Dialysis is a treatment recommended for people who have been diagnosed with kidney failure and have The aorta is the largest artery in the body artery that carries blood from the heart to the chest and into the abdomen. When an artery weakens, it can sometimes bulge out and expand, called an aneurysm. When it happens in the abdominal aorta, this is referred to as an abdominal aortic aneurysm or AAA.
Over 200,000 people in the United States are diagnosed with abdominal aortic aneurysms annually and approximately 15,000 die each year from a ruptured AAA. Luckily, there are effective treatments that can help prevent related complications.
What Causes an Abdominal Aortic Aneurysm?
AAA is caused by a breakdown in the proteins that provide structural strength to the wall of the aorta. Certain lifestyle choices, age, or medical conditions increase the risk of AAA. Risk factors include:
- Smoking
- Chronic lung disease
- Male
- Age over 65
- High blood pressure
- Family history
The highest risk group for an abdominal aortic aneurysm is men over 65 who were previous smokers. If you believe you are at risk of an AAA, speak to your doctor about screening and treatment options.
Common Symptoms and How to Spot Them
An aneurysm develops slowly over time and often has no symptoms. It is incidentally discovered during imaging, which is why screening is essential. A noninvasive abdominal ultrasound is a simple test that can detect the presence of an abdominal aortic aneurysm.
Symptoms of an abdominal aortic aneurysm will only appear if the condition becomes more severe. If the abdominal aorta expands too far, it can rupture and leak blood. Symptoms to look out for include:
- Pain in the stomach or back that is severe, sudden, and constant
- Pain that spreads to the groin, legs, or buttocks
- Passing out
- Nausea and vomiting
- Rapid heart rate
- Dizziness
- Shock
Some of the signs of an abdominal aortic aneurysm might be similar to other medical conditions; therefore, it is important to seek IMMEDIATE medical attention for the correct diagnosis. A ruptured aorta requires emergency treatment.
How Doctors Diagnose Abdominal Aortic Aneurysms
A diagnosis of an abdominal aneurysm will typically start with a physical exam and questions about your medical history. During this exam, your provider will examine your abdominal area and feel the pulses in your legs. They look for a pulsatile mass in the abdomen, which could be a signs of an aneurysm.
If your doctor suspects you have an abdominal aneurysm, they will order an abdominal aortic ultrasound. This simple, quick, noninvasive test may reveal the exact size and location of the aneurysm, especially for people at high risk. Treatment will depend on the size and location of the aneurysm.
More advanced tests, like a CT scan and MRI, may be required for a complete diagnosis and are often included in the diagnostic workup. Once an aneurysm has been diagnosed, patients will be referred to a vascular surgeon for further evaluation.
Men over 65 who have smoked during their lifetime or have other risk factors will often be offered a screening for an aortic aneurysm, as this is the group with the highest risk. This screening is part of the “Welcome to Medicare” package and is conducted with no charge to the patient.
Available Treatments and Their Effectiveness
At Empire Vein and Vascular Specialists, we prefer minimally invasive abdominal aortic aneurysm treatments whenever it’s an option versus open surgical repair.
Over 98% of our patients undergo minimally invasive surgery to treat AAA with a technique known as Endovascular Aneurysm Repair (EVAR). The risks of this procedure are low, with less than 5% of patients experiencing infections or bleeding.
EVAR involves two tiny incisions in the groin and a catheter is inserted. Under X-ray guidance, a covered stent is delivered through the catheter and placed inside the aneurysm. This stent fits snugly into the normal artery above and below the aneurysm so that it forms a new pathway for the blood to flow. This excludes the aneurysm sac, which then usually begins to shrink. The procedure usually lasts less than two hours. Most patients are discharged within 24 hours, with a recovery time of approximately two weeks.
While not all patients are candidates for this type of procedure, your vascular surgeon will review your medical history and imaging results to determine if you are.
If the aneurysm is very large or has ruptured, and you are bleeding into your body, you may still be able to have an EVAR, which we perform on 90% of patients. Depending on your situation, you may still need to have an open surgical repair of the aorta. This is when a large incision is made into the abdomen, and the aneurysm sac is entered and repaired with a prosthetic tube graft. Surgery requires a more extensive recovery, and it can take several weeks to resume normal activities, but it is a very durable operation.
If caught before it ruptures, the prognosis for an aneurysm repair is quite good. But, once the aneurysm begins to tear or rupture, the prognosis can be poor, with only one in five people surviving a rupture. This is why if you are at high risk of an AAA, you should get a screening to ensure an early diagnosis and treatment plan.
Tips for Prevention and Managing the Condition
Many of the factors that increase the risk of an AAA are within your control, such as not smoking, maintaining a healthy blood pressure, and managing medical conditions such as heart disease. If you are at high risk, regular screening is painless and essential for preventing a rupture or other complications.
Our board-certified vascular surgeons at Empire Vein and Vascular Specialists can help with screening and lowering your chances of complications from an AAA. We offer many treatment options to fit your needs. We are in-network with most insurance providers and can work with you to get your treatment fully covered. To start working with our team, reach out today by calling 1-800-VARICOSE (1-800-827-4267) or send a message to our office online.
To date, we have performed a total of 385 EVARS.
FAQs
I have been diagnosed with an Abdominal Aortic Aneurysm (AAA). Is this an emergency?
Most of the time, surgery is not needed for an abdominal aortic aneurysm. AAAs less than five cm can be safely monitored over time. If you do require surgery, it is rarely emergency surgery. At Empire Vein and Vascular Specialists, we offer minimally invasive treatment options, with most procedures only requiring an overnight stay in the hospital.
I have been told that my aneurysm is small and doesn’t require surgery. Now what?
If your AAA doesn’t require surgery, your vascular surgeon will place you on a surveillance program, where they will perform a noninvasive ultrasound once or twice a year. Additionally, to slow down the progression of the aneurysm, you should quit smoking and monitor your blood pressure.
Why are aneurysms considered so dangerous?
Aneurysms can grow silently for months to years with no symptoms. When they rupture, the patient can experience major blood loss, which can lead to death.
I have a family history of aneurysms. What can I do to decrease my chances of developing one?
Quitting smoking is the most important thing one can do.
I have been diagnosed with an aneurysm. How do I find the right physician to treat it?
You want to look for a board-certified vascular surgeon, a doctor who has special training and experience in treating aneurysms with the latest minimally invasive techniques. Here at Empire Vein and Vascular Specialists, our surgeons collectively have over 30 years of experience and have treated over 4,800 aneurysms.
References:
- https://my.clevelandclinic.org/health/treatments/22649-ascending-aortic-aneurysm-repair
- https://www.sciencedirect.com/science/article/pii/S0741521420306005
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313801/
- https://medlineplus.gov/ency/article/007391.htm