Abdominal aortic aneurysm: diagnosis and specialist treatment

An abdominal aortic aneurysm is a dilation of the aorta that can gradually increase in size over time and raise the risk of rupture if it reaches a certain size.

Specialist assessment of abdominal aortic aneurysms

An abdominal aortic aneurysm is a dilation of the aorta — the body’s main artery — which can gradually increase in size over time and raise the risk of rupture if it reaches a certain size.

At the Aortic Aneurysm Unit at Memorial Publio Cordón Hospital, we carry out a specialist assessment of this condition using advanced vascular diagnostics to determine the size of the aneurysm, assess the risk of rupture and decide on the most appropriate monitoring or treatment for each patient.

The aorta originates in the heart and distributes blood to all the body’s organs. As it travels through the body, it passes through the abdomen; this section is known as the abdominal aorta and is responsible for carrying blood to the abdominal organs and to the arteries that supply the legs.

An abdominal aortic aneurysm is defined as an enlargement of this artery beyond normal size. Under normal conditions, its diameter is around two centimetres; when it exceeds approximately three centimetres, an aneurysm is considered to be present.

In many cases, the aneurysm is detected incidentally during an imaging scan carried out for another reason. Early diagnosis and monitoring in a specialist unit make it possible to monitor its progression and identify the right time to intervene safely.

Progression of an aneurysm and when it should be assessed by a specialist

An abdominal aortic aneurysm usually develops slowly and, in many cases, causes no symptoms for years.

Over time, the artery wall may weaken and the diameter of the aorta may gradually increase. The main risk arises when the aneurysm continues to grow, as the likelihood of rupture increases once it reaches a certain size.

The rupture of an abdominal aortic aneurysm is a serious medical condition requiring urgent treatment. For this reason, early identification of the aneurysm and its monitoring by vascular surgery specialists allow its progression to be monitored and the appropriate time for intervention to be determined.

Many small aneurysms can be monitored for years through regular check-ups without the need for immediate treatment.

Specialist diagnosis of abdominal aortic aneurysms

The investigation of abdominal aortic aneurysms relies on imaging techniques that enable the size and anatomy of the aorta to be analysed accurately.

The most commonly used initial test is an abdominal ultrasound scan, a quick and non-invasive procedure that can detect dilation of the artery and estimate its diameter.

When the aneurysm requires a more detailed assessment or treatment is being considered, a contrast-enhanced CT scan (CT angiography) is performed. This test provides a three-dimensional reconstruction of the aorta and allows its relationship with the renal and visceral arteries to be studied.

A detailed analysis of these images enables specialists to determine the risk of rupture and decide whether the aneurysm should be monitored regularly or treated.

When is treatment required for an abdominal aortic aneurysm?

Not all aneurysms require immediate treatment.

When the diameter is small and the risk of rupture is low, the usual approach is to carry out regular check-ups using ultrasound or CT scans to monitor its progress.

Surgery is usually considered when the aneurysm reaches a size at which the risk of rupture increases, when it is growing rapidly, or when it begins to cause symptoms.

At that point, the aim of treatment is to isolate the aneurysm from the blood flow to prevent it from continuing to grow or rupturing, whilst maintaining blood flow to the abdominal organs and the legs.

Treatment of an aneurysm: endovascular repair and surgery

Treatment for an abdominal aortic aneurysm can be carried out using minimally invasive endovascular techniques or open surgery, depending on the anatomy of the aneurysm and the patient’s circumstances.

In many patients, repair can be carried out using endovascular treatment, a technique that allows the aneurysm to be treated from inside the artery without the need to open the abdomen.

The most commonly used technique is EVAR (Endovascular Aneurysm Repair), in which a stent graft is inserted via the groin arteries and deployed within the aorta to isolate the aneurysm from the blood flow and prevent its growth or rupture.

For aneurysms with more complex anatomy, customised stents such as FEVAR or BEVAR may be used; these are designed to adapt to the anatomy of the aorta and preserve blood flow to the renal and visceral arteries.

When the anatomy of the aneurysm does not allow for endovascular treatment, or where other clinical circumstances make it advisable, open surgery may be performed; this involves replacing the dilated segment of the aorta with a vascular graft via an abdominal procedure.

The choice of technique is made following a detailed study of the aortic anatomy and an individualised assessment by the vascular surgery team.

Specialist monitoring of the condition

Regular follow-up is essential both for patients with small aneurysms and following treatment.

Check-ups using ultrasound or CT scans allow the condition of the aorta to be monitored and confirm that the aneurysm remains stable or has been successfully excluded from the circulation following repair.

In addition to monitoring the aneurysm, the medical team assesses associated cardiovascular risk factors, such as smoking, high blood pressure or high cholesterol.