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Abdominal aortic aneurysm

Published by Bupa's health information team, August 2008.

This factsheet is for people who have an abdominal aortic aneurysm (AAA), or who would like information about it.

An AAA is a widening or bulge in the aorta (the largest artery in the body). An AAA usually occurs at a weak spot in the aortic wall. If your AAA ruptures (bursts) it can be fatal so you may need surgery to repair it.

About abdominal aortic aneurysm
Symptoms of abdominal aortic aneurysm
Complications of abdominal aortic aneurysm
Causes of abdominal aortic aneurysm
Diagnosis of abdominal aortic aneurysm
Treatment of abdominal aortic aneurysm
Animation - How open abdominal aortic aneurysm surgery is carried out
Animation - How keyhole abdominal aortic aneurysm is carried out
Prevention of abdominal aortic aneurysm
Further information
Questions and answers
Related topics
Sources

About abdominal aortic aneurysm

What is the aorta?

The aorta carries all the blood that is pumped out of your heart and distributes it, via its many branches, to all the organs of your body. The aorta projects upwards from your heart and then turns downwards, travelling through your chest (the thoracic aorta) and into your abdomen (the abdominal aorta).

The normal diameter of the abdominal aorta is around 2 to 3cm (about one inch).

What is an aortic aneurysm?

An aortic aneurysm is a thin, weakened section of the wall of your aorta that bulges outward. Most aneurysms occur in the section of the aorta that passes through your abdomen and are called abdominal aortic aneurysms.

Aneurysms can also occur in the part of your aorta that is near your heart; these are called thoracic aortic aneurysms. This factsheet will only discuss AAAs.

The artery wall of an aneurysm is weaker than normal artery wall so it may not withstand the pressure of blood inside. This may cause it to rupture.

The chance of an AAA rupturing depends on its size. If your aneurysm is greater than 5.5cm wide the chances of rupture are higher - and the risk increases with increasing size.

Illustration showing abdominal aortic aneurysm
Abdominal aortic aneurysm

Symptoms of abdominal aortic aneurysm

You could have an AAA for years before you develop any symptoms and you may not get any at all. If you have an AAA you may have:

abdominal pain
back pain

Complications of abdominal aortic aneurysm

If your AAA becomes very large and ruptures it can cause excruciating pain. You may also have a lump in your abdomen that expands and contracts. A ruptured AAA causes severe internal bleeding which is often fatal unless emergency surgery to repair the rupture is carried out.

Causes of abdominal aortic aneurysm

The main cause of AAAs is atherosclerosis. This is a condition in which fatty deposits are laid down in the walls of your arteries. The deposit is called an atheroma. This weakens your artery walls and makes them less elastic and weaker as a result.

You are more likely to develop atherosclerosis, and therefore an AAA, depending on:

your gender (men are more likely to develop an AAA than women)
if you smoke
your age - AAAs are more common people over 65
your family history - if you have a first degree relative who has had an AAA you have a higher chance of having one yourself
if you have high blood pressure
if you do little physical activity
if you have high cholesterol
if you are overweight

Diagnosis of abdominal aortic aneurysm

Abdominal AAs can be diagnosed from your symptoms when they occur but this may be too late. They are usually found when you have a routine physical examination and chest and abdominal X-rays.

When your doctor examines you, he or she may feel a pulsating mass in your abdomen which may be tender if your AAA is large. If your doctor suspects an AAA, he or she will request tests including those below.

An ultrasound scan is the most common test to detect an aneurysm. It can also measure its size.
Other scans may also be performed before you have surgery. For example a CT scan uses X-rays to make three-dimensional images of the body. This is very useful for determining the exact position of your AAA.

Screening

At present there isn't a national screening programme to detect AAAs. However, the Government is considering plans to introduce a programme.

Treatment of abdominal aortic aneurysm

Your treatment for an AAA will depend on your symptoms and the size of your aneurysm.

Surgery

Emergency surgery is needed if your AAA ruptures. This is a major operation and carries significant risks. A number of people will die during, or shortly after, an emergency operation. The decision to have surgery is based on the size of your aneurysm.

If you have a small AAA, the risk of death caused by surgery is higher than the risk of rupture. Surgery isn't usually advised but you will need regular ultrasound checks to see if your AAA grows over time. It's also important to manage your condition by changing your lifestyle - for more information see Prevention.

For larger aneurysms the risk of rupture is usually higher than the risks of surgery. However, this will depend on your personal state of health. For some people the risks of surgery will still outweigh the benefits.

Surgery is usually advised if your aneurysm is:

larger than 5.5cm
growing by more than 1cm per year
causing you pain

Your doctor will advise you if surgery is the best treatment for you.

There are two main surgical options for an AAA. Both are usually done under general anaesthetic. This means you will be asleep during the operation.

Open surgery

In the traditional surgical method, your surgeon will make an opening in your abdomen. Your aorta will then be opened at the site of the aneurysm and be replaced with a graft. The graft can be made with a piece of blood vessel taken from another place in your body or it can be synthetic. A synthetic graft is made out of an elastic material and is similar to your normal healthy aorta. It gives your artery support to prevent the aneurysm getting bigger. This procedure can also be performed using keyhole surgery.

How open abdominal aortic aneurysm surgery is carried out

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Stent-graft insertion

Alternatively your surgeon may place a stent-graft into your aorta. A stent-graft is a graft placed over an artificial piece of rigid tubing called a stent. This is a recently developed technique and isn't suitable for everyone. A small cut will be made in your groin and the stent-graft will be passed up inside one of your leg arteries until it reaches the area of your aneurysm. The stent will be positioned so that your blood vessel is repaired and the aneurysm is protected from further pressure. This method doesn't involve open surgery.

How keyhole abdominal aortic aneurysm surgery is carried out

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Your surgeon will advise you which procedure is best for you.

Prevention of abdominal aortic aneurysm

There are several things you can do to reduce your chance of developing an aneurysm:

don't smoke
have your blood pressure and cholesterol checked regularly
exercise regularly
maintain a healthy weight

You should also have regular medical check ups if you have a family history of arterial disease so that any problems can be detected early.

Further information

The British Heart Foundation
0845 070 8070
www.bhf.org.uk
The Circulation Foundation
020 7304 4779
www.circulationfoundation.org.uk