Abdominal Aortic Aneurysm | Freedmans Health

Diagnosis

Abdominal aortic aneurysms are often discovered accidentally during a physical exam or imaging test performed for another reason. To confirm the condition, healthcare providers review your medical and family history and perform a physical examination.

Tests Used for Diagnosis

Common tests include:

Abdominal ultrasound – The most frequently used test. Sound waves create images of the abdomen, showing how blood flows through the aorta.
CT scan (Abdominal CT) – Uses X-rays to produce detailed images of the abdomen. It clearly shows the size and shape of the aneurysm.
MRI (Abdominal MRI) – Uses a magnetic field and radio waves to provide high-resolution images of the abdominal structures.

In some cases, a contrast dye may be given during CT or MRI scans to make blood vessels more visible.

Screening Recommendations

Screening helps detect aneurysms before symptoms appear. It is especially advised for people at higher risk:

Men aged 65 to 75 who have ever smoked – A one-time abdominal ultrasound screening is strongly recommended.
Men aged 65 to 75 who have never smoked – Screening decisions depend on other risk factors, such as family history.
Women who have never smoked – Screening is generally not recommended.
Women aged 65 to 75 with a history of smoking or family history – Evidence is not clear, so talk with your healthcare provider about whether screening is appropriate.

Treatment Overview

The primary goal of treating an abdominal aortic aneurysm (AAA) is to prevent aneurysm rupture, which can result in life-threatening hemorrhage. Treatment options depend primarily on:

Aneurysm size
Rate of expansion
Presence of symptoms
Patient’s age and overall health status

Treatment generally falls into two categories:

Medical management (surveillance)
Surgical intervention

1. Medical Management (Surveillance / Watchful Waiting)

Medical monitoring is recommended for small, asymptomatic aneurysms, particularly those measuring less than 4.8 to 5.6 cm in diameter.

Surveillance Includes:

Regular imaging studies:
- Initial abdominal ultrasound typically performed 6 months after diagnosis
- Ongoing ultrasound or CT imaging at scheduled intervals to monitor aneurysm growth
Routine clinical assessments:
- Evaluation of risk factors, especially hypertension, hyperlipidemia, and smoking
- Optimization of cardiovascular health

Goals of Medical Monitoring:

Detect rapid aneurysm expansion
Identify onset of symptoms
Determine the appropriate timing for surgical intervention

2. Surgical and Endovascular Repair

Surgical treatment is generally indicated in the following scenarios:

Aneurysm diameter ≥ 5.0–5.5 cm
Rapid aneurysm growth (>0.5 cm in 6 months)
Presence of symptoms, including abdominal or back pain
Evidence of aneurysm leakage, tenderness, or rupture

Surgical Treatment Options:

A. Endovascular Aneurysm Repair (EVAR)

Preferred in most cases due to reduced perioperative morbidity
A catheter-based approach is used to deliver a stent graft through the femoral artery
The stent graft is deployed at the aneurysm site to reinforce the weakened aortic wall and redirect blood flow

Considerations:

Requires suitable vascular anatomy
Postoperative imaging surveillance is essential to monitor for endoleaks or graft migration

B. Open Surgical Repair

Involves direct abdominal access and replacement of the aneurysmal segment of the aorta with a synthetic graft, which is sutured in place
Indicated in patients who are not candidates for EVAR, have complex aneurysm anatomy, or in emergent cases of rupture

Recovery:

Open repair typically involves a longer recovery period, often 4–6 weeks, but provides durable long-term outcomes.

Outcomes and Prognosis

Long-term survival rates are comparable between EVAR and open repair
Choice of procedure should be individualized based on:
- Aneurysm anatomy
- Comorbid conditions
- Surgical risk profile
- Patient preferences