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Abdominal aortic aneurysm


Expert reviewer Mr Mark Yeatman, Cardiothoracic surgeon
Next review due September 2020

An abdominal aortic aneurysm is when the aorta, which is the largest blood vessel in your tummy (abdomen) bulges outwards, increasing in size. It’s a serious condition that needs to be monitored closely because if the aneurysm bursts, it can be fatal.

An image showing an abdominal aortic aneurysm

About abdominal aortic aneurysms

Your aorta is the artery (blood vessel) that carries blood from your heart to the rest of your body, branching off to other blood vessels. It travels down through your chest, where it’s called the thoracic aorta, and to your abdomen where it becomes the abdominal aorta. Normally, your aorta is about 2 to 3cm (about an inch) wide.

If you have a weak spot in your aorta, it can cause it to get wider and create an aneurysm. If this happens in the part of your aorta as it goes through your chest, it’s called a thoracic aortic aneurysm. We have a separate topic on thoracic aortic aneurysm. If it’s in your aorta as it goes through your abdomen, it's called an abdominal aortic aneurysm. You can have more than one aneurysm at the same time.

Most people who get an abdominal aortic aneurysm are over 50. As many as four in 100 men aged 65 to 74 have an abdominal aortic aneurysm. In this age group, they’re six times more common in men than in women.

Symptoms of abdominal aortic aneurysm

You’re unlikely to have any symptoms of an abdominal aortic aneurysm unless it bursts open (ruptures). But if it’s pressing on nearby organs, you may feel pain in your back, tummy (abdomen), side or groin.

If your abdominal aortic aneurysm ruptures, you may get sudden and severe pain in your tummy or in your back. Or, you may feel a pulsating sensation in your tummy. You might get other symptoms too that include:

  • feeling cold and sweaty
  • a rapid heartbeat
  • feeling faint, or blacking out
  • feeling sick or vomiting

If the pain in your tummy is really bad, and you have any of these other symptoms, seek urgent medical attention. If the aneurysm does rupture, it may cause severe internal bleeding. This will be fatal if you don’t have emergency surgery to repair it.

Diagnosis of abdominal aortic aneurysm

It’s unlikely that you’ll have any symptoms of an abdominal aortic aneurysm unless it ruptures so it’s usually diagnosed in a screening test. It might also be picked up if you’re having tests for another condition, or during a routine examination by your GP.

Your GP will examine you and ask you about your medical history. If you have an aortic aneurysm, they may feel a pulsating mass in your tummy (abdomen). If your GP feels this pulsating mass, they’ll send you straight to hospital, otherwise they might organise for you to have a scan to confirm if you have one.

You may need to have other tests too, such as:


Screening for abdominal aortic aneurysm

In the UK, men over 65 are invited to be screened for an abdominal aortic aneurysm at a GP surgery or local hospital. You should receive a letter in the post about it once you hit 65. If you don’t get a letter contact your GP.

Screening involves having an ultrasound scan of your tummy and it’s usually a one-off test unless you’re found to have any swelling in your aorta. If there are any signs of swelling, you’ll be offered another scan. How soon you need to go back depends on the size of the swelling.

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 your aneurysm is small (less than 5.5cm), your doctor won’t usually advise you to have treatment. But you’ll need regular ultrasound checks to see if the aneurysm gets any bigger. How often you need these checks will depend on the size of your aneurysm.

Self-help

If you have an abdominal aortic aneurysm and it’s being monitored, there are some things you can do to help yourself.

Take some steps to change your lifestyle to combat anything that increases your risk of the aneurysm getting bigger. This might be getting help for a condition that may be causing the aneurysm, such as high blood pressure. If you smoke, try to quit, and lose weight if you need to. And take steps to lower your cholesterol.

See Related information for tips and advice on how to achieve these. You can also read more about lowering your risk of a rupture in our Complications section below.

Surgery

Your doctor will probably suggest you have planned (elective) surgery if your aneurysm grows to 5.5cm or more. You may also need surgery if you have symptoms because it can mean your aneurysm is growing fast.

They’ll also suggest surgery if you have Marfan syndrome and your aneurysm is 5cm or more, or you have a family history of aneurysms. For more information about this condition, see our FAQ: Marfan syndrome below.

You’ll need to have emergency surgery if your aneurysm ruptures as this is a serious medical emergency. There are two main types of operation for an abdominal aortic aneurysm.

Open surgery

In open surgery for an abdominal aortic aneurysm, your surgeon will open your tummy (abdomen) to reach your aorta. They’ll then put a graft into the weak area of your aorta. This is usually a synthetic graft that’s made out of an elastic material. Blood will flow through the graft inside your aorta instead of going through the aneurysm, which will prevent the aneurysm expanding.

Keyhole surgery

It’s also possible to have keyhole surgery to treat an abdominal aortic aneurysm, and this is called endovascular aneurysm repair (EVAR). In this procedure, your surgeon will feed a tube through an artery in your groin and up through to your aorta and the aneurysm. They’ll put a stent through this tube and into your artery. Your surgeon will take CT images before your operation, and will take X-rays during it, to guide them to put the stent in the right place. The stent will be covered with synthetic graft material that will bond with the wall of your aorta. Blood will then flow through the stent instead of the aneurysm.

Stents aren't suitable for everyone. It will depend on where your aneurysm is and your general health, as well as other things. Ask your doctor or surgeon for more information and if it’s an option for you.

For more information on both open and keyhole surgery for an abdominal aortic aneurysm, see our separate topic: Aortic aneurysm surgery.

Causes of abdominal aortic aneurysm

You can get an abdominal aortic aneurysm if the wall of your aorta weakens, which causes it to bulge outwards. Doctors don’t know exactly why this happens but think it’s probably due to a number of things.

Lots of people with an abdominal aortic aneurysm have atherosclerosis. This is where fatty deposits build up on the inside of your arteries, which make them weaker.

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

  • are a man (they’re far more common in men than women)
  • smoke
  • have a family history of abdominal aortic aneurysm or atherosclerosis
  • have high blood pressure, or high cholesterol
  • have chronic obstructive pulmonary disease (COPD)
  • have Marfan syndrome (to learn more about this see our FAQ: Marfan syndrome below), or another type of what’s called a connective tissue disorder
  • have an infection, such as HIV

Complications of an abdominal aortic aneurysm

An abdominal aortic aneurysm can burst if the weakened artery wall of your aorta can't contain the pressure of the blood inside. This is a really serious situation – it’s usually fatal unless you get treatment in time.

The chance of an aneurysm rupturing depends on its size. If your aneurysm is more than 5.5cm wide, the chances of it rupturing are high. The risk increases as the aneurysm gets bigger. It’s important to have regular check-ups and change your lifestyle to help prevent this from happening.

Here’s what you can do to prevent your abdominal aortic aneurysm from rupturing.

  • Make sure you have regular check-ups to monitor your abdominal aortic aneurysm. The screening service will let you know how often you need to have a check-up ultrasound scan.
  • If you smoke, get some help to quit. Your pharmacist or GP surgery might have some information about the support available. We also have advice in our Related information below.
  • If you have high blood pressure, take steps to lower it. Along with taking medicines, losing weight and exercising can help with this.

See Related information below for advice on making these changes. There may be local services in your area that can help you to achieve your goals too.

Prevention of abdominal aortic aneurysm

You can take steps to reduce your risk of getting an aortic aneurysm by:

  • not smoking
  • having your blood pressure and cholesterol checked regularly, and getting treatment if necessary
  • exercising regularly
  • keep to a healthy weight
  • eating a healthy diet

See Related information below for tips and advice on how to make these changes.

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 your doctor can pick up any problems early.

Frequently asked questions

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

    Before you go into hospital, there are some things that you can do to speed up your recovery and make life easier for yourself.

    It’s important to stop smoking as it can increase your chances of getting a chest infection, which will slow your recovery. If you're overweight, your surgeon may recommend a weight loss programme because this can increase your risk too.

    It's a good idea to prepare your home for when you return from hospital. You might want to rearrange your furniture to make it easier to move around, and put any items that you use a lot at arm level. You won’t have to strain to reach for them then. It's also a good idea to stock up on frozen and tinned food, or do an online shop before your operation.

    Open surgery for an abdominal aortic aneurysm is a major operation. You’ll probably stay in hospital for over a week and you may be off work for about two to three months. If you have keyhole surgery, you’re likely to be in hospital for two to three days. And you’ll most probably be off work for around a month.

  • Marfan syndrome is a condition that affects the way your body produces the elastic fibres that make up the connective tissue in your body.

    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. It can involve your heart, lungs, skeleton, skin and eyes, for example.

    About three in 10,000 people have Marfan syndrome. You can inherit the condition from one of your parents if they have Marfan syndrome. But not everybody who gets Marfan syndrome inherits it.

    If you have Marfan syndrome, you're more at risk of getting an aortic aneurysm earlier because the elastic tissue of your aorta isn't produced correctly. This makes your aorta weaker, so it widens more easily. You’ll probably need to take medicines, such as beta blockers, to make your heart beat more slowly and with less force, and have regular scans.

  • If your abdominal aortic aneurysm isn’t likely to rupture any time soon, it’s perfectly safe to fly. But sometimes your travel plans can be affected.

    If you have an abdominal aortic aneurysm that’s less than 5.5cm, you’ll be OK to fly. The Association of British Insurers has been advised by experts that abdominal aortic aneurysms aren’t more likely to rupture in the air than on the ground. So airlines don’t generally refuse people. But you’ll need to declare it when you apply for travel insurance or, tell your current insurer. They might charge you an extra premium or exclude your condition from cover.

    If you’ve had surgery to treat an aortic aneurysm, you’ll need to wait a while to fly. This should be about four or five days if you had keyhole surgery, or 10 days if you had open surgery. But check with your doctor before you make any travel plans. It’s also a good idea to let your airline know, to make sure they’re happy to have you on board.

  • You can drive if you have an aortic aneurysm (thoracic or abdominal), but you may need to tell the DVLA (Driver and Vehicle Licensing Agency) about your aneurysm. Whether you can drive or not will also depend on the type of vehicle you drive and the size of your aneurysm. There are also slightly different rules if you have Marfan syndrome.

    It’s important to talk to your specialist doctor about whether it’s safe to drive or not. It’s also worth checking with your insurer to see if they have any specific recommendations.

    Always follow your doctor’s advice and if you’re unsure about anything, ask.


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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, September 2017
    Expert reviewer Mr Mark Yeatman, Cardiothoracic surgeon
    Next review due September 2020



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