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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of segment of the aorta that is inside of the abdomen. An abdominal aortic aneurysm usually causes no signs of illness except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually critical. An aorta abdomen less than 50 mm wide comes with a below average expectation of rupture. A surgery to fix the aneurysm can be proposed if it is larger sized than 50 mm, as above this size the threat of rupture increases. Males 65 years old and over are to be offered a routine scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the most significant artery (blood vessel) in the human 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 natural artery wall. The force of the blood in the artery results in the weaker section of wall to balloon.

 

Aneurysms can occur in any existing artery, but they most generally occur in the aorta. Most aortic aneurysms take place in the segment of the aorta that goes through the abdomen. These are known as abdominal aortic aneurysms (AAAs). In some cases they occur in the section heading via the chest. These are known as thoracic aortic aneurysms.

The standard dimension of the aorta in the abdomen is related to 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 only about AAAs.

AAAs range in dimensions. As a rule, after you develop an AAA, it has a tendency progressively to obtain larger. The speed at which it obtains larger differs from person to person. In spite of this, on average, an AAA leads to get larger by around 10% for each year.

What causes an abdominal aortic aneurysm? In most cases The particular cause why an aneurysm figures in the aorta in most cases is not clear. Most cases take place in older people. An AAA is exceptional in people below the age of 60. Therefore, ageing has a main role to play.

The wall of the aorta usually has layers of smooth muscles, and layers built 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 normal toughness and flexibility in some people as they become older. Scientific tests recommends that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that trigger these modifications. Some people are more vulnerable than others to these changes.

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

Atheroma could additionally play a part. Atheroma is a oily material that stores within the inside lining of arteries. Atheroma is sometimes named furring of the arteries. Most AAAs are lined with some atheroma. Any individual can develop atheroma, but it develops more often with increasing age. Particular risk variables also enhance the chance of atheroma developing. They include: cigarette smoking, 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 triggers of AAAs have injury or infection of the aorta. As well, certain uncommon genetic circumstances can affect the artery framework. In these unusual situations an aneurysm may develop at a rather young age.

How regularly occurring are abdominal aortic aneurysms? About 6 in 100 men and about 2 in 100 women over the age of 65 have an AAA. It gets more common with raising age. Though, most people with an AAA are not aware that they have one. An AAA is rare in people less than 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 less strong than a usual artery wall and may not be able to endure the pressure of blood internally. 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? Quite often there are no signals or 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 trigger any symptoms unless it gets large enough to put pressure on native structures. If symptoms do happen, they are most likely to be mild abdominal or back discomfort. There are many triggers of mild abdominal and back pain. For that reason, the identification could be postponed until the aneurysm is big enough to be sensed by a medical expert when he or she inspects your abdomen.

From time to time 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 damaging. For example, total blockage of an artery that provides a foot may lead to reduction of blood to part of the foot, which can result in problems in the foot and gangrene if left untreated.

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

The way in which an abdominal aortic aneurysm is diagnosed? Occasionally a medical professionsal feels the stick out of an aneurysm throughout a program checking of the abdomen. Even so, many AAAs are too small to feel.An X-ray of the abdomen (often carried out for different causes) will display calcium stores lining the wall of an AAA in some, but not all, cases.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is an uncomplicated evaluation. It is the identical type of scan that expecting a baby 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 done if your current medical expert requires to know whether the aneurysm is affecting any of the arteries that come off the aorta. For instance, if the aneurysm involves the section of the aorta where the arteries to the kidneys branch off, surgeons need to know this information if they plan to operate.

What is the probability of an abdominal aortic aneurysm rupturing? The chance of rupture is low if an AAA is minimal. As a rule, the risk of rupture raises with growing measurement. This is much like a balloon - the larger you blow it up, the greater the force, and the larger the chance it will burst open. The dimension of an AAA can be assessed by an ultrasound check. The following gives general risk 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 background of an AAA.

Should certainly everybody with an abdominal aortic aneurysm have surgery treatment? The short answer is no. Operative restoration of an AAA is a significant operation and carries threats. A small quantity of people will die while in, or quickly after, the surgery. If you have a small AAA, the danger of dying caused by surgical procedures is higher than the risk of rupture. For that reason, surgical treatment is often not advised if you have an AAA less than 50 mm broad. However, common ultrasound tests will normally be recommended to discover if it gets larger over time.

Medical procedures is normally suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the risk of rupture is generally higher than the risk of surgical treatment. But, if your basic condition of health is bad, or if you have certain other medical related conditions, this could improve the chance if you have surgery. So, in several cases the choice to operate may be a problematic one.

Urgent situation surgical procedure is important if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the immediate severe bleeding. However, urgent surgery is lifesaving in some cases.

What procedures are executed? There are two types of surgical operation to repair an AAA.

The traditional operation is to cut out the negative piece of aorta and replace it with an man made piece of artery (a graft). This is a main operation and, as mentioned, provides certain danger. Some people die for the duration of this operation. On the other hand, it is effective in the majority of scenarios and the aneurysm is absolutely repaired. The long-term prospect is good. The graft commonly works well for the rest of your life.

A modern technique makes it possible for the aorta to be restored by a method called endovascular repair. This has become a popular alternative in the latest years. In this method a tube is passed up from inside one of the leg arteries into the area of the aneurysm. This tube is then passed across the increased aneurysm and repaired to the good aorta wall using metal clips. The advantage to this specific type of restoration is that there is no abdominal surgical procedure. This technique is therefore more secure than the classic operation, and you need to have to spend less time in hospital. A negative aspect is that some individuals have to undergo an additional operation at a later stage to improve the early procedure.

Medical techniques continue to develop and improve. Your doctor will recommend about the pros and negatives of surgical procedure, the various kinds of surgery, and the best option for you.

Other solutions may be necessary If you have an AAA, you are most likely to have a substantial amount of atheroma that lines the artery. Therefore, you are at danger of having substantial atheroma in other arteries, such as the coronary (heart) arteries and brain arteries. Therefore, you are likely to be at increased 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 conditions, such as a heart attack or stroke.

Therefore, you should consider doing what you can to minimize the risk of these factors by other means. For illustration: 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 over weight.</li>Do not smoke.</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 leaflet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research analyses suggest that a program ultrasound check 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 scan, surgical treatment 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 authorities 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 widespread in men than in women. One study shared in 2009 predicted that if all men in their 60s and 70s were screened in England then this could save nearly 2,000 lives a year. However, there are some people who have worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.