Abdominal aortic aneurysm

About abdominal aortic aneurysm

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

The aorta is usually 2 to 3cm (about one inch) in diameter. A weak spot in the aorta can cause it to bulge outwards and this is called an aneurysm. If the bulge occurs in the aorta as it goes through your chest, it's called a thoracic aortic aneurysm. If it occurs in the aorta as it goes through your abdomen, it's called an abdominal aortic aneurysm. An abdominal aortic aneurysm is more common than a thoracic aneurysm. You can have more than one aneurysm at the same time.

Most people who get an abdominal aortic aneurysm are over 50 and they are three times more common in men than in women. Around four in 100 men aged between 65 and 74 in England have an abdominal aortic aneurysm.

Symptoms of abdominal aortic aneurysm

You’re unlikely to have any symptoms of an abdominal aortic aneurysm, unless it ruptures. If the aneurysm does rupture, it will cause severe internal bleeding. This will be fatal without emergency surgery to repair it. The chance of an aneurysm rupturing depends on its size. If your aneurysm is greater than 5.5cm wide, the chances of rupture are relatively high – and the risk increases with increasing size.

If your abdominal aortic aneurysm ruptures you may get severe pain in the middle or side of your abdomen or in your groin, or you may feel a pulsating sensation in your abdomen. You may also have other symptoms that include:

  • a rapid heartbeat
  • feeling faint
  • loss of consciousness
  • feeling sick or vomiting

If you lose consciousness, or have severe pain in your abdomen and any of these other symptoms, you must seek urgent medical attention.

Causes of abdominal aortic aneurysm

Abdominal aortic aneurysms develop when the wall of your aorta weakens, which causes it to bulge or dilate. The exact reasons why your aorta weakens aren't fully understood at present and are often due to a variety of factors.

Many people with an abdominal aortic aneurysm also have atherosclerosis. This is a process in which fatty deposits build up on the inside of your arteries and weaken the artery walls.

You’re more likely to develop an aneurysm, if you:

  • smoke
  • have a family history of abdominal aortic aneurysm or atherosclerosis
  • have high blood pressure
  • have chronic obstructive pulmonary disease (COPD)
  • have Marfan syndrome or another connective tissue disorder
  • do little physical activity
  • are overweight

Diagnosis of abdominal aortic aneurysm

You may not have any symptoms of an abdominal aortic aneurysm, unless it’s large or is expanding quickly. Your GP may suspect you have an aortic aneurysm only following a routine physical examination.

Your GP will examine you and ask you about your medical history. When your GP examines you, he or she may feel a pulsating mass in your abdomen. This may be tender if your abdominal aortic aneurysm is large. If your GP suspects you have an abdominal aortic aneurysm, you may need to have other tests in hospital, which may include the following.

  • An ultrasound scan can provide a clear image of your abdominal aorta to identify an aneurysm and measure its size.
  • A CT or MRI scan can provide images of your aorta. They are useful for determining the exact position of the aneurysm.

Screening

If you're a man over 65, you’re likely to be invited to be screened for an abdominal aortic aneurysm at your GP surgery or local hospital. Ask your GP for more information.

Treatment of abdominal aortic aneurysm

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

Watchful waiting

If you have a small aneurysm, your doctor won’t usually advise you to have surgery but you will need regular ultrasound checks to see if your aneurysm is expanding. It's also important to manage your condition by changing your lifestyle and treating any condition that may be causing the aneurysm (such as high blood pressure) and you should consider stopping smoking and losing weight if you’re overweight.

Surgery

Your doctor will advise you to have elective (planned) surgery if your aneurysm is:

  • larger than 5.5cm
  • expanding by more than 1cm per year
  • causing symptoms, such as pain

You will need to have emergency surgery if your aneurysm ruptures as this is a serious medical emergency.

There are three main surgical options for an abdominal aortic aneurysm.

Open surgery
In open surgery for an abdominal aortic aneurysm, your surgeon will open your abdomen to gain access to your aorta. He or she will insert a graft into the weak area of your aorta. The graft is likely to be a synthetic graft. A synthetic graft is made out of an elastic material. Blood will flow through the graft inside your aorta instead of going through the aneurysm and this will prevent the aneurysm getting bigger.

Keyhole surgery
In keyhole surgery, your surgeon will make two or three small cuts in your abdomen and will insert a tube-like telescopic camera, which will send pictures to a monitor so he or she can see the aneurysm. Your surgeon will pass specially-designed surgical instruments through the other cuts and put the graft into place. However, keyhole surgery isn't suitable for everybody – ask your surgeon if it’s an option for you.

Endovascular stent graft replacement
In endovascular aneurysm repair (EVAR), your surgeon or doctor will feed a stent – a tube that is covered with synthetic graft material – through an artery in your groin and up through your aorta to the area of the aneurysm. Your surgeon will use X-ray images to guide the placement of the stent. The graft material will bond with the wall of your aorta and blood will flow through the stent instead of the weakened aneurysm. However, stents aren't suitable for everyone, it depends on the location of the aneurysm and other factors. Ask your surgeon for more information.

Prevention of abdominal aortic aneurysm

There are several things you can do to reduce your chance of developing an aneurysm – and the associated risk factor of atherosclerosis – including:

  • not smoking
  • having your blood pressure and cholesterol checked regularly and treated if they are elevated
  • exercising regularly
  • maintaining a healthy weight
  • eating a healthy diet

It’s important to have regular medical check-ups if you have a family history of arterial disease. Also, make sure you attend any screening appointments so that problems can be detected early.

What is Marfan syndrome?

Answer

Marfan syndrome is a condition that affects the way in which your body produces fibres that make up the connective tissue in your body, such as between your joints and organs.

Explanation

People with Marfan syndrome have a defect in a gene that controls the production of elastic fibres in their body. The elastic fibres (connective tissue) hold your joints and organs in place and help control how your body grows. Because connective tissue is found throughout your body, the effects of Marfan syndrome can be widespread, and involve your heart, lungs, skeleton, skin and eyes, for example.

About one in 5,000 people have Marfan syndrome. People can inherit the condition, meaning that they get it from a parent who also has the syndrome.

If you have Marfan syndrome, you're more at risk of getting an aortic aneurysm because the elastic tissue of your aorta isn't produced correctly. This makes your aorta weaker and so it can widen.

I have an abdominal aortic aneurysm and I've heard that these can rupture. What does this mean and what can I do to help prevent it happening?

Answer

An abdominal aortic aneurysm can rupture (burst) if the weakened artery wall of your aorta can't contain the pressure of the blood inside. A ruptured aneurysm is very serious and requires emergency surgery to treat it. It’s important to have regular check-ups and change your lifestyle to help prevent this.

Explanation

If you have an abdominal aortic aneurysm, you will need to attend regular appointments with your doctor to check it’s not at risk of rupture (bursting). A ruptured abdominal aortic aneurysm is very serious – and about eight out of 10 people who have a ruptured abdominal aortic aneurysm will die as a result.

Your abdominal aortic aneurysm is more likely to rupture if you smoke or have:

  • chronic obstructive pulmonary disease (COPD)
  • high blood pressure
  • a large abdominal aortic aneurysm – over 5.5cm
  • an abdominal aortic aneurysm that grows by more than 1cm per year

To help prevent your abdominal aortic aneurysm from rupturing:

  • have regular (every six months) check-ups to monitor your abdominal aortic aneurysm
  • stop smoking
  • lower your blood pressure
  • lose excess weight
  • increase the amount of exercise you do

Ask your GP for information about the support available to help you quit smoking, lose excess weight and increase the amount of exercise you take. There may be local services in your area that can help you to achieve your goals.

What can I do to make my recovery easier after having surgery to treat an abdominal aortic aneurysm?

Answer

Aim to be as fit and healthy as possible before your operation and prepare your home for when you return.

Explanation

Before you go into hospital there are several things that you can do to make your recovery quicker and easier.

It’s important to stop smoking as smoking can increase your chances of getting a chest infection and slow your recovery. If you're overweight, your surgeon may recommend a weight-loss programme because being overweight can also slow your recovery.

It's a good idea to prepare your home for when you return from hospital. This may involve rearranging your furniture to make it easier to move around and placing commonly used items at arm level so you don't have to reach for them. It's also a good idea to stock up on non-perishable foods, such as frozen or tinned items, so that you don't need to go shopping immediately after your surgery.

Open surgery for abdominal aortic aneurysm is a major operation. You're likely to stay in hospital for around eight to 10 days and you may be off work for about six to 12 six weeks. If you have endovascular aneurysm repair surgery you’re likely to be off work for around a month so make any necessary arrangements in advance. You may want to have books, CDs or DVDs at home to keep you occupied while you recover.