Abdominal Aortic Aneurysm (AAA): A Silent but Serious Threat

An abdominal aortic aneurysm (AAA) is a life-threatening condition if not diagnosed and treated promptly. It occurs when the lower portion of the aorta—the main artery that supplies blood to the abdomen, pelvis, legs, and other parts of the body—enlarges and balloons out. Because the aorta is the largest artery in the body, a ruptured or burst aneurysm can cause massive internal bleeding and lead to fatal complications. Due to their fragile and weakened structure, aneurysms carry a high risk of rupture. That’s why early detection and timely treatment are critical. Treatment plans range from regular monitoring to emergency surgery, depending on the size, location, and growth rate of the aneurysm. In layman’s terms, this condition is sometimes referred to as a “stomach aneurysm” or “abdominal aneurysm.”

What Is an Abdominal Aortic Aneurysm?

An aneurysm refers to a localized enlargement of an artery due to a weakened area in the vessel wall. The high pressure and volume of blood in arteries can cause the walls to stretch and potentially rupture over time. An abdominal aortic aneurysm is defined as a bulging or ballooning in the abdominal segment of the aorta—the body’s main and largest artery. While aneurysms can occur anywhere along the aorta, the majority develop in its abdominal section. Several factors contribute to the development of an AAA, including:

• Atherosclerosis (hardening of the arteries): This occurs when fats, cholesterol, and other substances build up in artery walls, narrowing the vessel, reducing blood flow, and potentially weakening the artery wall, leading to aneurysm formation or blockages.
• High blood pressure: Chronically elevated blood pressure can damage and weaken the aortic wall, increasing the risk of aneurysm development.
• Vascular diseases: Inflammatory conditions affecting blood vessels (vasculitis) can weaken the artery walls and impair their function.
• Infections in the aorta: Although rare, certain bacterial or fungal infections can infect the aortic wall and contribute to aneurysm formation.
• Trauma: High-impact injuries, such as car accidents, can increase the risk of abdominal aortic aneurysms.
• Tobacco use: Smoking is a major risk factor for all types of aneurysms, including AAAs. It damages structural proteins in the arterial walls, leading to weakening and increased risk of rupture. The longer and more intensely a person smokes, the greater the risk. Screening via abdominal ultrasound is recommended for men aged 65–75 with a history of smoking.
• Age: Risk increases significantly after age 65. While aging itself can’t be changed, healthy aging can reduce overall risk.
• Gender: Men are more likely to develop AAAs than women.
• Family history: Having a first-degree relative with an AAA increases an individual’s risk. Genetic conditions such as Marfan Syndrome or Ehlers-Danlos Syndrome, which affect connective tissue, can also increase the likelihood of aneurysm formation, especially in the abdominal aorta.
• History of aneurysms elsewhere in the body: Aneurysms in other areas, such as behind the knee or in the thoracic (chest) aorta, raise the risk of developing an AAA.
• Obesity and high cholesterol: Excess fat and elevated cholesterol or triglycerides can damage arteries and increase the likelihood of aneurysm formation.

In individuals with these risk factors, managing blood pressure and minimizing damage to the arterial walls are essential preventive strategies.

Symptoms of Abdominal Aortic Aneurysm

Most AAAs remain asymptomatic until they rupture. Symptoms, if present, are often subtle and easily overlooked, which can delay diagnosis. However, some of the signs may include:

• Persistent pain in the abdomen, back, or legs
• A pulsing sensation in the abdomen, like a heartbeat
• Cold, pale, and clammy skin
• Dizziness or lightheadedness
• Fainting or altered consciousness
• Rapid pulse
• Abdominal discomfort
• Nausea and vomiting
• Shortness of breath
• Sudden, intense, tearing pain in the abdomen that may radiate to the lower back or legs

Important: If severe, sudden pain—particularly described as tearing—is experienced, immediate emergency medical attention is required. The two most serious complications of an AAA are aortic dissection (a tear in the inner layer of the aorta) and aneurysm rupture. The larger and faster-growing the aneurysm, the higher the risk of rupture and severe bleeding. Sudden, continuous abdominal or back pain accompanied by low blood pressure and a rapid pulse may indicate a rupture.

How Is Abdominal Aortic Aneurysm Diagnosed?

Because most AAAs are asymptomatic, they’re often discovered incidentally during exams or tests for other conditions. Common diagnostic tools for abdominal vascular diseases and AAAs include:

• Abdominal Ultrasound: A quick, painless imaging method using sound waves to view internal organs. It is highly effective in detecting aneurysms and ruptures.
• 3D CT Angiography (CTA): If an aneurysm is suspected or detected via ultrasound, a CT angiogram may be ordered. This involves injecting contrast dye and provides detailed images of the aneurysm’s size, exact location, and severity. However, it should be used cautiously in patients with kidney problems.

Treatment for Abdominal Aortic Aneurysm

Treatment depends on the size and location of the aneurysm. AAAs smaller than 5 centimeters typically pose a lower risk of rupture and may not require immediate surgical intervention. Even in cases where observation is recommended, close monitoring is critical. Important precautions and follow-ups include:

• Regular ultrasounds to track aneurysm size and growth rate
• Maintaining low and stable blood pressure with prescribed medications
• Strict avoidance of smoking and secondhand smoke
• Adopting an active lifestyle and maintaining a healthy weight
• Eating a heart-healthy diet to manage cholesterol and reduce atherosclerosis risk
• Avoiding alcohol