Schematic diagram showing the different types of abdominal aortic aneurysms (AAA).
An abdominal aortic aneurysm (AAA) is a bulge or swelling in the aorta, the main blood vessel that runs from the heart down through the chest and tummy.
An AAA can be dangerous if it isn't spotted early
on. It can get bigger over time and could burst
(rupture), causing life-threatening bleeding. Men aged 65 and over are most at risk of AAAs. This is the reason why men are invited for screening to check
for an AAA when they're 65.
Symptoms of an AAA
AAAs don't usually cause any obvious symptoms, and
are often only picked up during screening or tests carried out for another
reason. Some people with an AAA have:
- a
pulsing sensation in the tummy (like a heartbeat)
- tummy pain that doesn't go away
- lower back pain that doesn't go away.
If an AAA bursts, it can cause:
- sudden,
severe pain in the tummy or lower back
- dizziness
- sweaty,
pale and clammy skin
- a
fast heartbeat
- shortness of breath
- fainting or passing out.
When to get medical help
Make an appointment to see your doctor/ GP as soon as
possible if you have symptoms of an AAA, especially if you are at a higher risk of an AAA. An ultrasound scan (USS) of your tummy may
be done to check if you have an AAA. You must call 999 for an ambulance immediately if
you or someone else develops symptoms of a burst AAA.
Who is at risk of an AAA
An AAA can form if the sides of the aorta
weaken and balloon outwards. It's not always clear why this happens, but there
are things that increase the risk.
People at a higher risk of getting an AAA include:
- men aged 65 or over –
AAAs are up to six times more common in men than women, and the risk of
getting one goes up as you get older
- people who smoke – if you smoke or used
to smoke, you're up to 15 times more likely to get an AAA
- people with hypertension (high blood pressure) –
high blood pressure can double your risk of getting an AAA
- people with a parent, sibling or child with an
AAA –
you are about four times more likely to get an AAA if a close relative has
had one.
You should speak to your GP if you are worried you may be at
risk of an AAA. They may suggest having a scan to check if you have one and
making healthy lifestyle changes to reduce your risk of an AAA.
Treatments for an AAA
The recommended treatment for an AAA depends on how
big it is. Treatment isn't always needed straight away if
the risk of an AAA bursting is low. Treatment for a:
- small AAA (3cm to 4.4cm across) –
ultrasound scans are recommended every year to check if it's getting
bigger; you'll be advised about healthy lifestyle changes to help stop it growing
- medium AAA (4.5cm to 5.4cm) – ultrasound
scans are recommended every three months to check if it's getting
bigger; you'll also be advised about healthy lifestyle changes
- large AAA (5.5cm or more) – surgery to stop it getting bigger or bursting is usually recommended.
Schematic diagram showing the open repair of an abdominal aortic aneurysm (AAA).
Reducing your risk of an AAA
There are several things you can do to reduce your
chances of getting an AAA or help stop one getting bigger. These include:
- stopping smoking
- eating healthily – eat a balanced diet and cut down on fatty food
- exercising regularly – aim
to do at least 150 minutes of exercise a week
- maintaining a healthy weight
- cutting down on alcohol.
If you have a condition that increases your risk of
an AAA, such as high blood pressure, your doctor may also recommend taking tablets
to treat this.
Screening for AAAs
In England, screening for AAA is offered to men
during the year they turn 65. This can help spot a swelling in the aorta
early on, when it can be treated. The test involves a quick and painless ultrasound
scan to see how big your aorta is.
If you're a man over 65 and you haven't
been screened, you can request a test by contacting your local AAA screening service directly.
Women and men under 65 are not
routinely invited for screening. But if you think you might have a higher risk of an AAA, you should talk to your GP
about the possibility of having a scan.
Treatments for an abdominal
aortic aneurysm
The treatment for an
abdominal aortic aneurysm (AAA) mostly depends on how big it is. AAAs are grouped into three sizes:
- small AAA – 3cm to 4.4cm
across
- medium AAA – 4.5cm to 5.4cm
across
- large AAA – 5.5cm or more
across.
Large AAAs are more likely to burst (rupture), so
surgery to stop this happening is usually recommended. The risk of a small or medium AAA bursting is much
lower, so you'll normally be advised to have regular scans to check its
size and to make healthy lifestyle changes to help stop it getting bigger.
Small and medium AAAs
You might not need treatment if you have a small or
medium AAA. This is because the risk of the AAA bursting is smaller than
the risk of complications of surgery. You will be asked to come back for regular ultrasound scans to check if your
aneurysm is getting bigger. Scans are done:
- every
year if you have a small AAA
- every
three months if you have a medium AAA.
Surgery may be offered if your aneurysm
becomes a large AAA. You will also be told about lifestyle changes
that can help reduce the risk of an aneurysm getting bigger, such as
eating healthily. You can otherwise carry on as normal,
although having an AAA may have some implications for things
such as driving and getting travel insurance.
Large AAAs
If you have a large AAA, surgery to strengthen it
with a piece of man-made tubing (a graft) is usually recommended because
the risk of it bursting is bigger than the risk of surgery complications. There are two main types of surgery for an AAA:
- endovascular surgery – the
graft is inserted into a blood vessel in your groin and then
carefully passed up into the aorta
- open surgery – the
graft is placed in the aorta through a cut in your tummy.
Both techniques are equally good at reducing
the risk of an AAA bursting, but each has its own advantages and disadvantages.
Talk to your surgeon about which is best for you. If surgery is not suitable for you, you will have
regular scans to monitor your aneurysm and be given advice about healthy
lifestyle changes, and you may be prescribed medication to help stop the
aneurysm bursting.
Endovascular surgery
In endovascular surgery, a graft is inserted into a
blood vessel in your groin through small cuts made in your skin. It's then
carefully guided up into the aneurysm. This is usually done under general anaesthetic, where you are
asleep. You will normally stay in hospital for two or three
days after the operation, and it'll take a few weeks or months to fully
recover.
The risk of complications is generally lower than
with open surgery, and the hospital stay and recovery time is often shorter.
Around 98% of people make a full recovery. Risks of endovascular surgery include:
- the
graft leaking or slipping out of position – you'll have regular
scans to check for this, and you may need another operation to fix
any problems
- a
wound infection or infection of the graft
- heavy
bleeding from your groin
- a blood clot, heart attack or stroke.
Open surgery
During open surgery, a cut is made in your tummy
and your surgeon replaces the affected section of aorta with a graft. This is
done under general anaesthetic. You will usually stay in hospital for 7-10 days after
the operation, and it'll take a few weeks or months to fully recover.
The risk of complications is generally higher than
with endovascular surgery, and the hospital stay and recovery time is often
longer. Around 95-97% of people make a full recovery. Risks of open surgery include:
- a
wound infection or infection of the graft
- a blood
clot
- heavy
bleeding from your groin
- a
heart attack or stroke
- in
men, erectile dysfunction or ejaculation problems.
The risk of graft problems is lower than with
endovascular surgery. The graft will usually work well for the rest of your
life and you won't normally need regular scans to check it.
Treatment for a burst AAA
A burst aneurysm is treated with emergency
surgery using the same techniques used for a large aneurysm. The decision about whether to perform open or
endovascular surgery is made by the surgeon carrying out the operation. Only about 2 in 10 people who have a burst aneurysm
survive, which is why an operation to stop an aneurysm bursting is
usually recommended if it's large.
Source: NHS Choices