What You Should Know about Abdominal Aortic Aneurysms

Of all the diseases that people are concerned about as they age, abdominal aortic aneurysm (AAA) rarely makes the list compared to conditions like heart attacks, diabetes or cancer. Though it’s not as common as those other diseases, AAA is still an issue of concern for many.

According to a 2019 estimate published in the Annals of Surgery, the global prevalence of the disease was over 35 million people. The Society for Vascular Surgery adds that this includes about 200,000 people in the U.S. each year. It’s the 15th leading cause of death and the 10th leading cause of death for people over age 55 in the U.S.

What is an abdominal aortic aneurysm?

When people think of aneurysms, it’s often of a brain aneurysm, which is a common cause of stroke. But an abdominal aortic aneurysm, as the name implies, impacts the aorta, the largest artery in the body, as it runs through your abdomen from your chest to your hips. As the wall of the aorta weakens over time, it can begin to bulge. In some cases, this can cause a rupture, which leads to internal bleeding and life-threatening consequences.

“An aneurysm is a dilation of a vessel that is 1.5 times its normal size,” says Stefan Kenel-Pierre, M.D., a vascular and endovascular surgeon with the University of Miami Health System. “So, if the aorta dilates to 3 centimeters or more, that is considered an aneurysm.”

Dr. Kenel-Pierre adds that not every detected AAA requires immediate medical intervention. He says that the threshold for operating is 5.5 centimeters and above for men and 5 centimeters and above for women. “If it’s small, we’ll monitor its progression regularly with the use of ultrasound,” he says. “This will typically occur every 6 to 12 months.”

Knowing your risk of AAA and whether you have one is very important, particularly as you age.

Dr. Kenel-Pierre says that if the aorta ruptures as the result of an AAA, it’s a life-threatening medical emergency with a high mortality rate. “We can treat a ruptured AAA, but the internal bleeding is quite serious and is a significant mortality risk,” he says. “That’s why early detection and monitoring or treatment is so important.”

What makes matters worse is that AAA rarely presents symptoms before it occurs. That’s why Dr. Kenel-Pierre recommends active screening for patients who may be at a high risk of the disease. Screening is non-invasive and performed with an ultrasound machine. He suggests asking your doctor for AAA screening if you:

• Have a history of smoking and are over 60
• Have a family history
• Have uncontrolled blood pressure
• Have certain rare tissue disorders or other complications that increase your risk

Screening is the best way to detect the presence of AAA, but in some cases, it may give you a warning with symptoms. These can include:

• A deep and steady pain in the lower abdomen or back, often on the left side
• A pulsing sensation in that area, almost like a heartbeat
• Pain that radiates to the pelvis, groin or leg

Any of these could be a potential sign of an AAA. If the pain becomes severe and is accompanied by rapid heartbeat, shortness of breath, dizziness, nausea or fainting, seek emergency medical attention, as those could be the signs of a rupture.

The good news? Treatment strategies for the condition are much better than they were years ago.

Smaller AAAs can often be monitored for years without worsening or requiring the need for treatment. And many AAAs can be treated with less invasive endovascular surgeries, where the surgeries are performed percutaneously using fluoroscopy (a special form of X-ray) and repairing the damaged portion of the aorta with specialized stents known as endografts. In some instances, however, a more invasive open surgery may be required.

“The most important thing to know about AAA is that it’s not a death sentence,” says Dr. Kenel-Pierre. “We know far more about the disease than we did a few decades ago. Many can be observed and do not require treatment. For those that do, we have less invasive options, and the patient can often go home the next day after the procedure.”

Wyatt Myers is a contributor for UHealth’s news service.

Tags: AAA diagnosis, Aneurysm monitoring, Aneurysm screening, Dr. Stefan Kenel-Pierre