Abdominal aortic aneurysm

An abdominal aortic aneurysm is a life-threatening medical condition, characterised by a permanent dilation or swelling in the aorta (Davis et al, 2015), which is the main artery that runs from the heart down through the thorax and abdomen. An abdominal aortic aneurysm is localised to the abdominal aorta and is at least 3 cm in diameter, which is one-and-a-half times the usual diameter of the aorta (McMahon, 2023).

Abdominal aortic aneurysms are differentiated by their location in relation to the kidneys. They can occur above the renal arteries (suprarenal), at the level of the renal arteries (pararenal) and below the renal arteries (infrarenal) (Schreiber, 2018). While aneurysms can occur elsewhere in the aorta, the abdomen is the most common site, with the majority being infrarenal (McMahon, 2023). 

Most abdominal aortic aneurysms may cause general symptoms, such as:

• abdominal pain
• back pain
• leg pain
• groin pain (McMahon, 2023)

Some people with an abdominal aortic aneurysm experience a pulsation in the abdomen, which is related to the size of the aneurysm (NHS, 2023). Large aneurysms may be felt on palpating the abdomen.

Signs and symptoms of abdominal aortic aneurysm usually remain limited until they rupture, which is usually catastrophic and presents as:

• abdominal pain
• back pain
• hypotension
• loss of consciousness
• death

Although abdominal aortic aneurysms are more prevalent in men, the rupture of the aneurysms are more common in women (Davis et al, 2015).

The causes of abdominal aortic aneurysms can relate to pre-existing health issues such as:

• hypertension
• history of heart disease
• a history of vascular disease
• chronic obstructive pulmonary disease (National Institute for Health and Care Excellence (NICE), 2020)

There are some genetic conditions which predispose individuals to abdominal aortic aneurysm, including Marfan syndrome (Hagerty et al, 2017) and Ehlers–Danlos syndrome (Eagleton, 2016). Studies have shown a strong familial element to the development of abdominal aortic aneurysm. For example, men with a first degree relative with a history of abdominal aortic aneurysm are twice as likely to have an abdominal aortic aneurysm as age- and sex–matched people in the general population (Joergensen et al, 2014), especially if that relative is a woman. Other possible risk factors for abdominal aortic aneurysm include:

• older age
• lifestyle (eg smoking, stimulant use)
• male gender (Knypl, 2020)

An abdominal aortic aneurysm occurs where there is damage to

Many abdominal aortic aneurysms are identified as part of routine NHS screening programmes, which specifically target men as they turn 65 years old. Women or people under the age of 65 years are not screened, as they have a significantly lower prevalence of abdominal aortic aneurysm. Screening consists of an abdominal ultrasound scan and lasts only a few minutes (Public Health England, 2021). People who are over 65 years can ask for a scan for abdominal aortic aneurysm if they think they might need one but have not been offered a screening test.

NICE (2020) recommend screening for women over the age of 70 years if they have any of the risk factors that have been identified. 

An abdominal aortic aneurysm is diagnosed when the dilation of the aorta is such that its diameter is at least 1.5 times greater than usual - which would be 3 cm or more

The most recommended treatment for abdominal aortic aneurysms is prevention. This includes:

• not smoking
• good hypertension control
• management of hypercholesterolaemia
• maintaining a healthy body weight

For many, the diagnosis of an abdominal aortic aneurysm leads to a lifetime of waiting for a potential rupture, including frequent abdominal ultrasounds, which occur annually for small aneurysms and three times monthly for medium-sized aneurysms (NHS, 2023). This allows detection of any changes in the size or leakage of the abdominal aortic aneurysm.

NICE (2020) suggest that people diagnosed with an abdominal aortic aneurysm should be offered information about:

• what it is
• most being benign
• the possibility of a rupture and what this means
• the familial aspects of abdominal aortic aneurysms, and that other family members should be screened
• the options for repair
• how to reduce their risks of cardiovascular disease

Surgery is the only definitive treatment for abdominal aortic aneurysms, but this carries

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages

Part 2: Procedures for the planning, provision and management of person-centred nursing care

3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

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Bonner RJ, Wallce T, Jones AD et al. The content of pre-habilitative interventions for patients undergoing repair of abdominal aortic aneurysms and their effect on post-operative outcomes: a systematic review. Eur J Vasc Endovasc Surg. 2021;61(5):756-765. https://doi.org/10.1016/j.ejvs.2021.01.043 

Brinster CJ, Milner R. Fenestrated endovascular aortic repair and clinical trial devices for complex abdominal aortic aneurysms. J Cardiovasc Surg (Torino). 2018;59(3):342-359. https://doi.org/10.23736/S0021-9509.18.10460-5 

Bruggink JL, Tielliu IF, Zeebregts CJ, Pol RA. Mesenteric ischemia after abdominal aortic aneurysm repair: a systemic review. J Cardiovasc Surg (Torino). 2014;55(6):759-765

Davis FM, Rateri DL, Daugherty A. Abdominal aortic aneurysm: novel mechanisms and therapies. Curr Opin Cardiol. 2015;30(6):566-73. https://doi.org/10.1097/HCO.0000000000000216 

Eagleton MJ. Arterial complications of vascular Ehlers-Danlos syndrome. J Vas Surg. 2016; 64(6):1869-1880. https://doi.org/10.1016/j.jvs.2016.06.120 

Hagerty T, Geraghty P, Braverman AC. Abdominal aortic aneurysm in Marfan syndrome. Ann Vasc Surg. 2017;40:294.e1-294.e6.