aneurysm. The graft is then expanded to reinforce the weakened aortic wall.24,25

EVAR has a lower risk of complications and a faster recovery time than open surgery, but it requires more frequent follow-up to check for leaks around the graft.24,25 The choice between open repair and EVAR depends on factors like the size and location of the aneurysm, as well as your age and overall health.

In some cases, a combination of open and endovascular techniques may be used.24,25

No matter which treatment approach is used, ongoing monitoring is important to check for aneurysm growth or complications. People who have had an AAA repair need regular follow-up appointments and imaging tests for the rest of their lives.

Lifestyle Changes to Manage Abdominal Aortic Aneurysm

If you've been diagnosed with an AAA, making healthy lifestyle changes can help slow its growth and lower your risk of complications. Here are some of the most important steps you can take:

  1. Quit smoking. Smoking is a major risk factor for AAAs, and quitting is one of the best things you can do for your vascular health. One study found that people who quit smoking reduced their risk of developing an AAA by 29% compared to those who kept smoking.27,28
  2. Manage your blood pressure and cholesterol. High blood pressure and high cholesterol can weaken the aortic wall and make an aneurysm more likely to grow or rupture. Medications like ACE inhibitors and statins can help control these risk factors.27,36
  3. Eat a healthy diet. A diet rich in fruits, vegetables, and whole grains may help lower your risk of developing an AAA.31,35 The DASH diet, which emphasizes these foods and limits salt, red meat, and sugar, has been linked to better vascular health. If you smoke and have an AAA, a Mediterranean-style diet high in healthy fats, fruits, and vegetables may also be helpful.32,32
  4. Exercise regularly. Physical activity can help strengthen your cardiovascular system and reduce stress on your aorta. Exercise may slow the growth of small AAAs and reduce the need for surgery.33,34 Aim for at least 30 minutes of moderate exercise, like brisk walking, most days of the week.
  5. Maintain a healthy weight. Carrying extra weight puts added pressure on your aorta, so losing weight if you're overweight or obese can help reduce your AAA risk.29 Focus on eating a balanced diet and increasing your physical activity level.
  6. Get regular check-ups. If you have an AAA, it's important to see your healthcare provider for regular monitoring. How often you need imaging tests will depend on the size of your aneurysm and how quickly it's growing.26,30 Make sure to keep all your follow-up appointments and let your healthcare provider know if you have any new symptoms.

Making these lifestyle changes can be challenging, but they're an important part of managing your AAA and reducing your risk of serious complications. Work with your healthcare provider to develop a plan that fits your needs and preferences.

Preventing Abdominal Aortic Aneurysm Progression

The best way to prevent an AAA from progressing to the point of rupture is to catch it early through screening. Men aged 65 to 75 who have ever smoked should have a one-time ultrasound screening for AAA.37 Women with multiple risk factors, such as a family history of AAA or a history of smoking, may also benefit from screening.39

Once an AAA is detected, regular monitoring is important. Smaller aneurysms can typically be watched with ultrasounds or CT scans every 6 to 12 months.38,39 If the aneurysm grows to a certain size (usually around 5.5 cm in men or 5 cm in women), surgery is usually recommended to prevent a life-threatening rupture.38,39

While there's no medication that can cure an AAA, some drugs may help slow its growth. Statins, which are commonly used to lower cholesterol, have been shown to reduce inflammation in the aortic wall and may help stabilize AAAs.40,43

Conclusion

Abdominal aortic aneurysms are a serious condition that can be life-threatening if not detected and treated early. Risk factors like age, smoking, high blood pressure, and family history can increase the likelihood of developing an AAA.

Screening with ultrasound is recommended for certain high-risk groups, and regular monitoring is important for tracking aneurysm growth over time. Treatment options range from watchful waiting for smaller AAAs to open surgery or endovascular repair for larger or rapidly growing aneurysms.

You can help slow AAA progression and reduce the risk of rupture by making healthy lifestyle changes.

If you're concerned about your risk of developing an AAA, talk to your healthcare provider. They can help you understand your risk factors, recommend appropriate screening tests, and develop a personalized management plan that fits your needs and preferences.

Citations:

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Dr. Le obtained his MD from Harvard Medical School and his BA from Harvard College. Before Buoy, his research focused on glioblastoma, a deadly form of brain cancer. Outside of work, Dr. Le enjoys cooking and struggling to run up-and-down the floor in an adult basketball league.

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