What is aneurysm?
An aneurysm is an abnormal area of localized widening of a blood vessel.
- The aorta bulges at the site of an aneurysm like a weak spot on a worn tire.
- Aortic aneurysms are typically spindle-shaped and involve the aorta below the arteries to the kidneys.
- The most common cause of an aneurysm is arteriosclerosis. Smoking is a major risk factor.
- Abdominal aortic aneurysms often do not cause symptoms. If they do, they may cause deep boring pain in the lower back or flank. Prominent abdominal pulsations may be present.
- X-rays of the abdomen and other radiologic tests including ultrasound, CT, and MRI may be used in diagnosing and monitoring the aneurysm.
- Rupture of an aortic aneurysm is a catastrophe.
- Repair of the aneurysm can be done by surgery or endovascular stenting.
What is an aneurysm?
An aneurysm is an area of a localized widening (dilation) of a blood vessel. The word "aneurysm" is borrowed from the Greek "aneurysma" meaning "a widening."
What is an aortic aneurysm?
An aortic aneurysm involves the aorta, the major artery that leaves the heart to supply blood to the body. An aortic aneurysm is a dilation or bulging of the aorta.
What is the thoracic and abdominal aorta?
The aorta is the large artery that exits the heart and delivers blood to the body. It begins at the aortic valve that separates the left ventricle of the heart from the aorta and prevents blood from leaking back into the heart after a contraction, when the heart pumps blood. The various sections of the aorta are named based upon “arch-like” initial design and the location in the body. Thus, the beginning of the aorta is referred to as the ascending aorta, followed by the arch of the aorta, then the descending aorta. The portion of the aorta that is located in the chest (thorax) is referred to as the thoracic aorta, while the abdominal aorta is located in the abdomen. The abdominal aorta extends from the diaphragm to the mid-abdomen where it splits into the iliac arteries that supply the legs with blood.
What are the symptoms for aneurysm?
Abdominal aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Others expand quickly. Predicting how fast an abdominal aortic aneurysm may enlarge is difficult.
As an abdominal aortic aneurysm enlarges, some people may notice:
- A pulsating feeling near the navel
- Deep, constant Pain in your abdomen or on the side of your abdomen
- Back pain
If you have any of these signs and symptoms, such as sudden severe back or abdominal pain, get immediate emergency help.
When to see a doctor
You should see your doctor if you have any of the symptoms listed above. The recommendations below are for those who have no symptoms.
Because being male and smoking significantly increase the risk of abdominal aortic aneurysm, men ages 65 to 75 who have ever smoked cigarettes should have a screening for abdominal aortic aneurysms using abdominal ultrasound. If you are a man between ages 65 and 75 and you have never smoked, your doctor will decide on the need for an abdominal ultrasound, usually based on other risk factors, such as a family history of aneurysm. Those with a family history of aneurysm may have an ultrasound at age 60.
There isn't enough evidence to determine whether women ages 65 to 75 who have ever smoked cigarettes or have a family history of abdominal aortic aneurysm would benefit from abdominal aortic aneurysm screening. Ask your doctor if you need to have an ultrasound screening based on your risk factors. Women who have never smoked generally don't need to be screened for the condition.
What are the causes for aneurysm?
Most aortic aneurysms occur in the part of your aorta that's in your abdomen. Although the exact cause of abdominal aortic aneurysms is unknown, a number of factors may play a role, including:
- Tobacco use. Cigarette smoking and other forms of tobacco use appear to increase your risk of aortic aneurysms. Smoking can be damaging to the aorta and weaken the aorta's walls.
- Hardening of the arteries (atherosclerosis). Atherosclerosis occurs when fat and other substances build up on the lining of a blood vessel. This condition may increase your risk of an aneurysm.
- High blood pressure. High blood pressure can increase your risk of abdominal aortic aneurysms as it can damage and weaken the aorta's walls.
- Blood vessel diseases in the aorta. Abdominal aortic aneurysms can be caused by diseases that cause blood vessels to become inflamed.
- Infection in the aorta. Infections, such as a bacterial or fungal infection, may rarely cause abdominal aortic aneurysms.
- Trauma. Trauma, such as being in a car accident, can cause abdominal aortic aneurysms.
- Heredity. In some cases, abdominal aortic aneurysms could be hereditary.
Aneurysms can develop anywhere along the aorta, but when they occur in the upper part of the aorta, in the chest, they are called thoracic aortic aneurysms. More commonly, aneurysms form in the lower part of your aorta and are called abdominal aortic aneurysms. These aneurysms may also be referred to as AAA.
What are the treatments for aneurysm?
The goal of treatment is to prevent your aneurysm from rupturing. Generally, your treatment options are medical monitoring or surgery. Your doctor's decision depends on the size of the aortic aneurysm and how fast it's growing.
If your abdominal aortic aneurysm is small and you're not experiencing symptoms, your doctor may recommend medical monitoring, which includes regular appointments to make sure your aneurysm isn't growing, and management of other medical conditions that could worsen your aneurysm. Your doctor will also ask you about any signs or symptoms you may be experiencing that could be related to the aneurysm.
It's likely your doctor will order regular imaging tests to check on the size of your aneurysm. Expect to have an abdominal ultrasound at least six months after your aneurysm is diagnosed and at regular follow-up exams after the first imaging test. The frequency of your imaging tests depends on the size of the aneurysm, whether the aneurysm is growing and how fast it's growing.
If you have an abdominal aortic aneurysm, surgery is generally recommended if your aneurysm is about 1.9 to 2.2 inches (about 5 to 5.5 centimeters) or larger. Doctors may also recommend surgery if the aneurysm is growing quickly. In addition, your doctor may recommend treatment if you're experiencing symptoms such as stomach pain or you have a leaking, tender or painful aneurysm.
Surgery options may include:
Open abdominal surgery. Open abdominal surgery to repair an abdominal aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place.
This procedure requires open abdominal surgery, and it will generally take you a month or more to fully recover.
Endovascular surgery. Endovascular surgery is a less invasive procedure used more frequently today to repair an aneurysm. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta.
The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and expanded. The graft is fastened in place with the metal mesh that frequently has small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm.
Recovery time is generally much shorter with this procedure than with open abdominal surgery, but endovascular surgery can't be done in about 30 percent of people with an aneurysm. Discuss with your doctor whether you're a candidate for this procedure. After endovascular surgery, you'll need to have regular follow-up imaging tests to ensure that the graft isn't leaking. Long-term survival rates are similar for both endovascular surgery and open surgery.
The options for treatment of your aneurysm will depend on a variety of factors, including location and size of the aneurysm, your age, and other existing conditions that may increase your risk of surgery or endovascular repair. Your doctor will discuss with you the most appropriate treatment for you.
What are the risk factors for aneurysm?
Abdominal aortic aneurysm risk factors include:
- Age. Abdominal aortic aneurysms occur most often in people age 65 and older.
- Tobacco use. Tobacco use is a strong risk factor for the development of an abdominal aortic aneurysm and a higher risk of rupture. The longer you've smoked or chewed tobacco and the more cigarettes you smoked per day, the greater your risk.
- Being male. Men develop abdominal aortic aneurysms much more often than women do.
- Being white. People who are white are at higher risk of abdominal aortic aneurysms.
- Family history. People who have a family history of abdominal aortic aneurysms are at increased risk of having the condition.
- Atherosclerosis. Atherosclerosis — the buildup of fat and other substances that can damage the lining of a blood vessel — increases your risk of an aneurysm.
- Other aneurysms. People who have an aneurysm in another large blood vessel, such as the artery behind the knee or the thoracic aorta in the chest, may have a higher risk of developing an abdominal aortic aneurysm.
- High blood pressure. High blood pressure may increase your risk of developing an abdominal aortic aneurysm.
Is there a cure/medications for aneurysm?
An aneurysm is a bulge that forms in the thinning wall of an artery. Two of the most common and potentially life threatening locations for an aneurysm are the brain (cerebral aneurysm) and the aorta, the largest blood vessel in the body.
If an aneurysm ruptures, it is a medical emergency. Though an aneurysm can’t always be prevented, taking steps such as maintaining a healthy blood pressure, quitting smoking, and scheduling annual checkups can help lower your risks.