Abdominal aortic aneurysm

The term abdominal aortic aneurysm describes an abnormal enlargement of part of the abdominal aorta.

The aorta is the artery that carries oxygen-rich blood from the heart to the rest of the body. The part of the aorta that runs through the abdomen is called the abdominal aorta. It usually has a diameter of about 2 cm. If one part of the abdominal aorta becomes enlarged and bulges outward to a diameter of more than 3 cm, this is known as an abdominal aortic aneurysm.

An abdominal aortic aneurysm typically doesn’t cause any symptoms and most aneurysms are harmless. But there is a risk of the aorta suddenly rupturing (breaking open) if an aneurysm keeps on expanding. That is an emergency situation and life-threatening.

Abdominal aortic aneurysms seldom cause any symptoms and often go unnoticed.

Larger aneurysms of the abdominal aorta may cause symptoms such as back ache, abdominal pain or pain in the sides of the body.

If the abdominal aorta ruptures, it causes sudden back pain that radiates to the sides or groin. In the event of a rupture, a large amount of blood is lost, which may cause dizziness, loss of consciousness and, eventually, circulatory collapse.

An abdominal aortic aneurysm may arise if the vessel wall becomes less elastic, for example, as a normal part of aging or if there is too much pressure on the blood vessel, for instance due to high blood pressure. Smoking also increases the risk of developing an abdominal aortic aneurysm.

If one part of the vessel wall starts bulging, it tends to continue to expand, and the aneurysm grows larger over time.

Several factors increase the risk of an abdominal aortic aneurysm. These are listed below:

• Age: the risk increases with age. Most people who have an abdominal aortic aneurysm are over 65 years old.
• Smoking: smoking is the most important risk factor over which a person has control.
• High blood pressure or coronary heart disease: these also increase the risk of an abdominal aortic aneurysm.
• Blood lipids: high levels of blood lipids (blood fats) increase the likelihood of an aneurysm developing.
• Genetic predisposition: people who have fair skin or who have close relatives who have had an abdominal aortic aneurysm are at greater risk.

Sex also plays a role, with abdominal aortic aneurysms predominantly affecting men.

About 2 percent of all men between the ages of 65 and 75 have an abdominal aortic aneurysm.

Prevalence increases with age. Women are much less likely to have an abdominal aortic aneurysm.

In most cases, an abdominal aortic aneurysm causes no symptoms and remains harmless. If it widens, this usually only happens at a slow rate. 

Only some aneurysms become so large that there is an increased risk of the aorta suddenly rupturing. If the aorta ruptures, a large amount of blood leaks into the abdominal cavity – which is a life-threatening emergency.

The risk of an aneurysm rupturing is higher if the aneurysm is growing rapidly or if it is at least 5.5 cm in diameter. It is roughly estimated that abdominal aortic aneurysms with a diameter of more than 5.5 cm will rupture within one year in about 3 to 6 percent of men.

Abdominal aortic aneurysms are diagnosed using ultrasound imaging. The diameter of the abdominal aorta can be measured in this way. If the diameter of the aorta is greater than 3 cm, it is considered to be an aneurysm.

If an abdominal aortic aneurysm is causing symptoms, it is normally detected during testing to investigate the cause of these.

Early detection of an abdominal aortic aneurysm is possible using ultrasound imaging. Surgical intervention can then prevent large aneurysms from becoming large enough to rupture. If smaller bulges are detected, these can be checked regularly to see whether they are growing, and how quickly.

It has been shown that screening for men over the age of 65 lowers the risk of an abdominal aortic aneurysm rupturing and causing death. Only one high-quality study has investigated aneurysm screening tests for women. It shows that screening doesn’t have any advantages for women.

More information on the early detection of abdominal aortic aneurysms can be found in the brochure of the Joint Federal Committee (B-GA).

Various factors will determine whether an abdominal aortic aneurysm will benefit from treatment and which form of treatment is most suitable. This will mainly depend on the size of the aneurysm, but also on how it develops and on the patient’s general health.

Smaller abdominal aortic aneurysms that have a diameter of less than 5.5 cm are typically checked on a regular basis.

Smokers are usually asked to quit if possible because smoking can cause the aneurysm to grow. People who have risk factors, such as high blood pressure or high blood lipid levels, are advised to seek treatment for those conditions. However, it is not yet clear whether medication such as drugs used to lower blood pressure or cholesterol can slow the growth of an aneurysm and lower the risk of rupture.

If the risk of rupture is high, surgery is the only preventive measure. There are two options:

• Open surgery through an abdominal incision (cut): the aneurysm is opened, and replaced by an artificial vessel (graft).
• Endovascular procedure through a small incision in the groin: a small tube (stent) is put through the incision into the artery, pushed along to where the aneurysm is, and implanted in the aneurysm.

Both of these procedures are associated with risks, and should be assessed and evaluated individually. As well as the risks associated with a surgical procedure, there is a possibility that the aneurysm may suddenly rupture.

More detailed information about abdominal aortic aneurysms, for example when an operation is appropriate, can be found at gesundheitsinformation.de.

Open surgery on the abdominal aorta is a major procedure. Follow-up rehabilitative therapy following surgery for an abdominal aortic aneurysm offers people an opportunity to slowly get back to everyday activities and return to their normal lives.

The goal of rehabilitation is to minimize the negative effects of the surgery and improve quality of life.

Being diagnosed with an abdominal aortic aneurysm may trigger contradictory emotions. Some people are happy that their aneurysm was discovered, and the check-ups help make them feel safe.

Others would rather have not found out about the aneurysm. Knowing about it can be scary and troubling.

Many people with a diagnosed abdominal aortic aneurysm have to continue living their lives knowing that they are at risk. Symptoms such as abdominal pain can be frightening, as they are often thought to be associated with the aneurysm, even if that’s not actually the case. Many people affected stop doing certain things in everyday life out of fear. They become more cautious and avoid physical exertion to avoid an abdominal aortic aneurysm rupturing.