What is the treatment for an abdominal aortic aneurysm?

Treatment depends on the size of the aneurysm, which is the main factor that determines its risk of rupturing. Small aneurysms may not need treatment right away. Instead, your provider will monitor the aneurysm through regular ultrasound tests or CT (computed tomography) scans. This approach is called surveillance. Larger aneurysms may need surgery.

Surveillance of AAAs

Surveillance is typically appropriate when the AAA has a diameter of less than 5.5 centimeters (in people assigned male at birth) or less than 5.0 centimeters (in people assigned female at birth). The aneurysm also shouldn’t be causing any symptoms. You’ll have an ultrasound or CT scan at regular intervals depending on the size of the aneurysm. Larger aneurysms need imaging more often. If you’re close to the treatment threshold, you may get CT scans and not ultrasounds. Be sure to follow your provider’s instructions on when you need your imaging tests. Your provider will also tell you:

There are three components to a healthy life. These are diet, sleep and exercise.

What lifestyle changes you should make. These include avoiding all tobacco use, eating a heart-healthy diet and exercising.

Which medications you need to take to manage conditions like high blood pressure or high cholesterol.

Lifestyle changes and medications won’t shrink the aneurysm (currently there’s no treatment that can do this). But these measures may help slow aneurysm growth and lower your risk of other cardiovascular problems. Researchers continue to explore medications and other treatments that may limit or stop the growth of small AAAs.

Surgery for AAAs

You may need surgery for your AAA if:

The aneurysm has a diameter of at least 5.5 centimeters (in people AMAB) or 5.0 centimeters (in people AFAB). Some centers of excellence may advise elective surgery at smaller diameters depending on your overall health, risk profile and other factors.

The aneurysm is causing symptoms, no matter its size.

The aneurysm has ruptured. In this case, you need immediate surgery to save your life.

Surgery lowers your risk for aneurysm rupture by replacing the aorta or relining the aorta from the inside with a new graft. There are two surgical methods available to do this:

Traditional open aneurysm repair surgery.

Endovascular aneurysm repair (EVAR).

Surgeons and patients generally prefer EVAR for elective surgery because it offers an easier recovery and a better short-term survival rate. When the anatomy is appropriate, an EVAR can provide a long-lasting repair. But you’ll need evaluation with ultrasound or CT scans of the repair on a yearly basis. Certain factors (like your age or anatomy) may make open surgery a safer option. Each method has benefits and risks. Your provider will discuss these with you, and together, you can reach a decision.

Ruptured aneurysms need immediate surgery to give you a chance at survival.