Abdominal aortic aneurysm

Abdominal aortic aneurysms usually don't cause any noticeable symptoms. A big aneurysm can cause pain affecting your back, belly or sides, though.

If the abdominal aorta ruptures, it causes sudden and very severe back pain that radiates to the side or groin. The pain may be accompanied by nausea and vomiting, extreme sweating or shortness of breath. The rupture causes a great deal of blood to leak into the stomach and the blood pressure to drop. The brain and the other organs then no longer get enough oxygen, which leads to dizziness, loss of consciousness and then ultimately to cardiovascular collapse (where not enough blood flows around the body).

An abdominal aortic aneurysm may arise if the blood vessel wall becomes less elastic, for example due to smoking – or if there is too much pressure on the blood vessel, for instance due to high blood pressure. The body's normal aging processes can also increase the risk. In rare cases, the body's inflammatory processes can cause an aneurysm.

If one part of the vessel wall starts bulging, it tends to continue to expand, and then the aneurysm gets bigger.

There are a number of factors that can increase someone's risk of developing an abdominal aortic aneurysm.

• Sex: Abdominal aortic aneurysms are more common in men than in women.
• Age: The risk increases with age. Most people who develop a large abdominal aortic aneurysm are over 65 years old.
• Smoking: Smoking is the biggest risk factor that you can influence yourself.
• High blood pressure, cardiovascular disease or chronic obstructive pulmonary disease (COPD): People who have these conditions are more likely to develop an aneurysm.
• High blood lipid levels: These also increase the risk of an aneurysm.
• Genes: The risk is also greater in people with close relatives who have an abdominal aortic aneurysm. Rare genetic diseases affecting the connective tissue increase the risk of an aneurysm too.

About 2% of all men between the ages of 65 and 75 have an abdominal aortic aneurysm. The number increases with age.

Women are much less likely to have one. It is estimated that less than 1% of women over the age of 60 are affected.

If an aneurysm gets bigger, it usually does so only gradually. Most aneurysms never cause any problems.

Only some aneurysms become so large that they are more likely to suddenly rupture (break open). If the aorta ruptures, a large amount of blood leaks into the abdominal cavity. This is a life-threatening emergency. Many people die of a ruptured aorta.

The risk of an aneurysm rupturing is higher in men if the aneurysm is at least 5.5 cm in diameter. The risks increases with the diameter. It is estimated that an abdominal aortic aneurysm that is between 5.5 and 7 cm in diameter will rupture within one year in about 1 to 5 out of 100 men. The risk is much greater for aneurysms that are over 7 cm.

Abdominal aortic aneurysms are typically smaller in women. Doctors believe that the risk of a rupture in women already increases for aneurysms that are about 5 cm in diameter and larger. It is estimated that an abdominal aortic aneurysm that is between 5 and 5.4 cm in diameter will rupture within one year in about 1 to 3 out of 100 women.

For both men and women: The health risk of an aneurysm depends on its size and shape, as well as how fast it is growing.

Most aneurysms are discovered by chance during an examination done for another medical condition.

If an aneurysm is causing noticeable symptoms, it is usually discovered when doctors try to find the cause. The doctor asks about the exact symptoms and checks the body for other signs of disease.

Abdominal aortic aneurysms are diagnosed using ultrasound scans of the abdomen (belly). The diameter of the abdominal aorta can be measured in this way. If the diameter of the aorta is greater than 3 cm, it is typically considered to be an aneurysm. Because women have a narrower aorta, they are sometimes diagnosed with an even smaller diameter.

In Germany, public health insurers offer abdominal aorta screening tests for men over the age of 65 years. Ultrasound scans can help discover large aneurysms early on. The aneurysm can then be treated before it ruptures. If smaller bulges are found, they can be checked regularly to see whether they are growing, and how quickly.

Screening tests for men over the age of 65 reduce the risk of aneurysms rupturing and leading to death. But screening also has disadvantages: Some aneurysms are discovered and sometimes treated with surgery even though they never would have caused any problems. That is known as overdiagnosis. Also, the procedure itself may cause serious complications. Knowing that you have an aneurysm can be very distressing too.

Doctors offer advice on the abdominal aorta screening tests. They can help you make a decision to have a screening test or not.

In Germany, women are not offered abdominal aorta screening tests. This is because women are much less likely to develop an abdominal aortic aneurysm. Also, there is only one good-quality study that tested the screening test in women. It did not have any advantages for women.

Whether or not treatment is a good idea, and what type of treatment would be suitable, will mainly depend on

• the size of the aneurysm,
• how much it continues to grow, and
• your general health.

The position of the aneurysm also plays a role.

In general, smaller abdominal aortic aneurysms with a diameter of less than 5.5 cm in men and less than about 5 cm in women are regularly monitored. If you smoke, then doctors will advise you to quit. That is because smoking is a decisive risk factor that causes an aneurysm to grow faster. People who have other medical problems, such as high blood pressure or high cholesterol levels, are advised to seek treatment. Besides changing your diet and losing weight, effective medications are also available.

If the risk of rupture is high, surgery is the one option for prevention. There are two types of surgery for a large aneurysm:

• In open surgery the aneurysm is opened through an abdominal incision (cut) and an artificial blood vessel (graft) is implanted.
• In an endovascular procedure, a small tube (stent) is put into the artery through a small incision in the groin, and pushed along to where the aneurysm is, and implanted in the aneurysm.

Both of these procedures are associated with risks such as lung complications, heart damage and stroke.

In Germany, men over the age of 65 with public health insurance are eligible for one free abdominal aorta screening test using ultrasound. This screening test has advantages and disadvantages. On the one hand, surgery can performed on any aneurysm that is detected before it becomes life-threatening. On the other hand, aneurysms that would never have become a health risk are also detected. The diagnosis itself can then become distressing. Whether you want to have the screening or not depends on how you view the advantages and disadvantages yourself.

If a big aneurysm is discovered, there is the question of whether surgery is an option: There are risks involved, but there is also the possible danger of the aneurysm rupturing. It is also not always clear whether open surgery or a vascular procedure would be better suited: Besides your general health and other factors, it is also important how you yourself view the advantages and disadvantages of each procedure. Deciding on whether or not to have the treatment is a personal matter. Having enough information on all the options helps to make it easier. A decision aid can be a useful guide for that process.

Getting a second medical opinion can also make the decision easier. Doctors who recommend having surgery for an abdominal aorta aneurysm are required to tell you that you have a right to a second opinion free of charge.

Open surgery on the abdominal aorta is a major procedure. So the surgery is often followed by rehabilitative therapy. Its goal is to help you recover after surgery so you are a ready for everyday life.

Being diagnosed with an abdominal aortic aneurysm can stir up a lot of mixed feelings. Some people are happy that their aneurysm was discovered, and the regular check-ups help them to feel safe.

Others would rather have not found out about the aneurysm. Knowing about it can be scary and troubling. Many people who are diagnosed with an aneurysm constantly feel like their lives are in danger. Symptoms like a stomach ache may then be frightening: They are often thought to be related to the aneurysm, even if that's not actually the case. Many people who have an abdominal aorta aneurysm stop doing certain things in everyday life out of fear that the aneurysm could rupture. They are more cautious and avoid physical exertion, although that is not really necessary.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.