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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of section of the aorta that is located in the abdomen. An abdominal aortic aneurysm usually triggers no symptoms unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is often critical. An aorta abdomen less than 50 mm wide has a low probability of rupture. A surgical procedure to repair the aneurysm may be advised if it is larger sized than 50 mm, as above this size the threat of rupture improves. Individuals 65 years old and over are to be proposed a program scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the largest sized artery (blood vessel) in the body. It carries blood from the heart and descends through the chest and the abdomen. Many arteries come off the aorta to supply blood to all parts of the body. At about the level of the pelvis the aorta divides into two arteries, one going to each leg.

What is an aneurysm and an abdominal aortic aneurysm? An aneurysm is where a section of an artery widens (balloons out). The wall of an aneurysm is weaker than a normal artery wall. The pressure of the blood in the artery causes the weaker section of wall to balloon.

 

Aneurysms might occur in any artery, but they most typically occur in the aorta. Most aortic aneurysms take place in the section of the aorta that goes through the abdomen. These are identified as abdominal aortic aneurysms (AAAs). In some cases they occur in the section moving through the chest. These are known as thoracic aortic aneurysms.

The standard dimension of the aorta in the abdomen is about 20 mm. An abdominal aortic aneurysm is said to be present if a area of the aorta within the abdomen is 30 mm or more in diameter.

The rest of this leaflet is mainly about AAAs.

AAAs range in size. As a rule, once you develop an AAA, it tends gradually to obtain larger sized. The rate at which it gets larger varies from person to person. In spite of this, on average, an AAA leads to get larger by around 10% per year.

What causes an abdominal aortic aneurysm? In most cases The actual explanation why an aneurysm figures in the aorta in most cases is not well-defined. Most situations occur in aged people. An AAA is rare in people under the age of 60. So, growing older has a major factor to play.

The wall of the aorta commonly has levels of smooth muscle mass, and layers made from tissues termed elastin and collagen. Elastin and collagen are powerful boosting tissues. What seems to happen is that a part of the aorta loses its usual toughness and flexibility in some people as they get older. Medical studies suggests that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that lead to these changes. Some people are more vulnerable than others to these changes.

Your hereditary make-up plays a part, as you have a significantly higher chance of raising an AAA if one of your parents has, or had, one.

Atheroma may also play a part. Atheroma is a fatty substance that deposits within the inside lining of arteries. Atheroma is sometimes called furring of the arteries. Most AAAs are layered with some atheroma. Anybody can develop atheroma, but it develops more generally with growing age. Particular risk factors also improve the chance of atheroma developing. They include: smoking cigarettes, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that enhance the probability of atheroma forming in the heart (coronary) arteries, which can cause angina and heart attacks. In a minority of cases Rare causes of AAAs contain injury or infection of the aorta. As well, certain rare inherited circumstances can influence the artery structure. In these uncommon situations an aneurysm may develop at a rather young age.

How ordinary are abdominal aortic aneurysms? About 6 in 100 men and about 2 in 100 women over the age of 65 have an AAA. It will become more common with raising age. In spite of this, most people with an AAA are not careful that they have one. An AAA is uncommon in people below the age of 60.

What is the concern about an abdominal aortic aneurysm? The main concern is that the aneurysm could rupture (burst). The wall of the aneurysm is weaker than a natural artery wall and may not be able to stand up to the tension of blood inside. If it ruptures then severe internal bleeding occurs which is often fatal. Of course, most AAAs do not rupture - only a certain proportion (see below).

What are the symptoms of an abdominal aortic aneurysm? Usually there are no symptoms. At the time of diagnosis, 7 in 10 people with an AAA will not have had any symptoms due to the aneurysm. The ballooning of the aneurysm does not result in any symptoms except when it becomes large enough to put force on nearby structures. If signs do take place, they are most likely to be mild abdominal or back aches and pains. There are many factors of mild abdominal and back pain. For this reason, the diagnosis may be delayed until the aneurysm is large enough to be sensed by a medical expert when he or she inspects your abdomen.

In some cases small blood clots form on the inside lining of an AAA. These may break up off and be taken down the aorta and block a smaller artery further on. These blood clots are called emboli and can be threatening. For example, full blockage of an artery that delivers a foot may prospect to loss of blood to part of the foot, which can cause problems in the foot and gangrene if left without treatment.

If the aneurysm does rupture then you are likely to have sudden severe abdominal and/or back pain. This is generally soon followed by collapse as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed? In some cases a medical doctor senses the stick out of an aneurysm in the course of a routine checking of the abdomen. However, many AAAs are too small to medium sized to feel.An X-ray of the abdomen (often carried out for other causes) will indicate calcium deposits lining the wall of an AAA in some, but not all, situations.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is an uncomplicated evaluation. It is the identical option of diagnostic scan that pregnant women have to look at the baby in the womb. The size of the aneurysm can also be measured by ultrasound. As discussed later, it is important to know the size.A more detailed scan, such as a CT scan, is sometimes done. This may be executed if your current medical expert needs to know whether the aneurysm is impacting on any of the arteries that come off the aorta. For illustration, if the aneurysm entails the section of the aorta where the arteries to the kidneys branch off, specialists need to know this information if they prepare to operate.

What is the danger of an abdominal aortic aneurysm rupturing? The chance of rupture is minimal if an AAA is minimal. As a rule, the risk of rupture improves with increasing size. This is much like a balloon - the larger you blow it up, the greater the tension, and the greater the chance it will burst open. The size of an AAA can be tested by an ultrasound diagnostic scan. The following gives general danger figures for the size (diameter) of the aneurysm: 40 mm-55 mm: about a 1 in 100 chance of rupture per year.55 mm-60 mm: about a 10 in 100 chance of rupture per year.</li>60 mm-69 mm: about a 15 in 100 chance of rupture per year.</li>70 mm-79 mm: about a 35 in 100 chance of rupture per year.</li>80 mm or more: about a 50 in 100 chance of rupture per year.</li></ul> As a rule, for any given size, the risk of rupture is improved in smokers, females, those with high blood pressure, and those with a relatives history of an AAA.

Should really every person with an abdominal aortic aneurysm have surgical treatments? The quick answer is no. Medical restoration of an AAA is a significant operation and carries threats. A small quantity of people will die while in, or quickly after, the operation. If you have a small AAA, the danger of death generated by surgery is higher than the risk of rupture. For this reason, medical procedures is usually not recommended if you have an AAA less than 50 mm broad. Even so, regular ultrasound verification will normally be recommended to observe if it gets larger over time.

Surgery treatment is commonly advised if you develop an AAA larger than 50 mm. For these larger aneurysms the threat of rupture is normally higher than the risk of surgery treatment. In spite of this, if your common state of wellness is poor, or if you have certain other clinical problems, this could increase the chance if you have medical procedures. For that reason, in several cases the conclusion to operate may be a really difficult one.

Urgent situation surgical procedure is required if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the quick serious bleeding. Nevertheless, emergency surgery is lifesaving in some conditions.

What procedures are implemented? There are 2 types of operative procedure to repair an AAA.

The regular surgery is to cut out the negative piece of aorta and swap it using an man made section of artery (a graft). This is a main surgery and, as described, provides certain danger. Some people die while in this operation. On the other hand, it is effective in a lot of scenarios and the aneurysm is absolutely fixed. The long-term outlook is fine. The graft usually works well for the rest of your life.

A current method allows the aorta to be fixed by a technique called endovascular repair. This has become a popular alternative in latest years. In this method a tube is passed up from inside one of the leg arteries into the section of the aneurysm. This tube is then passed throughout the increased aneurysm and repaired to the good aorta wall using metal clips. The edge to this specific style of repair is that there is no abdominal surgical procedure. This tactic is thus more secure than the standard procedure, and you require to spend less time in clinic. A negative aspect is that certain persons have to undergo a further procedure at a later stage to refine the early procedure.

Surgical techniques keep going to develop and improve. Your surgeon will advise about the positives and negatives of surgical procedures, the various forms of procedure, and the best option for you.

Other treatment options may be necessary If you have an AAA, you are likely to have a significant amount of atheroma that lines the artery. For this reason, you are at risk of having significant atheroma formation in other arteries, such as the coronary (heart) arteries and brain arteries. Therefore, you are likely to be at enhanced risk of developing heart disease (angina, heart attack, etc) and stroke.

In fact, most people who develop an aortic AAA do not die of the aneurysm but die from additional vascular disorders, such as a heart harm or stroke.

Therefore, you should think of doing what you can to minimize the chance of these factors by other means. For example: Eat a healthy diet which consists of keeping a low salt intake.</li>If you are able, exercise often.</li>Lose excess weight if you are overweight.</li>Do not smoke cigarettes.</li>If you drink alcohol, do so in moderation.</li>If you have high blood pressure, diabetes, or a high cholesterol level, they should be well controlled on treatment.</li>You may be prescribed a statin drug to lower your cholesterol level and low-dose aspirin to help prevent blood clots from forming.</li></ul> See separate booklet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research studies propose that a program ultrasound scan is beneficial for all men aged 65. This is for the reason that most people with an AAA do not have symptoms. Following a program diagnostic scan, surgical procedure can be offered to men found to have an aneurysm over 50 mm wide. Follow-up scans can be provided to monitor those with smaller aneurysms.

In early 2008, the governing administration introduced that over the subsequent five years ultrasound screening would be rolled out to enable all men in England aged 65 and over to be screened. Screening is likely to begin in Scotland in 2011. Wales and Northern Ireland have yet to announce their plans. Screening for AAA is offered only to men, as the condition is much more typical in men than in women. One research published in 2009 determined that if all men in their 60s and 70s were screened in England then this could save nearly 2,000 lives a year. On the other hand, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.