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Abdominal Aortic Aneurysm

The aorta is the largest artery that supplies oxygen-rich blood to the body and it runs from the heart through the center of the chest and abdomen. When a weak area of the abdominal aorta expands or bulges, much like a balloon, it is called an abdominal aortic aneurysm (AAA).

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Causes

Atherosclerosis, a disease in which plaque builds up inside your arteries, is frequently associated with aneurysm. However, it is not thought that this disease alone causes the growth of an aneurysm. It is believed that other factors, such as high blood pressure or connective tissue disorders, must be present for an aneurysm to form.

Risk Factors

Factors that increase your chance of getting an aortic aneurysm include:

  • High blood pressure
  • Smoking
  • Arteriosclerosis, atherosclerosis
  • Inherited connective tissue defects such as Marfan syndrome and Ehlers-Danlos syndrome
  • Polyarteritis nodosa
  • Bacterial endocarditis
  • Syphilis
  • Age 60 or older
  • History of heart attack
  • Obesity
  • Family members with aneurysms, particularly male children of an affected mother
  • Infectious aortitis
  • Great vessel arteritis, also known as Takayasu’s disease
  • Injury to the aorta, from either a motor vehicle accident or a stab wound

Symptoms

Many aneurysms do not have symptoms. They are detected during a routine physical exam or during X-ray evaluation for another disorder. Symptoms may occur when the aneurysm grows or disrupts the wall of the aorta. Symptoms depend on the size and location of the aneurysm and may include:

  • Pain in the abdomen or in the lower back
  • Constant pain occurring over hours or days
  • Sudden onset of severe stabbing pain
  • Unusual sensation of pulsing in the abdomen
  • Cough, shortness of breath
  • Fainting
  • Hoarseness
  • Difficulty swallowing
  • Coughing up blood
  • Weight loss
  • Chest pain

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Pain is the symptom that will most likely cause you to go to the doctor. Most aortic aneurysms are discovered during a routine physical exam. Your doctor may need pictures of your heart. This can be done with:

  • Abdominal X-ray
  • Abdominal ultrasound
  • Computed tomography (CT) scan of the abdomen 
  • Magnetic resonance imaging (MRI) scan of the abdomen
  • Aortography
  • Transesophageal echocardiography
  • Cardiac catheterization

Treatments Offered at the Center for Vascular and Endovascular Surgery

The following procedures are offered for the treatment of an abdominal aortic aneurysm depending on a patient’s diagnosis:

  • Open Aneurysm Repair. This surgical procedure to repair an aortic aneurysm involves removing the portion of the aorta that contains the aneurysm and replacing it with a mesh graft. If the aneurysm involves important branches of the aorta, these vessels may either be repaired or bypassed.
  • Endovascular Aneurysm Repair (EVAR). Depending on where the aneurysm is located and how complex it is, an endovascular aneurysm repair may be done. This procedure is a minimally invasive approach and involves using a stent for the repair of the aneurysm. A stent-graft is a polyester tube covered by a tubular metal web. The stent-graft is inserted into the aorta. With the stent-graft in place, blood flows through the stent-graft instead of into the aneurysm, eliminating the chance of rupture.
  • Endovascular Aneurysm Repair Sealing (EVARS) Clinical Trail. St. Elizabeth’s Medical Center is the first hospital in Massachusetts to implant the innovative EndoVascular Aneurysm Sealing (EVAS) from Nellix™ as part of the EVAS FORWARD investigational trial. EVAS is the next generation abdominal aortic aneurysm (AAA) therapy intended to treat more anatomies than currently approved endovascular stent graft devices, and is the only technology whose operating principle is centered around sealing the aneurysm sac.

Prevention

There are no guidelines for preventing an aneurysm because the cause is not known. However, you can reduce some of your risk factors by following these recommendations:

  • Eat a healthy diet that is low in saturated fat and rich in whole grains, fruits, and vegetables.
  • Don't smoke. If you smoke, quit.
  • The U.S. Preventive Services Task Force recommends that men aged 65 to 75 who have ever smoked be screened once for abdominal aortic aneurysm with ultrasound. This is a painless procedure that gives a picture of the abdomen using sound waves. Early detection of abdominal aortic aneurysm in this group has been shown to reduce mortality from this condition.
  • Maintain a healthy weight.
  • Begin a safe exercise program with the advice of your doctor.
  • Seek treatment for high blood pressure, syphilis and other infections.
  • If you have Marfan syndrome, see your doctor regularly for monitoring and CT scans.

 


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Center for Vascular and Endovascular Surgery
St. Elizabeth's Medical Center
736 Cambridge Street
Brighton, MA 02135
617-779-6504

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