(AAA; Abdominal Aortic Aneurysm; Aneurysm, Abdominal Aortic; Thoracic Aortic Aneurysm; Aneurysm, Thoracic Aortic)
The aorta is the body's largest artery. It carries blood from the heart and delivers it to the rest of the body. The aorta travels through the chest and the abdomen. An aortic aneurysm is a weak, bulging area in the wall of the aorta. The bulging develops from a weakness or defect in the aortic wall. It tends to get bigger with time.
The greatest danger is that an aneurysm will rupture. This will cause heavy, uncontrollable bleeding. Aortic aneurysms can also occur with aortic dissection. Dissection is a small tear in the aortic wall. Blood from the aneurysm can leak through this tear and spread between the layers of the aortic wall. This leads to eventual rupture of the vessel.
Aneurysms can develop anywhere. They are most common in the aorta (thoracic and abdominal), iliac artery, and femoral artery.
Abdominal Aortic Aneurysm
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Atherosclerosis is frequently associated with aneurysm. However, it is not thought that this disease alone causes the growth of an aneurysm. It is believed that other factors, such as high blood pressure or connective tissue disorders, must be present for an aneurysm to form.
Aortic aneurysms are more common in adults over 60 years of age. Other factors that may increase your chances of an aortic aneurysm:
- High blood pressure
- Arteriosclerosis, atherosclerosis
- Inherited connective tissue defects such as Marfan syndrome or Ehlers-Danlos syndrome
- Polyarteritis nodosa
- Bacterial endocarditis
- History of heart attack
- Family members with aneurysms, particularly male children of an affected mother
- Infectious aortitis
- Great vessel arteritis, also known as Takayasu disease
- Injury to the aorta, from either a motor vehicle accident or a stab wound
Many aneurysms do not have symptoms. They are detected during a routine physical exam or during x-ray evaluation for another disorder.
Symptoms may occur when the aneurysm grows or disrupts the wall of the aorta. Symptoms depend on the size and location of the aneurysm and may include:
- Pain in the abdomen or in the lower back
- Boring, gnawing, or constant pain occurring over hours or days
- Sudden onset of severe stabbing pain
- Unusual sensation of pulsing in the abdomen
- Cough, shortness of breath
- Difficulty swallowing
- Coughing up blood
- Weight loss
- Chest pain
You will be asked about your symptoms and medical history. A physical exam will be done. Pain is the symptom that will most likely cause you to go to the doctor. Most aortic aneurysms are discovered during a routine physical exam.
Images of your heart may be needed. This can be done with:
Treatment includes surgery or stenting.
Surgery to repair an aortic aneurysm is called aneurysmectomy. It involves removing the portion of the aorta that contains the aneurysm and replacing it with a mesh graft.
With aneurysms of the thoracic aorta, the aortic valve may also be affected and need to be replaced or repaired. If the aneurysm involves important branches of the aorta, these vessels may either be repaired or bypassed.
Depending on where the aneurysm is located and how complex it is, stenting may be done. A stent-graft is a polyester tube covered by a tubular metal web. The stent-graft is inserted into the aorta. With the stent-graft in place, blood flows through the stent-graft instead of into the aneurysm, eliminating the chance of rupture.
There are no current guidelines for preventing an aneurysm because the cause is not known. However, you can reduce some of your risk factors:
- Eat a healthful diet that is low in saturated fat and rich in whole grains, fruits, and vegetables.
If you smoke, talk to your doctor about ways to
- The US Preventive Services Task Force recommends that men aged 65-75 who have ever smoked be screened once for abdominal aortic aneurysm with ultrasound. This is a painless procedure that gives a picture of the abdomen using sound waves. Early detection of abdominal aortic aneurysm in this group has been shown to reduce mortality from this condition.
- Maintain a healthy weight.
- Begin a safe exercise program with the advice of your doctor.
- Seek treatment for high blood pressure, syphilis, and other infections.
- If you have Marfan syndrome, see your doctor regularly for monitoring and CT scans.
American Heart Association
National Heart, Lung, and Blood Institute
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
Abdominal aortic aneurysm (AAA). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114361/Abdominal-aortic-aneurysm-AAA. Updated January 11, 2018. Accessed February 28, 2018.
Screening for abdominal aortic aneurysm: recommendation statement. US Preventive Services Task Force website. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/abdominal-aortic-aneurysm-screening. Updated June 2014. Accessed February 28, 2018.
Thoracic aortic aneurysm. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T908572/Thoracic-aortic-aneurysm. Updated June 1, 2017. Accessed February 28, 2018.
7/21/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T114361/Abdominal-aortic-aneurysm-AAA: Thompson SG, Ashton HA, Gao L, Scott RA, Multicentre Aneurysm Screening Study Group. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ. 2009;338:b2307.
7/17/2017 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T114361/Abdominal-aortic-aneurysm-AAA: Reis SP, Majdalany BS, Ali F, et al. ACR Appropriateness Criteria for pulsatile abdominal mass, suspected abdominal aortic aneurysm. Available at: https://acsearch.acr.org/docs/69414/Narrative. Updated 2016.
Last reviewed March 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 7/17/2017