Aorta is the largest blood vessel in the human body. It is responsible for carrying blood from the heart to the head, arms, abdomen, legs and pelvis. Due to certain problems, the walls of the aorta swell or bulge out like a balloon, when this happens in the part of the aorta in the abdomen, it is called as abdominal aortic aneurysm (AAA). Usually, AAAs don’t cause many problems, but a ruptured aneurysm can become life-threatening. That’s why, if diagnosed with AAA, the doctor will keep a close watch on the patient even if they don’t intervene right away. In most cases, AAA runs in families. A person is 12 times more likely to develop an abdominal aortic aneurysm if their first-degree relative has had AAA. Of patients in treatment to repair an AAA, 15 – 25 % have a first degree relative with the same type of aneurysm.
Let us look at the causes of AAA
There can be many factors that can contribute to the formation of AAA
- Various types of inflammation that weakens the walls of the aortic artery.
- Smokers or anyone with 1st generation relatives who has AAA are at the highest risk.
- Age (50+ for men, 60+ for women) with a history of atherosclerosis, high BP, high cholesterol, heart or vascular disease are all at risk of AAA formation.
- AAA can also be caused due to tears in the arterial wall, infections and congenital tissue disorders.
Abdominal aortic aneurysms often grow slowly without symptoms, making them difficult to detect. Some aneurysms never rupture. Many start small and stay small; others expand over time, some quickly. In most cases, they’re found only when the patient is being evaluated for another medical condition. If a patient has an enlarging abdominal aortic aneurysm, they can notice:
- Deep, constant pain in the abdomen or on the side of the abdomen
- Back pain
- A pulse near the bellybutton
In a small set of people, it is also seen that the plaque or blood clots from elsewhere in the body get collected in the feet and toes leading to pain, discoloured skin and sores on feet and toes.
The unruptured AAAs are most often diagnosed when the doctors are scanning or examining the patient’s abdomen for another reason. If the doctor suspects the patient of having AAA, then they will feel the patient’s stomach to check for any rigidity or pulsing mass. They’ll also check the blood flow to the patient’s legs or use the following tests:
- CT scan of the abdomen
- Abdominal ultrasound
- Chest X-ray
- Abdominal MRI
Based on the size & location of the aneurysm the doctor may either perform surgery to repair or remove the damaged tissue. It can be either open abdominal surgery or endovascular surgery (EVAR). It all depends on the patient’s health and type of aneurysm. Open abdominal surgery which is a more invasive form of surgery is used to remove damaged areas of the aorta. It has longer recovery time and is performed when the aneurysm is large or has already ruptured. Endovascular surgery (EVAR) is a less invasive form of surgery that involves using a graft to stabilize the weakened walls of the aorta. For a small AAA that’s less than 5.5 centimetres wide, the doctor may decide to monitor it regularly instead of performing surgery.
Your doctor will try and make an individualised risk assessment for you in terms of the size of the aneurysm and risk of rupture and your general health and fitness for undergoing a repair procedure before coming to a plan of treatment.
One of the best ways to prevent AAA is to focus on good health practices. Always follow a healthy diet, exercise and avoid cardiovascular risk factors like smoking. Go for smoke cessation programs that will help in quitting smoking. The doctors might also prescribe medicines to treat high blood pressure, cholesterol or keep diabetes in check. The doctor may also screen the patient for AAA when they turn 65, more so if they smoke. The screening test uses an abdominal ultrasound to scan the aorta for bulges.
Dr. Robbie George | Chief of Vascular & Endovascular Surgery | Mazumdar Shaw Medical Center, Bommasandra, Bangalore