Medicines for Abdominal aortic aneurysm

What it is

An abdominal aortic aneurysm (AAA) is a swelling or bulge in the aorta — the body's main artery — where it passes through the tummy (abdomen). The wall of the aorta weakens and stretches, forming a balloon-like enlargement. Most AAAs cause no symptoms and grow slowly over years, so people usually do not know they have one. The concern is that, if an AAA grows large enough, its wall can become dangerously thin and it can burst (rupture), causing sudden, catastrophic internal bleeding, which is often fatal — so the whole point of detecting and monitoring AAAs is to prevent this by treating them before they rupture. AAAs are more common in men, in older people (particularly over 65), and in smokers and those with high blood pressure or a family history. Because they are usually symptomless but dangerous if they rupture, and because treating them electively (in a planned way) before rupture is far safer than emergency treatment of a rupture, screening programmes exist: in the UK, men are invited for a simple ultrasound scan around age 65 to check for an AAA, which allows early detection and monitoring. A large AAA occasionally causes symptoms such as a pulsing feeling or pain in the tummy or back. A ruptured or rupturing AAA is a medical emergency.

How it is treated

Management depends on the size of the aneurysm and how quickly it is growing, and is guided by vascular specialists, with the key principle of monitoring and treating before rupture. Small and medium AAAs are usually monitored with regular ultrasound scans (surveillance) to track their size over time, since the risk of rupture is low while they remain small, alongside reducing the risk factors that make them grow or rupture — most importantly stopping smoking (which is very important), and controlling blood pressure and cardiovascular risk. When an AAA reaches a certain size (large enough that the risk of rupture outweighs the risk of surgery), or is growing rapidly, planned (elective) surgery is recommended to repair it and prevent rupture — either open surgery, or a less invasive technique (endovascular repair, EVAR) where a stent-graft is placed inside the aorta via the blood vessels; the choice depends on the individual. Elective repair is far safer than emergency repair of a rupture. A ruptured AAA, causing sudden severe tummy or back pain, collapse, or shock, is a life-threatening emergency needing immediate surgery. Attending screening and surveillance is central. The reassuring message is that most AAAs are found early through screening and monitored safely, with planned surgery offered before they become dangerous — so attending screening (for eligible men) and surveillance, and stopping smoking, are the key protective steps.