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3D representation of an AAA. Getty Images.

Abdominal aortic aneurysm: controlling blood pressure will save you from the catastrophe.

An abdominal aortic aneurysm is a bulge in the abdominal aorta, at least 1.5 times the conventional vessel calibre. A life-threatening condition that is often indolent but requires specific treatment and follow-up depending on the nature of the disease. Occasionally, doctors detect them during a routine examination or at the time of rupture.

A schematic representation of an abdominal aortic aneurysm.
A schematic representation of an abdominal aortic aneurysm.

The aorta, the largest artery in the body, supplies oxygenated blood to the body through various branches. It has a thoracic and abdominal portion. The walls of the aorta may weaken: the weakened wall may then bulge and rupture.

People older than 60 years are at an increased risk of aneurysms. Besides advanced age, atherosclerosis, smoking, high blood pressure, male gender, high blood cholesterol, and family history of abdominal aortic aneurysms are the other risk factors. Some diseases are associated with aneurysms: they include syphilis, HIV, Ehlers-Danlos, and Marfan syndromes.

Some aneurysms are small: others are big. Their size detects the management plan – from watchful waiting through serial monitoring to emergency and elective surgical repair.

Occasionally, an abdominal aortic aneurysm is asymptomatic. Doctors incidentally diagnose them during routine examinations for other diseases. The doctor may feel a non-tender pulsatile mass above or alongside the umbilicus (belly button). Aneurysms that are about to rupture produce abdominal pain around the umbilicus or at the back. Upon rupture, the patients often present to the hospital in shock.

Upon suspicion, doctors often request an ultrasound scan to detect the aneurysm. However, they will also do computed tomography (CT) scan to estimate the size and location of the bulge with greater accuracy. In selected scenarios, magnetic resonance imaging (MRI) may come in handy.

A ruptured abdominal aortic aneurysm is a surgical emergency that is fatal in more than half of the patients. Upon detection, the doctors will decide whether to operate on the aneurysm or watch it over time. The size and risk of rupture of the aneurysm determine the treatment modality.

Abdominal aortic aneurysm: controlling blood pressure will save you from the catastrophe.
Stages of abdominal aortic aneurysm rupturing, illustration. An aneurysm is a blood-filled dilation in a blood vessel.

For small aneurysms (less than 4cm), doctors watch over you at specific intervals: every six months to annual surveillance imaging. Any aneurysm that is greater than 5cm will need surgery. The operation often involves reinforcing the damaged portion of the aorta with synthetic mesh.

It’s noteworthy to understand the risk factors associated with abdominal aortic aneurysm, especially atherosclerosis and hypertension, such that you can prevent them.


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A few conditions may mimic abdominal aortic aneurysm: they include mesenteric ischaemia, renal stones, peptic ulcer disease, pyelonephritis, and diverticulitis.

Complications from abdominal aortic aneurysm include bleeding, myocardial infarction, pneumonia, graft infection, limb ischaemia, abdominal compartment syndrome, and delayed rupture following repair.

It’s prudent that you quit smoking, exercise, and take care of what you eat to prevent atherosclerosis and hypertension. If you have high blood pressure, take your medications and have them under control to prevent the rapid progression of the aneurysm.

For more information about abdominal aortic aneurysms, read this article.


MBChB (MUK), Graduate Fellow, Department of Physiology, Makerere University Founder and Content Creator Peer reviewer, Associate Editor

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