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Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is an enlargement of a weak area of your aorta, affecting the portion that is located in your abdomen.

At the UPMC Heart and Vascular Institute, our vascular surgeons in the Division of Vascular Surgery are experts in treating abdominal aortic aneurysms using minimally invasive repair or replacement techniques depending on the severity of your condition. We take a team approach to quickly and accurately diagnose your condition and develop a treatment plan that's right for you.

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What Are Abdominal Aortic Aneurysms?

The aorta is the main blood vessel in the body, supplying blood to the head, arms, legs, and organs in the chest and abdomen. An abdominal aortic aneurysm occurs when the aorta in the abdomen becomes abnormally large or balloons outward.

Although this can happen to almost any artery in the body, it is most common in the segment of the aorta located around the kidney arteries and before the aorta branches into the arteries leading to the legs.

The aorta is the largest artery in the body and carries oxygen-rich blood from the heart throughout the body. It begins at the base of the heart, extends up toward the brain, then arches downward, coursing down the chest and into the abdomen.

The aorta is the largest artery in the body and carries oxygen-rich blood from the heart throughout the body. It begins at the base of the heart, extends up toward the brain, then arches downward, coursing down the chest and into the abdomen. 

Abdominal aortic aneurysm risk factors

Abdominal aortic aneurysms can develop in anyone, but the condition is commonly inherited. They are most often diagnosed in men over the age of 60, but anyone who has smoked tobacco is at risk of developing an aneurysm.

In addition to a family history of aortic aneurysms, additional factors that increase your risk include:

Complications of abdominal aortic aneurysms

Abdominal aortic aneurysms can have serious complications if they burst or “rupture." The larger the aneurysm, the more likely it is to rupture and can result in life-threatening internal bleeding if not treated immediately. 

For this reason, early diagnosis of abdominal aortic aneurysms and regular appointments with your surgeon to track the growth of the aneurysm are important. If the aneurysm is large or growing quickly, having elective surgery to repair it can prevent rupture in the future.

Why choose UPMC's Division of Vascular Surgery for care?

Vascular surgeons at UPMC repair hundreds of abdominal aortic aneurysms every year. UPMC is also a major referral center for patients with complex aortic aneurysms, patients who have had previous aneurysm surgery, and patients who need additional operations.

Our surgeons are experts in traditional aneurysm surgery, as well as cutting-edge minimally invasive therapies for abdominal aortic aneurysms.

Our team works closely with other specialists throughout the UPMC Heart and Vascular Institute to ensure a comprehensive and coordinated approach to treatment. 

Learn More About Abdominal Aortic Aneurysms

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From the Society for Vascular Surgery

Abdominal Aortic Aneurysm Symptoms and Diagnosis

Aneurysms develop slowly over many years.

Most people do not feel any symptoms at all. Instead, most aneurysms are discovered either by a screening test ordered by their primary care doctor or on an imaging study such as an x-ray or CT scan done for another reason. Regardless of how it is diagnosed, an abdominal aortic aneurysm requires a follow-up appointment at least every six to 12 months to track its growth.

If symptoms do occur, this can be a sign that the aneurysm is about to rupture. Most people will have severe pain in their abdomen or back that comes on suddenly, and they may also feel dizzy, weak, or pass out.

These types of symptoms can indicate a life-threatening situation and may require immediate medical care. A ruptured abdominal aortic aneurysm is a medical emergency with a high risk of death if not treated immediately.

Diagnosing abdominal aortic aneurysms

If you are at high risk of developing an abdominal aortic aneurysm or if your doctor suspects one, you'll need to undergo a thorough physical exam at the UPMC Heart and Vascular Institute. Here, your doctor will perform a screening and assess the level of your condition, as well as examine your abdomen and evaluate pulses in your legs.

Following your exam, your doctor may order additional tests and procedures to help confirm the aneurysm and determine the size of your aorta.

The care team at the UPMC Heart and Vascular Institute uses the following imaging tests to help diagnose an abdominal aortic aneurysm:

  • Computerized tomographic (CT) scan — uses a ring of multiple x-rays to create detailed 3D images of your aorta.
  • Duplex ultrasound scanning — this pain-free test uses ultrasound waves to create images of the aneurysm.
  • Magnetic resonance imaging (MRI) — uses a large magnetic field, radio waves, and computers to create detailed images of your aorta

Testing results

Your doctor or nurse will tell you when to expect your test results and will call you when they're available. 

Learn More About Abdominal Aortic Aneurysm Symptoms and Testing

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UPMC Patient Education Materials

Abdominal Aortic Aneurysm Treatment

The main treatment goal for an aortic aneurysm is early diagnosis in order to prevent rupture. Less than 50 percent of people survive a ruptured abdominal aortic aneurysm, so prevention is by far the best way to treat this condition.

The UPMC Heart and Vascular Institute offers a full range of state-of-the-art treatment strategies for abdominal aortic aneurysms.

We create a customized treatment plan, which includes an assessment of:

  • The location of the aneurysm and how extensive the disease is.
  • The size of the aneurysm.
  • Your overall health, including a focused evaluation of your heart, kidneys, and lungs.

Based on our findings, we may recommend one of the following treatment options:

Aneurysm is small — less than 5-5.5 centimeters (about 2 inches)

  • Duplex ultrasound scan every six to 12 months to assess the aneurysm's size.
  • Lifestyle changes, such as quitting smoking.
  • Medication to lower your blood pressure if your blood pressure is high.
  • Medication to lower your cholesterol and reduce inflammation.
  • Regular follow-up visits to closely monitor the abdominal aortic aneurysm.

Aneurysm is large — more than 5-5.5 centimeters (about 2 inches)

  • At this size, the risk of rupture is still low, but if the aneurysm continues to grow, the risk will rapidly increase.
  • Surgery is often recommended at this size and may be either minimally invasive or traditional to repair the aneurysm before it ruptures.

Our experience in treating abdominal aortic aneurysms

UPMC’s highly skilled vascular surgeons — who are among the nation's most experienced — routinely treat abdominal aortic aneurysms.

The goal of aneurysm treatment is to replace the aorta with a man-made graft. This redirects the blood flow through the graft and away from the weakened aneurysm wall, preventing the aneurysm from getting bigger. This also prevents the aneurysm from rupturing. After the repair, the aneurysm will usually shrink over time.

Our experts are able to offer the widest variety of surgical treatments ranging from traditional surgery to the most complex minimally invasive techniques available. The main treatments for abdominal aortic aneurysms include:

  • Minimally invasive endovascular aneurysm repair (EVAR).
  • Traditional (open) surgery.
  • “Hybrid" procedures, combining open surgery, surgical repair, and minimally invasive techniques.

Our surgeons typically advise surgery when:

  • The aneurysm reaches approximately five centimeters (about two inches) in diameter.
  • Smaller aneurysms exist that cause symptoms or grow rapidly.

However, these are general guidelines, and each patient is different. Your vascular surgeon will discuss your individual risks and benefits of surgery and come to a decision together with you about whether to wait or to undergo a repair.

Endovascular aneurysm repair (EVAR)

The majority of abdominal aortic aneurysms can be repaired with a minimally invasive EVAR procedure. In contrast to a traditional “open" surgery, no big incisions are made in the abdomen. Instead, the arteries in the groins are accessed either by a needle puncture or a small incision.

A metal and fabric stent is then inserted into the groin punctures, through the arteries to the aneurysm. The stent is initially collapsed in order to travel through the blood vessels. Once it reaches the aneurysm, it is expanded and sits tightly against the wall of the aorta, relining the weakened portion. This redirects the blood flow through the stent and relieves the pressure on the weakened areas of the aorta.

After an EVAR, most people recover quickly and can often go home the next day. However, because the stent can shift over time, yearly follow-ups with your surgeon are required.

EVAR vs. traditional open abdominal aortic aneurysm repair:

  • Reduces your hospital stay to two or three days.
  • Requires less recovery time.
  • Requires more frequent follow-up visits and imaging studies to ensure that the graft continues to function properly.
  • May require periodic maintenance procedures.

Whether or not you can receive an EVAR depends on the shape, location, and extent of the aneurysm.

Of those who may not be a good fit for a regular EVAR, other minimally invasive options are often available as the UPMC Division of Vascular Surgery participates in many trials of cutting-edge devices to treat complex aortic aneurysms.

Traditional (open) surgery for abdominal aortic aneurysms

UPMC vascular surgeons are also experts in traditional open aneurysm repair. This may be suggested by your surgeon if your aneurysm's characteristics are not ideal for an EVAR or if he or she believes that you may benefit from long-term durability of an open repair.

In open surgical aneurysm repair, your vascular surgeon makes a long incision in your abdomen to get to the aorta. The surgeon then removes the weakened portion and replaces it with a fabric graft. This is a more invasive surgery, and the hospital stay is usually five to seven days.

Recovery time is six weeks to three months for a complete recovery, depending on your circumstances.

Many open aneurysm repairs are successful for the long term with few complications. Follow-up after open aneurysm repair is less frequent than that for EVAR, with most patients coming back every two to three years for a checkup.

Learn More About Abdominal Aortic Aneurysm Treatments

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What is the success rate of aortic aneurysm surgery? 

The success rate of abdominal aortic aneurysm surgery is high. It depends on:

  • The location of the aneurysm.
  • The treatment approach (open versus EVAR).
  • Other health problems you have.

As with any surgery, there are risks with surgery for an abdominal aortic aneurysm. However, your vascular surgeon will only recommend repair for you if he or she believes that the benefits outweigh the risks.

Can you live a long life with an aortic aneurysm?

Many people live long lives with aortic aneurysms and never need surgery. An aneurysm will often stop growing or grow more slowly with the appropriate medication to control blood pressure and cholesterol and stopping smoking.
If the size of your aneurysm is less than five centimeters, the risk of rupture is low, and there is usually no need to treat it right away. If your aneurysm reaches five centimeters or grows in a short time, your surgeon may want to treat it depending on its shape and your overall health.

It is best to have your vascular surgeon follow the size of the aneurysm with an ultrasound or CT scan every six to 12 months. Changes in overall size and rapid growth can increase the risk of rupture.

How long does it take to recover from aortic aneurysm surgery?

With minimally invasive endovascular repair (EVAR), most people can go home in 24-48 hours. They can get back to their normal routine within three weeks after their follow-up visit.

With open abdominal aortic repair, the hospital stay is usually five to seven days. Overall recovery is four to six weeks, but most people need about three months to feel back to baseline.

What size aortic aneurysm requires surgery?

An aortic aneurysm typically requires surgery once it reaches 5-5.5 centimeters. Your surgeon may want to treat a smaller size aorta if you have:

  • Irregular size or shape of the aneurysm that is concerning for increased rupture risk.
  • Known or suspected connective tissue disease, such as Marfan syndrome, Loey-Dietz syndrome, or Ehlers-Danlos type IV. People with these conditions have a higher risk of aortic dissection or rupture.
  • Rapid growth of the aneurysm over a period of six to 12 months.

However, the final decision for aortic aneurysm surgery is an individual decision between you and your vascular surgeon. He or she will take into account the size and shape of the aneurysm and your own medical history before making a recommendation for surgery.

Please bring all prior imaging scans or reports regarding your aneurysm to your appointment.