What is AAA?

The aorta is the main artery that supplies oxygen-filled blood from the heart to the abdomen, pelvis, legs and other lower parts of the body.

Sometimes the aorta develops a weakened area that simply cannot support the force of the blood flow. When the weakened area of the aorta begins to bulge outward - like the weak spot on a worn tire - it is called an Abdominal Aortic Aneurysm (AAA).

If not treated, this condition could burst or rupture the aorta. The larger the aneurysm, the more likely it is to rupture. High blood pressure can also increase the risk of rupturing the aorta.

If an Abdominal Aortic Aneurysm should ever rupture, it is a medical emergency. Ruptured aneurysms are often fatal and are the 13th leading cause of death in the US. Joe DiMaggio, Lucille Ball and Albert Einstein are examples of famous people who have passed from AAA.

What are the symptoms of AAA?

Unfortunately, many people do not experience any symptoms with AAA. Some patients have experienced:

Other patients have said they could actually feel the aneurysm - a pulsating or throbbing mass in the abdomen.

Is AAA treatable?

Yes, if it is detected early, AAA may only require monitoring. If it does require one of the treatments for the condition, they have high success rates.

What causes AAA?

An Abdominal Aortic Aneurysm can develop in anyone, but is most often seen in males older than 60 who have one or more risk factors:

How do I get screened for AAA or help a family member get screened for AAA?

Talk with your local family physician for a referral to a specialist or click here to find a specialist in your area that can perform a screening.

Is AAA screening expensive?

Screening tends to be very affordable and may even be free under Medicare. Because the type of test may vary depending on your individual situation, you should discuss this with your screening physician.

Does insurance cover the cost?

At this time, most insurance providers do not cover the costs of preventive screenings. If a physician orders the screening, it may be covered. It is suggested that you contact your insurance provider directly with these questions. If you are found to have abnormal results, insurance will typically cover any further diagnostic testing and procedures necessary.

What is the Medicare benefit for AAA screening?

Medicare recognizes the importance of good vascular health and offers a free screening process to check for Abdominal Aortic Aneurysm (AAA). Qualified seniors are eligible for a one-time AAA ultrasound screening as part of their Welcome to Medicare physical exam. The physical must be conducted during the first 12 months of enrollment.

Are these tests painful?

Not at all. These tests are typically non-invasive (no needles), and no radiation is involved.

If I need these tests why wouldn't my doctor perform them as part of my routine or annual exam?

Most insurance companies do not allow doctors to order screenings as a preventive measure, therefore your doctor will only order them if you are displaying outward symptoms. The Society for Vascular Surgery, a non-profit group of vascular specialists, has recommended ultrasound screenings for those older than 55 with risk factors such as: family history, high-blood pressure, high-cholesterol, diabetes, known cardiovascular disease and smoking.

How often should I be screened?

This is a question best addressed by your specialist and / or your family physician. Typically such decisions are based on family history, age, findings from screenings and other risk factors. Cardiovascular diseases are progressive, so periodic follow-up is common for patients with risk factors.

I am less than 50 and in good health - should I get screened?

Age is not the primary risk factor for cardiovascular disease. Family genetics and lifestyle choices affect individuals differently. If you feel that you are at risk for AAA, talk with your family physician or one of the specialists in the screening directory to determine the appropriateness of a screening.

How long do these tests take?

The screening process typically takes 10-15 minutes, but it is recommended that you allow an hour to complete the screening process.

How should I prepare for these tests?

It is recommended to wear loose fitting, two-piece clothing that would allow access to the abdomen. You may also be asked not to eat for a few hours prior to the screening. You are encouraged to talk about your specific needs with your screening physician.

Is it necessary to disrobe for the screening?

No. Screening for an Abdominal Aortic Aneurysm will require that you lift your shirt to allow the technician access to your abdomen, but that is all. Tests are typically conducted in a private area to ensure patient comfort.

Can I get screened if I have a pacemaker?

Yes, a pacemaker should not interfere with the screening.

Should I get screened for AAA if I've had a heart attack or stroke?

If you have a history of heart disease or stroke, you should discuss screening with your current specialist. Screening under these circumstances is highly recommended, and may be covered by insurance.

Which types of doctors are experts at treating AAA?

There are several physician specialties that train in the treatment of AAA. Among them are vascular surgeons, interventional radiologists, and interventional cardiologists.

What are the treatment options for AAA?

Your overall health, as well as the size and location of your Abdominal Aortic Aneurysm determine the best way for your physician to treat your condition.

If your aneurysm is small, your doctor may only recommend periodic check-ups to monitor the aneurysm. However, because a larger or rapidly growing aneurysm increases the risk of rupturing, your physician may recommend one of two types of treatment:

Open Surgical Repair

During this type of operation, the doctor makes an incision in the abdomen. The aorta is then repaired by replacing the aneurysm with a synthetic graft or tube that is sewn into place.

Because of the complexity of this type of treatment, it can often result in long hospital stays and painful recoveries.

Endovascular Repair

Endovascular repair is less invasive than open surgery. It involves sealing off the aneurysm by placing an endovascular graft or tube inside the aorta.

The endovascular graft is compressed into the end of a long, thin, tube-like device called a delivery catheter. Then the delivery catheter is inserted into the bloodstream through two small incisions that are made in the groin area. These tiny incisions are much smaller than what is required in open surgical repair.

The catheter is then extended to the portion of the aorta that needs repair. When the catheter is in place, the graft is released, creating a new passageway for the blood to flow.

How successful is medical management of AAA?

Often an AAA can be monitored over time by periodic imaging without it growing significantly. Lifestyle changes and reduction of high blood pressure may help an aneurysm from growing and becoming worse. It is only if the aneurysm grows at an accelerated rate or to sufficient size that it needs surgical or endovascular treatment.

How successful is open surgical treatment for AAA?

Surgical repair of AAA involves sewing in a synthetic graft to replace the aneurysmal aorta. This acts as a new pipe through which the blood can flow. This graft is permanent and will stay in for the rest of your life.

Such repairs are highly successful, but do require additional recovery time due to the extent of the abdominal incision (12-14 inches) to expose the aorta. The advantage of an open repair is that long-term post-operative follow up is minimal.

What is the typical recovery from open surgery to repair AAA?

Hospitalization following an open surgical repair of AAA can run from five to ten days. Because of the extent of the incision, it may take some time before normal activities can be resumed.

How successful is endovascular treatment for AAA?

Endovascular treatment of AAA involves fixing the aneurysm from within the vessel. The procedure consists of performing two small groin incisions through which a graft is inserted into the aorta. The graft is held in position by stents similar to those used to open blockages in blood vessels. This graft effectively isolates the aneurysm from the flow of blood, which is now directed through the graft. This graft is permanent and will stay in your body the rest of your life.

Endovascular repairs of the aorta are highly successful, and because of the small size of the groin incisions offer an easier recovery. Endovascular grafts do require ongoing follow-up.

What is the typical recovery from endovascular treatment for AAA?

The majority of patients are able to go home 24 to 48 hours after surgery. Patients return to normal activities much sooner than with open repairs. In some cases this procedure can be performed without general anesthesia.

What questions should I ask my physician about AAA?

There are no set questions to ask your physician. Providing a complete family history, as available, and talking honestly about your lifestyle risk factors will provide your physician with the best chance to treat you.

How can I get more information about AAA?

For further information about AAA, contact one of the screening sites found in the directory, or the Society for Vascular Surgery.

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