Abdominal aortic aneurysms (AAAs) are aneurysms that occur in the part of the aorta that passes through the abdomen. They may occur at any age, but are most common in men between 50 and 80 years of age. Many people with an AAA have no symptoms, but some people have a pulsing sensation in the abdomen and/or pain in the back. If the aneurysm ruptures, it may cause deep, severe pain; nausea; vomiting; fast heart rate; clammy skin; and/or shock. About 20% of AAAs eventually rupture and are often fatal. The condition has multiple genetic and environmental risk factors, and may sometimes occur as part of an inheritedsyndrome. When more than one family member is affected, it may be considered "familial abdominal aortic aneurysm." Treatment depends on the size of the aneurysm and may include blood pressure medications, or surgery to repair the aneurysm.

The aorta is your body’s main artery. An artery is a blood vessel (or tube) that carries blood from your heart. The aorta carries blood from your heart to your abdomen, pelvis, and legs.

If the wall of your aorta is weak, it can swell up like a balloon. This balloon-like swelling is called an aneurysm (“AN-yoor-izm”). AAA is an aneurysm that happens in the part of the aorta running through the abdomen.

Men over age 65 who have smoked at any point in their lives have the highest risk of AAA. Both men and women can have AAA, but it's more common in men.

Risk factors for AAA include:

• Family history – for example, if a parent or sibling had AAA
• Smoking
• Older age
• High blood pressure
• High cholesterol
• Heart disease or vascular disease (problems with blood vessels)

Abdominal aortic aneurysm (AAA) is thought to be a multifactorial condition, meaning that one or more genes likely interact with environmental factors to cause the condition. In some cases, it may occur as part of an inherited syndrome.

Having a family history of AAA increases the risk of developing the condition. A genetic predisposition has been suspected since the first report of three brothers who had a ruptured AAA, and additional families with multiple affected relatives have been reported. In some cases, it may be referred to as " familial abdominal aortic aneurysm." A Swedish survey reported that the relative risk of developing AAA for a first-degree relative of a person with AAA was approximately double that of a person with no family history of AAA. In another study, having a family history increased the risk of having an aneurysm 4.3-fold. The highest risk was among brothers older than age 60, in whom the prevalence was 18%.

While specific variations in DNA (polymorphisms) are known or suspected to increase the risk for AAA, no one gene is known to cause isolated AAA. It can occur with some inherited disorders that are caused by mutations in a single gene, such as Marfan syndrome and Ehlers-Danlos syndrome, vascular type. However, these more typically involve the thoracoabdominal aorta.

Because the inheritance of AAA is complex, it is not possible to predict whether a specific person will develop AAA. People interested in learning more about the genetics of AAA, and how their family history affects risks to specific family members, should speak with a genetics professional.

AAA doesn't usually cause symptoms until it’s a medical emergency. Blood vessels like the aorta can swell up slowly over time, so it’s important to talk with your doctor about AAA to see if you need to get tested.

A ruptured aneurysm can cause dangerous bleeding that can lead to death. If this happens, you may suddenly have:

• Pain in your lower back, abdomen, or legs
• Nausea (feeling like you're going to throw up)
• Vomiting (throwing up)
• Clammy (sweaty) skin

If you have a ruptured aneurysm, you'll need to have surgery right away.

To screen for AAA, your doctor may order an ultrasound. An ultrasound uses sound waves to look inside the body. It can help your doctor see if there's any swelling in your aorta. Ultrasounds are usually painless.

Talk with your doctor about your risk for AAA.

Here are some questions you might want to ask your doctor or nurse:

• Do I need to get screened for AAA?
• How can I get help to quit smoking?
• What are my blood pressure and cholesterol numbers?
• What other steps can I take to keep my heart and blood vessels healthy?

Treatment for your aortic aneurysm will depend on its cause, its size and location, and the factors that put you at risk. Small aortic aneurysms may be managed with healthy lifestyle changes or medicine. The goal is to slow the growth of the aneurysm and lower the chance of rupture or dissection. Your doctor may treat other medical conditions that raise your risk for rupture or dissection, such as high blood pressure, coronary heart disease, chronic kidney disease, and high blood cholesterol. Surgery may be recommended to repair large aneurysms.

Healthy lifestyle changes

Your doctor may recommend heart-healthy lifestyle changes, such as the following:

• Quitting smoking to slow the growth of the aneurysm
• Heart-healthy eating to help lower high blood pressure or high blood cholesterol
• Managing stress to help control high blood pressure, especially for thoracic aortic aneurysms. Your doctor may also suggest that you avoid heavy weightlifting and powerful stimulants, such as cocaine.

Medicines

Your doctor may recommend medicines to treat an aortic aneurysm, including:

• Aspirin, especially if you have other cardiovascular risks
• Blood pressure medicines to lower blood pressure, slow down aneurysm growth, and lower the risk of rupture. These medicines include beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs).
• Statins to control cholesterol levels, and stop or slow the growth of aortic aneurysms

Procedures or surgery

Depending on the cause or size of an aortic aneurysm or how quickly it is growing, your doctor may recommend surgery to repair it. Rupture or dissection of an aneurysm may require immediate surgical repair.

• Open surgical repair is the most common type of surgery. You will be asleep during the procedure. Your surgical team first makes a large incision, or cut, in your abdomen or chest, depending on the location of the aneurysm, then removes the aneurysm and sews a graft in its place. This graft is typically a tube made of leak-proof polyester. Recovery time for open surgical repair is about a month.
• Endovascular aneurysm repair (EVAR) is less invasive than open surgical repair. This is because the surgical cut is smaller, and you usually need less recovery time. EVAR is used to repair abdominal aortic aneurysms more often than to repair thoracic aortic aneurysms. During the procedure, your surgical team makes a small cut, usually in the groin, then guides a stent graft—a tube covered with fabric—through your blood vessels up to the aorta. The stent graft then expands and attaches to the aortic walls. A seal forms between the stent graft and the vessel wall to prevent blood from entering the aortic aneurysm.

Possible surgery-related complications

Complications of both types of aortic aneurysm repair can occur, and they may be life-threatening. These include:

• Bleeding and blood loss
• Blood clots in blood vessels leading to the bowel, kidneys, legs, or in the graft
• Damage to blood vessels or walls of the aorta when placing the stent graft. The stent graft may also move after it is placed.
• Endoleak, which is a blood leak around the stent graft into the aneurysm. Endoleak may cause rupture of the aneurysm if not treated.
• Gastrointestinal bleeding, which rarely occurs if an abnormal connection forms between the aorta and your intestines after the repair. Blood may show up in your stool, or your stool may be black.
• Heart complications such as heart attack or arrhythmia
• Decreased blood flow to the bowels, legs, kidneys or other organs during surgery. This may lead to injury to these organs.
• Infection of the incision or the graft
• Kidney damage
• Spinal cord injury which may cause paralysis
• Stroke

It’s never too late to take steps to lower your risk for AAA.

Quit smoking.

Quitting smoking is the most important thing you can do to lower your risk for AAA.

If you smoke, now is the time to quit. Call 1-800-QUIT-NOW (1-800-784-8669) for free support and help making a plan to quit.

Check your blood pressure.

Get your blood pressure checked. If your blood pressure is high, you can help lower it by getting active, watching your weight, and eating less sodium (salt).

Get your cholesterol checked.

Find out what your cholesterol levels are. If your cholesterol is high, start a heart-healthy eating plan. This means eating foods low in saturated fat, trans fat, and cholesterol.

Aim for 2 hours and 30 minutes of physical activity every week.