What is an aneurysm?

The aorta is the main large blood vessel that leaves the heart and runs down through the central chest and abdomen towards the legs. Sometimes the wall of the aorta develops a weakness causing the weak area to “bulge out.” The bulging area is called an aneurysm.

The weakness can happen to any large blood vessel, including along the aorta. The bulges in the aorta that occur in the area around the stomach (abdomen) are called abdominal aneurysms.

Abdominal aortic aneurysms

Abdominal aortic aneurysms can enlarge and grow slowly. Aneurysms are also common in the chest, known as a “thoracic aneurysm.” Often they can increase in size without any warning, feelings or pain. As a result, they can be exceedingly difficult to detect.

With some aneurysms, some patients say they can feel a “heartbeat” near their belly-button. Others say they can feel pain in the stomach, back or sides. This pain can occur if the aneurysm enlarges and presses on structures or organs next to it. A blood clot can also form inside the aneurysm and become dislodged and travel downstream. This clot can block the blood supply to other organs. When the blood supply is interrupted to the brain, this is known as a stroke.

If an aneurysm breaks, it can be life-threatening from loss of blood, consciousness, stroke or heart attack. Many report a sharp, terrible “tearing pain” in the stomach when an aneurysm ruptures.

Risk factors for an abdominal aneurysm

• Family history of aneurysms
• Male
• Tobacco use
• Over age 50
• Cardiovascular disease/atherosclerosis
• High blood pressure
• Birth defects or genetic disease (e.g. Marfans syndrome)
• Injury to the vessel (car accident, athletic trauma, surgery)

Diagnosis of an abdominal aneurysm

The diagnosis can be achieved on physical examination by doctor. The doctor may feel a pulsating mass in the area and/or hear abnormal blood flow in the area with a stethoscope. Imaging studies like an ultrasound, MRI, CT scan or angiography can also confirm the diagnosis.  

Treatment of an abdominal aneurysm

Treatment of an abdominal aortic aneurysm is often dependent on the size and any symptoms related to the aneurysm. If the aneurysm is relatively small and there are no symptoms (pain, strange feelings, or “pulsating” sensations), the treatment may be only one of careful observation.

If the abdominal aneurysm is large or expanding rapidly, a surgical treatment may be required. A guideline for surgical treatment is if the aneurysm is 5 cm wide. The surgical repair of any aneurysm is very complicated. For other aneurysms, the treatment will depend on the recommendations of the surgeon after taking several risk and benefit factors into consideration, including how rapidly the aneurysm is changing.

For the surgical repair of an aneurysm, the bulging area of the aorta is taken out and replaced with a specially designed synthetic tube. Other, less aggressive repairs involve the placement of a special support mesh in the area of the bulge to prevent it from spreading or rupturing.

If you have an abdominal aneurysm, be sure to develop a plan with your doctor to have it examined regularly, and know what to do urgently if the aneurysm changes or becomes symptomatic. This plan could very well save your life!

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.