What is an abdominal aortic aneurysm?

Vascular Surgeon Dr. Peter Hunt answers six questions about this ‘silent killer’

You may think it’s just back pain or an upset stomach. But, it could be more severe – especially if you are a smoker or have a family history of aneurysms.

An aneurysm occurs when the walls of any artery begin to weaken, resulting in an abnormal enlargement of the artery, explains Dr. Peter Hunt, vascular surgeon with St. Joseph’s/Candler Physician Network.

The most common type of aneurysm occurs in the portion of the aorta that runs through the abdomen, says Dr. Hunt. The aorta is the largest blood vessel in the body, delivering oxygenated blood from the heart to the rest of the body.

An abdominal aortic aneurysm (AAA) is a bulging, weakened area of the wall of the aorta. A normal aortic diameter is two centimeters. Anything larger than three centimeters is considered an aneurysm, explains Dr. Hunt.

Over time, the blood vessel balloons and is at risk for rupturing. This can cause life-threatening bleeding and potential death.

Aortic aneurysms were the cause of more than 9,900 deaths in 2017, or about one death per hour, according to the latest numbers from the Centers for Disease Control and Prevention. About 60 percent of deaths from AAA were among men, and 75 percent had a history of smoking.

Who’s at risk for an abdominal aortic aneurysm?

There are many factors that contribute to the formation of an AAA. The biggest risk factor is smoking, says Dr. Hunt. Family history also is a risk factor.

Men are more likely than women to get AAA, so much so that men with a history of smoking can get a free screening for AAA with Medicare.

AAA is rare in younger people and even the elderly. It’s most likely to occur to someone in their 50s or 60s. In fact, Dr. Hunt says if an ultrasound or CT scan doesn’t show an aortic aneurysm by your mid to late 60s, your chance of forming one is unlikely.

What are the symptoms of AAA?

Usually people with an AAA do not have symptoms until it becomes a problem, Dr. Hunt says. “It’s one of the things that we call a ‘silent killer,’” he says.

Some people will have sudden onset of severe back pain. Others may experience upset stomach or symptoms similar to the flu. It’s important to talk to your doctor about these symptoms, especially if you have a history of smoking and/or a family history of AAA.

How is AAA diagnosed?

Most AAAs are discovered through ultrasound or CT scans after someone comes to the emergency room with back pain or other symptoms. Your primary care physician also can detect a possible AAA by feeling your stomach, Dr. Hunt.

If you have a history of smoking or family history of AAA, Dr. Hunt stresses the importance of screening, if you qualify, and making sure you see your primary care physician regularly.

What are treatment options?

The first line of defense to at least slow the growth of an AAA is to stop smoking, if you are a smoker.

“When you smoke, you damage the walls of the blood vessels,” Dr. Hunt says. “That leads to weakening of the wall and plaque formation and that combination is what leads to the aneurysm.”

Early treatment for most patients with AAA is surveillance of the aneurysm. For some people, the aneurysm doesn’t grow and stays the same size, Dr. Hunt says. For others, it grows slowly. On average, an aneurysm will grow three milliliters per year, he says.

Surgery is required when the AAA is:

• growing rapidly – more than one centimeter per year;
• symptomatic – meaning it’s causing pain that signals a possible leak or small rupture; or
• larger than five and a half centimeters in size.

There are two surgical options: endovascular, or stent graft, and open surgery. The most common is endovascular, which is a minimally-invasive procedure that typically requires just one night in the hospital.

During an endovascular aneurysm repair, the vascular surgeon makes one small incision in each groin. Using X-ray guidance, the surgeon can repair the aneurysm by inserting the stent graft inside the blood vessel to block the flow of blood into the bulged area and reroute it, Dr. Hunt describes.

This accounts for 90 percent of surgery to treat AAA, Dr. Hunt says. For more complicated aneurysms, open surgery is needed. This begins with an incision down the stomach, below the belt line. It’s a more in-depth procedure, often requiring a five to seven day stay in the hospital.

Long term, the results of both the minimally-invasive endovascular procedure and open surgery are equivalent, Dr. Hunt says. However, open surgery does not require further testing for AAA. Endovascular aneurysm repair, on the other hand, requires patients to be screened yearly to make sure the stent graft is still working.

Why is it important to treat AAA?

An abdominal aortic aneurysm is nothing to ignore. A free rupture of one can result in almost certain death.

A free rupture is when the aneurysm breaks, resulting in bleeding into the stomach cavity. Half of people who have a free rupture die before they get to the hospital, Dr. Hunt says. Of the people that get to the hospital, half of them die before they could leave the hospital.

Some patients may experience a contained rupture, or small leak in the AAA. These are the patients that experience sudden extreme back pain, Dr. Hunt says. If discovered in a timely manner, these patients can be successfully treated.

Can AAA be prevented?

The three biggest ways to prevent AAA is stop smoking, know your family history and get screened – either through ultrasound or visiting your physician annually.

“We encourage anybody with any kind of issues with their arteries to stop smoking,” Dr. Hunt says. “It’s the worst thing you can do for your arteries.”

St. Joseph’s/Candler offers a Comprehensive Tobacco Cessation Program that gives you the support and resources needed to help you quit for good. Learn more about it here.