Abdominal aortic aneurysm: what you should lnow

Published by Health Professional

on Monday, March 27th 2023

Heart DiseasesMen's HealthWomen's Health

An abdominal aortic aneurysm (AAA) is a bulge or swelling in the aorta, the main blood vessel that runs from the heart down through the chest and tummy.

An AAA can be dangerous if it is not spotted early on.

It can get bigger over time and could burst (rupture), causing life-threatening bleeding.

Women aged 70 or over with underlying risk factors such as high blood pressure may also be advised to attend a screening for AAA.

Symptoms of an abdominal aortic aneurysm (AAA)

AAAs do not usually cause obvious symptoms and are often only picked up during screening or tests for another reason.

Some people with an AAA have:

  • a pulsing sensation in the tummy (like a heartbeat)
  • tummy pain that does not go away
  • lower back pain that does not go away

If an AAA bursts, it can cause:

  • sudden, severe pain in the tummy or lower back
  • dizziness
  • sweaty, pale, and clammy skin
  • a fast heartbeat
  • shortness of breath
  • fainting or passing out

Call 911 for an ambulance immediately if you or someone else develops symptoms of a burst AAA.

When to get medical help

Make an appointment to see a GP as soon as possible if you have symptoms, especially if you’re at a higher risk of an AAA.

An ultrasound scan of your tummy may be done to check if you have one.

Call 911 for an ambulance immediately if you or someone else develops symptoms of a burst AAA.

Who’s at risk of an abdominal aortic aneurysm (AAA)

An AAA can form if the sides of the aorta weaken and balloon outwards. It’s unclear why this happens, but some things increase the risk.

People at a higher risk of getting an AAA include all men aged 66 or over and women aged 70 or over who have one or more of the following risk factors:

  • high blood pressure
  • chronic obstructive pulmonary disease
  • high blood cholesterol
  • a family history of AAA
  • cardiovascular diseases, such as heart disease or a history of stroke
  • they smoke or have previously smoked

Speak to a doctor if you’re worried you may be at risk of an AAA. They may suggest having a scan and making healthy lifestyle changes to reduce your risk of an AAA.

Treatments for an abdominal aortic aneurysm (AAA)

The recommended treatment for an AAA depends on how big it is.

Treatment is not always needed immediately if the risk of an AAA bursting is low.

Treatment for a:

  • small AAA (3cm to 4.4cm across) – ultrasound scans are recommended every year to check if it’s getting bigger; you’ll be advised about healthy lifestyle changes to help stop it from growing
  • medium AAA (4.5cm to 5.4cm) – ultrasound scans are recommended every 3 months to check if it’s getting bigger; you’ll also be advised about healthy lifestyle changes
  • large AAA (5.5cm or more) – surgery to stop it from getting bigger or bursting is usually recommended

Ask your doctor if you’re not sure what size your AAA is.

Reducing your risk of an abdominal aortic aneurysm (AAA)

You can do several things to reduce your chances of getting an AAA or help stop one from getting bigger.

These include:

  • stopping smoking – read stop smoking advice and find out about Smokefree, a stop-smoking service
  • eating healthily – eat a balanced diet and cut down on fatty food
  • exercising regularly – aim to do at least 150 minutes of exercise a week
  • maintaining a healthy weight – use the BMI healthy weight calculator to see if you need to lose weight, and find out how to lose weight safely
  • cutting down on alcohol – read tips on cutting down and general advice about alcohol

If you have a condition that increases your risk of an AAA, such as high blood pressure, your GP may also recommend taking tablets.

Screening for AAAs

In England, screening for AAAs is offered to men when they turn 65. This can help spot swelling in the aorta early on when it can be treated.

The test involves a quick and painless ultrasound scan to see how big your aorta is.

If you’re a man over 65 and you have not been screened, you can ask for a test by contacting your local AAA screening service directly.

An ultrasound scan may benefit women aged 70 or over with underlying risk factors such as high blood pressure or chronic obstructive pulmonary disease. You must ask a GP for a referral, as women are not routinely invited for scanning.

The treatment for an abdominal aortic aneurysm (AAA) mostly depends on its size.

AAAs are grouped into 3 sizes:

  • small AAA – 3cm to 4.4cm across
  • medium AAA – 4.5cm to 5.4cm across
  • large AAA – 5.5cm or more across

Large AAAs are more likely to burst (rupture), so surgery to stop this is usually recommended.

The risk of a small or medium AAA bursting is much lower, so you’ll normally be advised to have regular scans to check its size and make healthy lifestyle changes to help stop it from getting bigger.

Ask your doctor if you’re not sure what size your aneurysm is.

Small and medium AAAs

You might not need treatment if you have a small or medium AAA. This is because the risk of the AAA bursting is smaller than the risk of complications from surgery.

You’ll be asked to return for regular ultrasound scans to check if your aneurysm is getting bigger.

Scans are done:

  • every year if you have a small AAA
  • every 3 months if you have a medium AAA

Surgery may be offered if the scans show that a AAA larger than 4 cm has grown by more than 1cm over 12 months. Surgery may also be offered if you have symptoms linked to AAA, such as a pulsing sensation or tummy pain that does not go away.

You’ll also be told about lifestyle changes that can help reduce the risk of an aneurysm getting bigger, such as eating healthily.

You can otherwise carry on as normal, although having an AAA may have some implications for driving and getting travel insurance.

Large AAAs

If you have a large AAA, surgery to strengthen it with a piece of manmade tubing (a graft) is usually recommended because the risk of it bursting is bigger than the risk of complications from surgery.

There are 2 main types of surgery for an AAA:

  • endovascular surgery – the graft is inserted into a blood vessel in your groin and then carefully passed up into the aorta
  • open surgery – the graft is placed in the aorta through a cut in your tummy

Both techniques are equally good at reducing the risk of an AAA bursting, but each has its own advantages and disadvantages. Talk to your surgeon about which is best for you.

If surgery is not suitable for you, you’ll have regular scans to monitor your aneurysm and be given advice about healthy lifestyle changes. You may also be prescribed medicine to help stop the aneurysm from bursting.

Endovascular surgery

In endovascular surgery, a graft is inserted into a blood vessel in your groin through small cuts made in your skin. It’s then carefully guided up into the aneurysm.

This is usually done under a general anesthetic where you’re asleep.

You’ll normally stay in the hospital for 2 or 3 days after the operation, which can take a few weeks or months to recover fully.

The risk of complications is generally lower than with open surgery, and the hospital stay and recovery time are often shorter.

Risks of endovascular surgery include:

  • the graft leaking or slipping out of position – you’ll have regular scans to check for this and may need another operation to fix any problems
  • wound infection or infection of the graft
  • heavy bleeding from your groin
  • a blood clot, heart attack, or stroke

Conclusion

In conclusion, abdominal aortic aneurysm is a potentially life-threatening condition that affects many people, particularly those over the age of 60. 

It is important to understand the risk factors and symptoms associated with this condition in order to receive an early diagnosis and appropriate treatment. Individuals at higher risk should consider regular screenings to monitor their aortic health. 

With awareness, early detection, and proper treatment, individuals with an abdominal aortic aneurysm can improve their chances of a successful outcome and enjoy a better quality of life. It is important to consult with a healthcare professional if you have any concerns or questions about this condition.