Abdominal Aortic Aneurysm (AAA): What you need to know

Heart Health

by Dennis Gable, MD, MD, RVT, DFSVS, FACS

Jun 16, 2020

If you have ever seen a bulge in the side of a bicycle tire, you already have a good idea of what an abdominal aortic aneurysm (AAA) looks like inside the body.

The aorta is the largest blood vessel in the body and supplies oxygen-rich blood to the head, neck, chest and abdomen before splitting in two and filling the iliac arteries (by the hip) with blood for the legs and lower extremities. In the case of an AAA, a weakening of a section of the aortic wall causes it to expand and create the effect like that of the bicycle tire.

Abdominal aortic aneurysm is most often caused by hardening of the arteries, or atherosclerosis, and can be life-threatening. Here’s what you need to know.

Symptoms of abdominal aortic aneurysm

People whose abdominal aorta is normal in diameter – 1-1.5 inches (or approximately 3 cm) – typically do not experience symptoms. In fact, 3 out of 4 AAAs do not cause symptoms.

“Most people don’t know they have or are in the beginning stages of the development of an abdominal aortic aneurysm. In this sense, a AAA left unrecognized can be a ‘silent killer,’” said Dennis R. Gable, MD, Chief of Vascular Surgery at Baylor Scott & White Heart Hospital – Plano.

“Much of the time, the patient’s physician will discover the AAA incidentally when reviewing imaging results or during x-ray tests while treating a different condition. It can also be found during a regular physical exam.”

Should symptoms present, you will likely experience:

  • Mild to severe pain in the mid or upper abdomen
  • Back pain
  • Pulsating feeling in the abdomen, usually near the belly button, that is noticeable when touched

“If a person begins to suspect they have symptoms that may be congruent with an AAA or is seeking peace of mind, it’s best to err on the side of caution and get checked out by a physician,” Dr. Gable said. “Maybe there’s no evidence of a AAA but, if there is, the physician and patient can be proactive in the next steps they take together.”

Who is at risk for abdominal aortic aneurysm?

The following risk factors can increase your likelihood of experiencing an abdominal aortic aneurysm:

  • Smoking: The single most important risk factor. The more you smoke, the higher your risk.
  • Atherosclerosis: Fatty deposits (aka plaque) cause the aorta to widen and weaken.
  • High-fat diet
  • High cholesterol
  • High blood pressure (hypertension): This increases pressure on the aorta’s wall.
  • Family history of AAA
  • Gender: Men are at higher risk than women.
  • Age: If you are 65 years or older, your risk of AAA is elevated.
  • Diabetes

Related: How to monitor blood pressure at home

Treatment options for abdominal aortic aneurysm

“After your doctor discovers an abdominal aortic aneurysm, they will check the AAA periodically to monitor its growth or possibly refer you to a vascular surgeon for monitoring,” Dr. Gable said.

When an AAA bulges to 50% or larger than its original size (typically 5.5 cm or greater in overall size), your condition can become critical, even life-threatening. There are times vascular surgeons have only minutes to save a life if the aneurysm ruptures and unfortunately, if the aneurysm does rupture, over 90% of patients will not survive.

In order to repair the aneurysm, the vascular surgeon will perform either an open repair (through an incision in the abdomen or side, or an endovascular repair of the aneurysm, meaning repair with a stent placed through small (less than 1”) incisions in the groin.

Endovascular repair

Endovascular repair is a minimally invasive approach which can be an option for about 85% of patients. In this procedure, the vascular surgeon makes a very small incision in the groin and accesses the artery via a needle puncture. A fabric-covered stent known as the stent-graft is deployed through a very narrow hollow tube called a catheter to the site of the AAA, therefore replacing the aneurysm with a new tube.

Open repair

In some cases, for various reasons, you may not qualify for an endovascular approach and will instead need to have the aneurysm repaired with an incision in the belly. Once repaired, the dangerously high pressure against the aortic wall is significantly reduced and the risk for rupture removed. You can typically resume usual activities in approximately three to six weeks after surgery.

How to prevent abdominal aortic aneurysm

The good news is that you can take steps today to help prevent an abdominal aortic aneurysm. This roadmap provides a healthy approach to make lifestyle changes that can help prevent an AAA and other conditions that may damage your blood vessels:

  • Stop smoking
  • Eat a heart-healthy diet
  • Exercise regularly
  • Achieve a healthy weight
  • Speak with your physician about any concerns you may have and possible screening for AAA

Think you might be at risk for an abdominal aortic aneurysm? Talk to your doctor today or learn more about our heart and vascular care.

About the Author

Dennis Gable, MD, MD, RVT, DFSVS, FACS, is a vascular surgeon and Chief of Vascular and Endovascular Surgery at the Baylor Scott and White Heart Hospital Plano. Dr Gable is a graduate of Baylor University with a BA in chemistry. He received his medical degree from Baylor College of Medicine, Houston, Texas in 1992 and completed a general surgery residency at University of Louisville, Louisville Kentucky in 1997. He completed a fellowship in peripheral vascular surgery at Baylor University Medical Center in Dallas, Texas in 1997.

Dr. Gable is a Distinguished Fellow for the Society for Vascular Surgery and has served as the Chair for multiple committees in the Society. He is the regional director for the Vascular Quality Initiative quality database for the Society for Vascular Surgery. He is a member of multiple other national and regional societies and is the past President of the Texas Vascular and Endovascular Surgery Society. Dr Gable has authored several book chapters as well as multiple peer reviewed journal articles. He has been the invited speaker for vascular surgery and has made presentations in over 15 countries around the globe. He participates and/or is the primary

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