What is Abdominal Aortic Aneurysm? Symptoms, Causes, & Treatment

An abdominal aortic aneurysm (AAA) is a bulging or ballooning of the aorta, your body's main artery, in the area of your belly. Think of it like a weak spot in a garden hose that starts to expand outward under pressure. The aorta normally measures about an inch wide, but when it stretches to 1.5 times its normal size or larger, doctors call it an aneurysm.

Most people with small abdominal aortic aneurysms feel perfectly fine and don't even know they have one. These often develop slowly over years and may never cause problems. However, larger aneurysms can be serious because they might burst, which is why understanding this condition matters for your health.

What are the symptoms of abdominal aortic aneurysm?

Many abdominal aortic aneurysms cause no symptoms at all, especially when they're small. This is why doctors sometimes call them "silent" conditions. You might live with a small aneurysm for years without feeling anything unusual.

When symptoms do appear, they often develop gradually as the aneurysm grows larger. Here are the signs your body might give you:

• Deep, constant pain in your belly or on the side of your belly
• Back pain that doesn't seem to have an obvious cause
• A pulsing feeling near your belly button, like you can feel your heartbeat there
• A feeling of fullness after eating only small amounts

Some people notice these symptoms come and go, while others experience them more consistently. The pain is often described as a deep ache rather than a sharp, stabbing sensation.

If an aneurysm ruptures or is about to rupture, the symptoms become much more severe and require immediate emergency care. These emergency symptoms include:

• Sudden, severe pain in your belly or back that feels like tearing
• Pain that spreads to your groin, buttocks, or legs
• Dizziness or fainting
• Fast heartbeat
• Sweating and nausea
• Skin that feels clammy or looks pale

These emergency symptoms mean the aneurysm may be leaking or bursting, which is life-threatening. If you experience these signs, call 911 immediately.

What are the types of abdominal aortic aneurysm?

Doctors classify abdominal aortic aneurysms based on their size and location. Understanding these types helps your medical team decide on the best monitoring and treatment approach for your specific situation.

By size, aneurysms are grouped into categories that guide treatment decisions:

• Small aneurysms: 3.0 to 4.4 cm (about 1.2 to 1.7 inches) across
• Medium aneurysms: 4.5 to 5.4 cm (about 1.8 to 2.1 inches) across
• Large aneurysms: 5.5 cm (about 2.2 inches) or larger

The larger the aneurysm, the higher the risk of rupture. Your doctor will measure your aneurysm regularly to track any changes in size.

Aneurysms are also classified by their shape and how they affect the artery wall:

• Fusiform aneurysms: The most common type, where the entire circumference of the artery bulges outward evenly
• Saccular aneurysms: Less common, where only one side of the artery wall bulges out, creating a pouch-like appearance

Your doctor will also note whether your aneurysm is above or below where the renal arteries (the arteries to your kidneys) branch off from the aorta. This location affects surgical options if treatment becomes necessary.

What causes abdominal aortic aneurysm?

The exact cause of abdominal aortic aneurysms isn't always clear, but they develop when the wall of the aorta becomes weakened over time. Several factors can contribute to this weakening process, and often it's a combination of things rather than just one cause.

The most common factors that can weaken your aortic wall include:

• Atherosclerosis: The buildup of fatty deposits and cholesterol in your arteries, which is the most common cause
• High blood pressure: The constant force against artery walls can cause them to stretch and weaken
• Smoking: Damages blood vessel walls and accelerates the weakening process
• Genetic factors: Some people inherit a tendency toward aneurysm formation
• Age-related changes: Natural wear and tear on blood vessels over time

Less common but important causes include infections that affect the aortic wall, inflammatory conditions like vasculitis, and certain connective tissue disorders. Some people develop aneurysms after trauma or injury to the abdomen, though this is relatively rare.

In some cases, aneurysms can be associated with genetic conditions like Marfan syndrome or Ehlers-Danlos syndrome, which affect the body's connective tissues. These conditions are uncommon but important to identify because they may affect other parts of your body as well.

When to see a doctor for abdominal aortic aneurysm?

You should see a doctor if you experience persistent belly or back pain, especially if you have risk factors for aneurysms. While many aneurysms don't cause symptoms, getting checked can provide peace of mind and catch any problems early.

Schedule a routine appointment with your doctor if you notice:

• Ongoing belly pain that doesn't have an obvious cause
• Back pain that persists despite rest and normal pain relief measures
• A pulsing sensation in your abdomen that you can feel with your hand
• Feeling full quickly when eating, especially if this is new for you

These symptoms don't necessarily mean you have an aneurysm, but they're worth discussing with your healthcare provider. Early detection allows for better monitoring and treatment options.

However, some symptoms require immediate emergency care. Call 911 right away if you experience:

• Sudden, severe belly or back pain that feels like tearing
• Fainting or severe dizziness
• Fast heartbeat with sweating and nausea
• Skin that suddenly becomes pale or clammy

These symptoms could indicate a rupturing aneurysm, which is a medical emergency that requires immediate treatment to save your life.

What are the risk factors for abdominal aortic aneurysm?

Certain factors can increase your chances of developing an abdominal aortic aneurysm. Understanding these risk factors can help you and your doctor decide if screening or preventive measures make sense for your situation.

The most significant risk factors include:

• Being male: Men are about 4 to 6 times more likely to develop AAA than women
• Age over 65: Risk increases significantly after age 65, especially for men
• Smoking: Current or former smokers have a much higher risk, with the risk increasing with pack-years
• Family history: Having a parent, sibling, or child with an aneurysm increases your risk
• Atherosclerosis: Hardening and narrowing of arteries throughout your body
• High blood pressure: Puts extra stress on artery walls over time

Additional factors that can contribute to your risk include having high cholesterol, chronic obstructive pulmonary disease (COPD), and a history of smoking. Even if you've quit smoking, your risk remains elevated compared to people who never smoked, though it does decrease over time.

Some less common risk factors include certain genetic conditions like Marfan syndrome, having had infections that affect blood vessels, and certain inflammatory conditions. Race and ethnicity also play a role, with white men having the highest risk.

The good news is that some risk factors, like smoking, high blood pressure, and high cholesterol, can be modified through lifestyle changes and medical treatment. This gives you some control over your risk level.

What are the possible complications of abdominal aortic aneurysm?

The most serious complication of an abdominal aortic aneurysm is rupture, where the aneurysm bursts and causes severe internal bleeding. This is a life-threatening emergency that requires immediate surgery, and unfortunately, many people don't survive a ruptured aneurysm.

The risk of rupture depends largely on the size of your aneurysm. Small aneurysms (under 5.5 cm) rarely rupture, with less than 1% rupturing per year. However, larger aneurysms carry a much higher risk, which is why doctors often recommend surgery when aneurysms reach 5.5 cm or larger.

Other complications that can occur include:

• Blood clots: Can form inside the aneurysm and potentially travel to other parts of your body
• Embolism: Small pieces of clot or debris can break off and block smaller arteries
• Compression: Very large aneurysms can press on nearby organs or structures
• Infection: Though rare, aneurysms can sometimes become infected

Blood clots that form in the aneurysm usually stay attached to the wall and don't cause problems. However, occasionally pieces can break off and travel to your legs, kidneys, or other organs, potentially causing pain or damage.

In rare cases, large aneurysms can press on your spine, causing back pain, or on your intestines, causing digestive symptoms. Some people develop what's called an inflammatory aneurysm, where the area around the aneurysm becomes inflamed and can cause additional symptoms.

The key thing to remember is that most small aneurysms never cause complications. Regular monitoring allows your doctor to track any changes and recommend treatment before serious complications develop.

How can abdominal aortic aneurysm be prevented?

While you can't prevent all abdominal aortic aneurysms, you can take steps to reduce your risk and slow the growth of existing aneurysms. The most effective prevention strategies focus on maintaining healthy blood vessels and managing risk factors you can control.

The most important steps you can take include:

• Don't smoke, or quit if you currently smoke: This is the single most important thing you can do
• Control your blood pressure: Keep it below 130/80 mmHg through diet, exercise, and medication if needed
• Manage your cholesterol: Follow a heart-healthy diet and take medications as prescribed
• Exercise regularly: Aim for at least 30 minutes of moderate activity most days
• Eat a healthy diet: Focus on fruits, vegetables, whole grains, and lean proteins
• Maintain a healthy weight: Extra weight puts additional stress on your cardiovascular system

If you have risk factors like a family history of aneurysms or are a man over 65 who has ever smoked, talk to your doctor about screening. Early detection through ultrasound screening can catch aneurysms when they're small and easier to monitor.

Regular check-ups with your healthcare provider are also important, especially if you have conditions like high blood pressure, diabetes, or heart disease. Managing these conditions well can help protect your blood vessels from damage.

While genetic factors and age can't be changed, focusing on the modifiable risk factors can significantly reduce your chances of developing an aneurysm or slow its growth if you already have one.

How is abdominal aortic aneurysm diagnosed?

Diagnosing an abdominal aortic aneurysm often happens during routine screening or when investigating other health concerns. Many aneurysms are discovered incidentally during imaging tests for unrelated problems, which is actually fortunate because early detection is key.

The primary screening test is an abdominal ultrasound, which is painless and uses sound waves to create pictures of your aorta. This test can accurately measure the size of your aorta and detect any bulging. It's the same type of ultrasound used during pregnancy, so it's completely safe and comfortable.

If an aneurysm is found or suspected, your doctor might order additional tests:

• CT scan: Provides detailed pictures and precise measurements of the aneurysm
• MRI: Offers detailed images without radiation exposure
• Abdominal X-ray: May show calcium deposits in the aneurysm wall
• Physical examination: Your doctor might feel a pulsing mass in your abdomen

During a physical exam, your doctor will place their hands on your belly to feel for any abnormal pulsing or masses. However, this method isn't always reliable, especially in people who are overweight or have small aneurysms.

CT scans are particularly useful because they provide detailed information about the aneurysm's size, shape, and relationship to nearby organs. This information helps your doctor plan treatment if surgery becomes necessary.

If you're at high risk for aneurysms, your doctor might recommend regular screening even if you don't have symptoms. The U.S. Preventive Services Task Force recommends one-time screening for men aged 65 to 75 who have ever smoked.

What is the treatment for abdominal aortic aneurysm?

Treatment for abdominal aortic aneurysms depends on their size, your symptoms, and your overall health. Small aneurysms that aren't causing problems are usually monitored with regular imaging tests, while larger aneurysms may require surgical repair.

For small aneurysms (under 5.5 cm), doctors typically recommend a "watchful waiting" approach. This involves:

• Regular ultrasounds or CT scans every 6 to 12 months
• Blood pressure management to reduce stress on the aneurysm
• Cholesterol control to slow atherosclerosis progression
• Smoking cessation support if you smoke
• Lifestyle modifications to support vascular health

Your doctor will closely monitor any changes in size during these regular check-ups. Most small aneurysms grow slowly, if at all, and never require surgery.

When aneurysms reach 5.5 cm or larger, or if they're growing rapidly, surgery is usually recommended. There are two main surgical approaches:

• Open surgical repair: A traditional operation where the surgeon replaces the weakened section with a synthetic graft
• Endovascular repair (EVAR): A less invasive procedure where a stent-graft is placed inside the aneurysm through small incisions

Open surgery involves making an incision in your abdomen and replacing the aneurysm with a tube made of synthetic material. While this is major surgery, it's very effective and the repair typically lasts for life.

Endovascular repair involves threading a collapsed stent-graft through blood vessels in your legs up to the aneurysm. Once in place, it expands to redirect blood flow through the graft instead of the aneurysm. This option has a shorter recovery time but may require follow-up procedures over time.

Your surgeon will help you choose the best option based on your aneurysm's characteristics, your age, and your overall health condition.

How to manage abdominal aortic aneurysm at home?

Managing an abdominal aortic aneurysm at home focuses on slowing its growth and reducing your risk of complications. The good news is that many of the steps you can take are the same healthy lifestyle choices that benefit your overall cardiovascular health.

The most important things you can do at home include:

• Take your medications as prescribed, especially blood pressure and cholesterol medications
• Monitor your blood pressure regularly if you have hypertension
• Avoid heavy lifting or straining that could suddenly increase pressure in your abdomen
• Follow a heart-healthy diet low in saturated fat and sodium
• Stay physically active with low-impact exercises like walking
• Manage stress through relaxation techniques or counseling

It's important to avoid activities that could cause sudden spikes in blood pressure, such as heavy lifting, intense straining, or explosive physical activities. However, gentle, regular exercise is actually beneficial for your cardiovascular health.

Keep track of any new symptoms and report them to your doctor promptly. This includes any new or worsening belly pain, back pain, or the pulsing sensation in your abdomen becoming more noticeable.

Make sure to attend all your scheduled follow-up appointments and imaging tests. These regular check-ups are crucial for monitoring whether your aneurysm is growing and determining if treatment plans need to change.

If you smoke, quitting is the most important thing you can do. Ask your doctor about smoking cessation programs or medications that can help you quit successfully.

How should you prepare for your doctor appointment?

Preparing for your appointment can help you make the most of your time with your doctor and ensure you get all the information you need. Having an organized approach reduces anxiety and helps your healthcare team provide the best care possible.

Before your appointment, gather important information:

• Write down all your symptoms, including when they started and what makes them better or worse
• List all medications you're taking, including over-the-counter drugs and supplements
• Bring any previous imaging results or medical records related to your aneurysm
• Note your family history of aneurysms, heart disease, or stroke
• Write down questions you want to ask your doctor

Some helpful questions to consider asking include: How large is my aneurysm? How often do I need monitoring? What symptoms should I watch for? What activities should I avoid? When might I need surgery?

Don't hesitate to bring a family member or friend to your appointment. They can help you remember important information and provide emotional support. Having someone else present can be especially helpful if you're feeling anxious about your diagnosis.

Be honest about your lifestyle habits, including smoking, alcohol use, and exercise patterns. Your doctor needs this information to provide the best recommendations for your care.

If you're being considered for surgery, ask about the risks and benefits of different surgical options, what to expect during recovery, and how to prepare for the procedure.

What's the key takeaway about abdominal aortic aneurysm?

The most important thing to understand about abdominal aortic aneurysms is that they're manageable conditions when detected early. Most small aneurysms never cause problems and can be safely monitored with regular check-ups and imaging tests.

While the thought of having an aneurysm can feel scary, remember that modern medicine offers excellent monitoring and treatment options. Small aneurysms rarely rupture, and when larger aneurysms do require treatment, surgical options are very effective.

The key is staying connected with your healthcare team and following their recommendations for monitoring and lifestyle changes. Taking medications as prescribed, maintaining healthy habits, and attending regular follow-up appointments gives you the best chance of a positive outcome.

If you have risk factors for aneurysms, especially if you're a man over 65 who has ever smoked, talk to your doctor about screening. Early detection through a simple ultrasound can provide peace of mind and catch any problems when they're most treatable.

Remember that having an aneurysm doesn't mean you can't live a full, active life. Many people with aneurysms continue to work, travel, and enjoy their favorite activities while managing their condition responsibly.