What is an abdominal aortic aneurysm and what are the symptoms?

The abdominal aorta is the main blood vessel that supplies blood to the abdomen, pelvis and legs, and if it expands, creating an aneurysm, it can be deadly. This is why it's important to know who is at risk and screen them early before it turns into a life-threatening condition.

Because abdominal aortic aneurysms are something that can be prevented with the right information, I want to make sure you understand what causes AAA, guidelines for screening and the treatments available to repair aneurysms.

What is abdominal aortic aneurysm (AAA)?

An abdominal aortic aneurysm occurs when part of the aorta becomes larger than normal. Typically, the abdominal aorta is a round structure that resembles a pipe, roughly the size of a golf ball. When an aneurysm develops, the aorta expands and the walls become weaker. This puts the aorta at risk for bursting, which can be fatal if not treated immediately.

What are common abdominal aortic aneurysm causes?

Research has shown us that there are specific tendencies that pose the greatest risks for developing AAA, such as:

• High blood pressure (especially poorly controlled high blood pressure)
• High cholesterol
• Smoking

Family history can also play an important role in identifying your risk level. There are higher incidences of abdominal aortic aneurysms if one or more family members have been diagnosed with an AAA previously. While this is true, it is not a forgone conclusion that you or your children will have an aneurysm simply because others in your family had an aneurysm.

Understanding the risk factors for abdominal aortic aneurysm and having regular exams to monitoring your cholesterol and blood pressure are important preventive measures that can lower your chances of having a severe AAA.

Abdominal aortic aneurysm symptoms

Ideally, we want to identify an abdominal aortic aneurysm before you have symptoms. By the time you begin having symptoms, there's so much pressure on the aneurysm that you’re going to be at risk for a life-threatening rupture.

The easiest way (and best time) to find the aneurysm is with a basic physical examination while you are asymptomatic (not experiencing any typical symptoms), but we can detect an aneurysm with a screening test if needed.

Abdominal aortic aneurysm ultrasound screening test

An ultrasound is the best screening test for identifying AAAs. Ultrasounds are painless, non-invasive, radiation-free tests that allow us to see and measure the aorta in great detail, as well as spot an aneurysm if it's there. Early detection is the key to preventing an untreated aneurysm from becoming deadly, and ultrasounds are a simple solution with life-saving potential.

Why and when would I need an abdominal aortic ultrasound?

If you have a family history of AAA, you should start getting screened at age 50. If your first screen is normal, I usually recommend you get checked again in 10 years. I really stress with my patients that they should let family members know how important it is that they get screened as well. I've had a number of brothers and sisters, as well as children, come in to get screened. We have been really diligent about promoting the screenings to family members of patients with family history, encouraging a follow-up evaluation.

If you do not have a family history but do have AAA risk factors (high blood pressure, high cholesterol, smoking), we suggest you begin screening at age 65. If you have a normal screening, it is likely that you will never have to be checked again. However, if your scan shows that an enlarged aorta, we will recommend rechecking once a year, or every other year, until the AAA grows to a size where we need to check it more frequently.

When is abdominal aortic aneurysm treatment needed and what are the treatment options?

We usually repair the aorta when an aneurysm reaches about 5 or 5.5 centimeters in width.

There are two general approaches we can take to repair aneurysms. One is with a standard, open abdominal surgery that has been done for many years. Open surgery is successful in repairing the aneurysm, however is a much more intensive procedure. This technique is often used for more complex patients who require standard surgical methods because their aorta needs to be shaped properly in order to be successful.

The second approach has been developed more recently over the past two decades. It's an endovascular (or stent) technique in which the aneurysm is repaired in a much less invasive procedure. A lot of aneurysms can now be treated with an endovascular procedure and about 90 percent of the patients we see at UChicago Medicine are able to have their aneurysm fixed with stents.

What is the abdominal aortic aneurysm surgery survival rate?

For most patients, the survival rate is very good. Overall, we know from the patients we follow after surgery that our long-term results are successful. We tailor the follow-up care to the specific needs of each patient, but in general, their post-surgery prognosis is positive.

Is someone likely to get an aneurysm a second time after it’s treated?

There is a low risk of having a second aneurysm. Though rare, you might develop an aneurysm in a different part of the aorta, or you could experience a problem with the original aneurysm repair.

Thankfully, there's little likelihood of having an issue that requires intervention, but we do follow our patient post-treatment, usually once a year, sometimes every six months, to make sure that no other heart problems are developing.

Why come to the UChicago Medicine to treat an abdominal aortic aneurysm?

The UChicago Center for Aortic Diseases has a very comprehensive, multidisciplinary program. We have a whole multispecialty aneurysm group that includes: anesthesia doctors, cardiologists, surgeons, ICU teams and nurses. It's a huge group that helps coordinate every aspect of a patient’s care, and we provide a wide range of treatment options, including endovascular treatment using stents and standard operations, depending on what is best suited for the individual patient.

What's on the horizon for future abdominal aortic treatments?

In medicine, we are always looking for ways to improve care for our patients. Right now, we are using new techniques that enable us to treat more of the aorta with endovascular, or less invasive, approaches. Because UChicago Medicine is on the leading edge of medicine, we're involved in various clinical trials that provide us access to devices sooner than other medical centers. We're able to treat more complicated aneurysms, and different parts of the aorta, with less invasive techniques.