The treatment for an abdominal aortic aneurysm (AAA) mostly depends on how big it is.
AAAs are grouped into 3 sizes:
- small AAA – 3cm to 4.4cm across
- medium AAA – 4.5cm to 5.4cm across
- large AAA – 5.5cm or more across
Large AAAs are more likely to burst (rupture), so surgery to stop this happening is usually recommended.
The risk of a small or medium AAA bursting is much lower, so you'll normally be advised to have regular scans to check its size and make healthy lifestyle changes to help stop it getting bigger.
Ask your doctor if you're not sure what size your aneurysm is.
Small and medium AAAs
You might not need treatment if you have a small or medium AAA. This is because the risk of the AAA bursting is smaller than the risk of complications from surgery.
You'll be asked to come back for regular ultrasound scans to check if your aneurysm is getting bigger.
Scans are done:
- every year if you have a small AAA
- every 3 months if you have a medium AAA
Surgery may be offered if the scans show that a AAA larger than 4cms has grown by more than 1cm over 12 months. Surgery may also be offered if you have symptoms linked to AAA, such as a pulsing sensation in your tummy or tummy pain that does not go away.
You'll also be told about lifestyle changes that can help reduce the risk of an aneurysm getting bigger, such as eating healthily.
Read more about how to stop an aneurysm growing.
You can otherwise carry on as normal, although having an AAA may have some implications for things such as driving and getting travel insurance.
Read some frequently asked questions about AAAs for more information.
If you have a large AAA, surgery to strengthen it with a piece of manmade tubing (a graft) is usually recommended because the risk of it bursting is bigger than the risk of complications from surgery.
There are 2 main types of surgery for an AAA:
- endovascular surgery – the graft is inserted into a blood vessel in your groin and then carefully passed up into the aorta
- open surgery – the graft is placed in the aorta through a cut in your tummy
Both techniques are equally good at reducing the risk of an AAA bursting, but each has its own advantages and disadvantages. Talk to your surgeon about which is best for you.
If surgery is not suitable for you, you'll have regular scans to monitor your aneurysm and be given advice about healthy lifestyle changes. You may also be prescribed medicine to help stop the aneurysm bursting.
In endovascular surgery, a graft is inserted into a blood vessel in your groin through small cuts made in your skin. It's then carefully guided up into the aneurysm.
This is usually done under general anaesthetic, where you're asleep.
You'll normally stay in hospital for 2 or 3 days after the operation, and it can take a few weeks or months to fully recover.
The risk of complications is generally lower than with open surgery, and the hospital stay and recovery time is often shorter.
Risks of endovascular surgery include:
During open surgery, a cut is made in your tummy and your surgeon replaces the affected section of aorta with a graft. This is done under general anaesthetic.
You'll usually stay in hospital for 7 to 10 days after the operation, and it will take a few weeks or months to fully recover.
The risk of complications is generally higher than with endovascular surgery, and the hospital stay and recovery time is often longer.
Risks of open surgery include:
- a wound infection or infection of the graft
- a blood clot
- heavy bleeding
- a heart attack or stroke
- erectile dysfunction or ejaculation problems in men
The risk of graft problems is lower than with endovascular surgery. The graft will usually work well for the rest of your life and you will not usually need regular scans to check it.
Treatment for a burst AAA
A burst aneurysm is treated with emergency surgery using the same techniques used for a large aneurysm.
The decision about whether to perform open or endovascular surgery is made by the surgeon carrying out the operation.