The aorta carries all the blood that is pumped out of your heart and carries it, via its many branches, to all the organs of your body. The aorta passes upwards from your heart before curving backwards, downwards and to the left before travelling through your chest (the thoracic aorta) and into your abdomen (the abdominal aorta).
The aorta is usually 2 to 3cm (about one inch) in diameter. A weak spot in the aorta can cause it to bulge outwards and this is called an aneurysm. If the bulge occurs in the aorta as it goes through your chest, it's called a thoracic aortic aneurysm. If it occurs in the aorta as it goes through your abdomen, it's called an abdominal aortic aneurysm. An abdominal aortic aneurysm is more common than a thoracic aneurysm. You can have more than one aneurysm at the same time.
Most people who get an abdominal aortic aneurysm are over 50 and they are three times more common in men than in women. Around four in 100 men aged between 65 and 74 in England have an abdominal aortic aneurysm.
You’re unlikely to have any symptoms of an abdominal aortic aneurysm, unless it ruptures. If the aneurysm does rupture, it will cause severe internal bleeding. This will be fatal without emergency surgery to repair it. The chance of an aneurysm rupturing depends on its size. If your aneurysm is greater than 5.5cm wide, the chances of rupture are relatively high – and the risk increases with increasing size.
If your abdominal aortic aneurysm ruptures you may get severe pain in the middle or side of your abdomen or in your groin, or you may feel a pulsating sensation in your abdomen. You may also have other symptoms that include:
If you lose consciousness, or have severe pain in your abdomen and any of these other symptoms, you must seek urgent medical attention.
Abdominal aortic aneurysms develop when the wall of your aorta weakens, which causes it to bulge or dilate. The exact reasons why your aorta weakens aren't fully understood at present and are often due to a variety of factors.
Many people with an abdominal aortic aneurysm also have atherosclerosis. This is a process in which fatty deposits build up on the inside of your arteries and weaken the artery walls.
You’re more likely to develop an aneurysm, if you:
You may not have any symptoms of an abdominal aortic aneurysm, unless it’s large or is expanding quickly. Your GP may suspect you have an aortic aneurysm only following a routine physical examination.
Your GP will examine you and ask you about your medical history. When your GP examines you, he or she may feel a pulsating mass in your abdomen. This may be tender if your abdominal aortic aneurysm is large. If your GP suspects you have an abdominal aortic aneurysm, you may need to have other tests in hospital, which may include the following.
If you're a man over 65, you’re likely to be invited to be screened for an abdominal aortic aneurysm at your GP surgery or local hospital. Ask your GP for more information.
Your treatment for an abdominal aortic aneurysm will depend on your symptoms and the size of your aneurysm.
If you have a small aneurysm, your doctor won’t usually advise you to have surgery but you will need regular ultrasound checks to see if your aneurysm is expanding. It's also important to manage your condition by changing your lifestyle and treating any condition that may be causing the aneurysm (such as high blood pressure) and you should consider stopping smoking and losing weight if you’re overweight.
Your doctor will advise you to have elective (planned) surgery if your aneurysm is:
You will need to have emergency surgery if your aneurysm ruptures as this is a serious medical emergency.
There are three main surgical options for an abdominal aortic aneurysm.
In open surgery for an abdominal aortic aneurysm, your surgeon will open your abdomen to gain access to your aorta. He or she will insert a graft into the weak area of your aorta. The graft is likely to be a synthetic graft. A synthetic graft is made out of an elastic material. Blood will flow through the graft inside your aorta instead of going through the aneurysm and this will prevent the aneurysm getting bigger.
In keyhole surgery, your surgeon will make two or three small cuts in your abdomen and will insert a tube-like telescopic camera, which will send pictures to a monitor so he or she can see the aneurysm. Your surgeon will pass specially-designed surgical instruments through the other cuts and put the graft into place. However, keyhole surgery isn't suitable for everybody – ask your surgeon if it’s an option for you.
Endovascular stent graft replacement
In endovascular aneurysm repair (EVAR), your surgeon or doctor will feed a stent – a tube that is covered with synthetic graft material – through an artery in your groin and up through your aorta to the area of the aneurysm. Your surgeon will use X-ray images to guide the placement of the stent. The graft material will bond with the wall of your aorta and blood will flow through the stent instead of the weakened aneurysm. However, stents aren't suitable for everyone, it depends on the location of the aneurysm and other factors. Ask your surgeon for more information.
There are several things you can do to reduce your chance of developing an aneurysm – and the associated risk factor of atherosclerosis – including:
It’s important to have regular medical check-ups if you have a family history of arterial disease. Also, make sure you attend any screening appointments so that problems can be detected early.
Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, June 2012.