What is an Abdominal aortic aneurysm (AAA)

Aortic aneurysms are separated into two categories, thoracic, which involves the ascending aorta, the aortic arch, and the first part of the descending aorta, and abdominal, which involves the descending aorta.  This article will focus on abdominal aneurysms

Abdominal aortic aneurysms (AAAs) are relatively common and potentially life-threatening.

An aneurysm is a focal enlargement of the aorta ,caused by weakening of the vessel’s walls, resulting in a bulging dilatation of 1.5 times the normal size . A diameter more than 3.0 cm defines an aortic aneurysm.

Patients at greatest risk for AAA are men who are older than 65 years with peripheral vascular disease ( blockages in leg arteries ) and with smoking history. One time screening with an ultrasound is recommended for these patients .

Risk factors for AAA :

• Hypertension

• Atherosclerosis

• Hypercholesterolemia

• Infections, such as endocarditis

• Smoking

• Injury to the chest or stomach

• Genes associated with aortic aneurysms include ACTA2, FBN1, MYH11, and TFFBR1/2.

Symptoms of AAA

• Most of the time there are no symptoms and the AAA is found incidentally during a CT or ultrasound done for a different condition

• Abdominal pain

• A pulsing sensation in the stomach

• If an aortic aneurysm tears and causes an aortic dissection, the symptoms will appear suddenly . Intense pain will be sudden and intense, dizziness and nausea with drop in blood pressure . A dissection is a medical emergency

Treatment of AAA

If there is ruptured AAA or dissection, treatment is emergent surgery with replacement by a graft of ruptured part of the aorta

Elective repair of the aneurysm can be done Endovascular with a stent or open surgery with graft replacement.

The timing of surgery depends on the size and location of the aneurysm

SMALL AAA < 5.0 cm have a very low risk of rupture. The following are recommended

Monitoring with ultrasound test every 6–12 months for enlargement

Blood pressure control

Smoking cessation

Daily exercise

LARGE AAA >5.5 cm for abdominal location or AAAs causing symptoms are usually repaired by open surgery or stent placement

What should you remember

• One time screening with ultrasound is recommended in men older than 65 years with peripheral vascular disease ( blockages in leg arteries ) and with smoking history.

• If abdominal aneurysm is less than 5.0 cm , ultrasound monitoring every 6-12 months is recommended .

• For abdominal aneurysms surgery or stent is recommended if larger than 5.5 cm or associated with symptoms