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Ask a Doc - Abdominal Aortic Aneurysm

An aneurysm in the artery near the stomach is known as an abdominal aortic aneurysm (AAA), and it occurs when atherosclerosis, or plaque buildup, causes the walls of the abdominal aorta to become weak and bulge outward like a balloon.  An AAA develops slowly over time and has few noticeable symptoms.  The larger an aneurysm grows, the more likely it will burst or rupture, causing intense abdominal or back pain, dizziness, nausea or shortness of breath.  New advances in diagnosis and therapy are dramatically improving the detection and management of the aneurysm.

The aorta is the largest artery in the body and receives all the oxygenated blood pumped out from the left ventricle of the heart.  After leaving the heart, the aorta ascends toward the neck, and then descends toward the abdomen.  Any part of the aorta can develop an aneurysm; however, most occur in the lower part of the artery as it travels through the abdomen carrying blood to the legs.  Over time, as the artery expands and contracts with each heartbeat, the walls may become weak and widen.  The pressure of blood pumping through the weakened wall of the aorta may begin to create the balloon-like dilation.
 
A number of factors play a role in atherosclerosis, the weakening of the wall of the aorta including hardening of the arteries.  Atherosclerosis occurs when fat and other substances build up on the lining of the blood vessel.  High blood pressure also can damage and weaken the aorta’s walls.  Blood vessel diseases, infection or trauma also can result in the creation of an AAA.  Due to aging, the elastic tissue in the artery walls may wear down and the aorta is unable to replenish or repair this vital material.  AAAs are rare before age 55, but become increasingly common after age 65.  Gender is another important risk factor, as AAAs are much more common in men than in women and tend to occur 10 years earlier in males than females.  However, women face a higher risk of rupture and death than men with aneurysms of comparable size.  Family history may also be a contributing factor in some cases.
 
Other risk factors for developing an AAA are reversible, such as smoking, high blood pressure and cholesterol.  The nicotine in tobacco products raises blood pressure and heart rate while narrowing and hardening the artery walls.  Quitting smoking or chewing tobacco can greatly decrease the risks of aorta damage.  It is necessary to maintain blood pressure and cholesterol as well.  Consuming a variety of fruits and vegetables, whole grains, poultry, fish, and low-fat dairy products while avoiding saturated and trans fats assists in keeping cholesterol and blood pressure low.  Regular exercise – at least 150 minutes a week – also is beneficial.

As the AAA develops slowly over time, there are few noticeable symptoms and detection can be difficult.  Often, an AAA is discovered during routine examinations for other medical conditions.  As the aneurysm enlarges, some patients may experience a deep, constant pain in the abdomen or back.  A pulsating sensation near the navel also may be present.  It is vital to detect an AAA early before a tear or rupture occurs.  A rupture can cause life-threatening internal bleeding.  Signs and symptoms that the AAA has ruptured can include:

  • Sudden, intense and persistent abdominal or back pain, which can be described as a tearing sensation
  • Low blood pressure
  • Fast pulse
Aortic aneurysms also can cause a blood clot to develop in the area.  If a blood clot breaks loose from the inside wall of an aneurysm and blocks a blood vessel elsewhere in the body, it can cause pain or block the blood flow to the legs, toes, kidneys or abdominal organs.

To diagnose an AAA, a primary care physician or vascular surgeon reviews a patient’s medical and family history and performs a complete physical examination.  Specialized tests, such as an abdominal ultrasound or a computerized tomography (CT) scan, can be performed to determine if an AAA has developed and how large it may be.  For a smaller aneurysm, the physician or vascular surgeon will monitor the area to determine if it should be considered for repair.  A larger aneurysm or rupture may require surgery to repair the damage.  A vascular surgeon may prefer to use an endovascular stent.  A metal stent covered with a synthetic fabric is placed into the aorta through a thin catheter inserted into the femoral artery in the groin.  When the stent is in place, the surgeon expands the material and withdraws the catheter.  Over time, the aneurysm shrinks around the stent.  Endovascular surgery offers a quicker recovery time for the patient.

Screening recommendations for an AAA vary; however, men ages 65 to 75 who have a history of smoking cigarettes should receive a one-time screening using abdominal ultrasound.  Talk to a physician or vascular surgeon to determine if an ultrasound is needed based on other risk factors.  For more information on the services provided at Licking Memorial Vascular Surgery, call (220) 564-1965 or visit LMHealth.org. 

| Posted On : 6/30/2021 2:25:52 PM