What is an AAA?
An abdominal aortic aneurysm is a ballooning of the main blood vessel (aorta) that brings blood from the heart down to the vital organs (kidneys,intestines,liver) and to the legs. Aneurysms can occur in any blood vessel in the body but is most common in the aorta below the renal arteries (arteries that supply the kidneys). The balloon can get bigger over time until it eventually bursts or rupture. When that occurs, the risk of death is over 80%.

The risk of rupture of the aneurysm depends on its diameter. The normal aorta is about 2 cm in diameter. An aneurysm is a dilatation more than twice the normal size (ie more than 4 cm). The risk of rupture becomes significant when the aneurysm is greater than 5cm in diameter.

Who is at risk for an AAA?
Aneurysms are more common as one ages and occur most frequently in those over the age of 55. Men are four times more likely to be affected than women. There is a genetic predisposition to AAA, but the most common risk factor is cigarette smoking, even in the past. High blood pressure, hardening of the arteries (atherosclerosis), and infection can be contributing factors. More than 15,000 people die each year of AAA-it is the 12th most common cause of death in the US.

How is AAA diagnosed?
Most aneurysms are found by feeling the abdomen during a routine physical exam, although this is getting more difficult as more people are overweight or obese. It can be felt as a pulsating mass near the belly button. They are also found on Xrays or ultrasound obtained for unrelated reasons. Occasionally, when aneurysms are rupturing or enlarging, people will develop belly or back pain, weakness, fainting, rapid heartbeat, etc. This is a true emergency and a patient with these symptoms should go immediately to the emergency room.

What tests are done once an aneurysm is found?
An ultrasound is usually done first if the aneurysm is suspected by physical exam or symptoms. If more information is needed then a CT scan will give exact dimensions of the aneurysm as well as other information necessary for treatment. The CT scan uses special xrays and contrast dye to show your blood vessels. Occasionally an angiogram, which uses contrast dye to show blood flow through your blood vessels is necessary.

What kind of treatments are available for AAA?
Aortic aneurysms can be treated with either traditional “open surgery” or the newer endovascular (within the blood vessel) procedure.

Open Surgery involves making a large incision on the abdomen so that the intestines and other organs can be pulled aside to reveal the aorta which lies on your backbone, The aorta then is clamped above and below the aneurysm, where it is healthy. The aneurysm is opened and a piece of plastic tubing called a graft is sewn in place above and below to healthy aorta. The old aneurysm is then closed over the graft to protect it. the graft functions as a bridge for blood flow in the abdomen. The intestines and other organs are then replaced in the abdominal cavity and the muscles and skin are sewn back together. Most patients stay in the intensive care unit for a couple of days after this procedure and in the hospital for 7-10 days. It takes about 8-10 weeks for them to fully recover at home.

Endovascular Stent Grafting is a newer method to treat AAA that is significantly less invasive than traditional surgery. Unfortunately, only about 50% of patients have aneurysms that can be treated in this way because of their anatomy (how long certain parts of the aneurysm are, how far it is from the kidney arteries, whether there are also aneurysm in other adjacent arteries, etc.). This procedure requires two small incisions in the groin. Using an xray imaging device, a delivery catheter(tube) is guided through a blood vessel in the groin up to the the area of the aneurysm. Often a second piece of the graft is introduced from the other groin. There are 3 FDA devices available now, and each are slightly different in their appearance and the way that they work. They all effectively exclude the aneurysm from the main circulation and guide blood flow through the graft. Most patients stay in the intensive unit overnight with this and are discharged home the following day. It has a significantly shorter recovery period and less pain associated with it than the open repair, but has some problems with leakage or movement associated with it. Careful follow-up with Xrays and CT scans is needed with this type of repair.

Risk Assessment

• Are you a male over 55 years of age?
• Do you have diabetes?
• Do you have pre-existing heart disease?
• Is there a family history of abdominal aortic aneurysms?
• Do you have high blood pressure or do you take medication for high blood pressure?
• Do you have hardening of the arteries?
• Do you smoke?
• Are you more than 30 pounds overweight?

If you have checked Yes for one (1) or more of the above risk factors, you may be a candidate for an Abdominal Aortic Aneurysm Screening.