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Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a dilation (ballooning) of segment of the aorta that is located in the abdomen. An abdominal aortic aneurysm mostly triggers no warning signs until it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually lethal. An aorta abdomen much less than 50 mm broad holds a low chance of rupture. A procedure to repair the aneurysm may be advised if it is larger sized than 50 mm, as above this size the probability of rupture increases. Men aged 65 and more are to be proposed a program scan to screen for abdominal aortic aneurysm.

What is the aorta?

The aorta is the most significant 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 area of an artery widens (balloons out). The wall of an aneurysm is vulnerable than a natural artery wall. The tension of the blood in the artery triggers the weaker section of wall to balloon.

<img style="width:294px;height:270px;float:left;" src="http://www.abdominalaneurysm.net/wp-content/uploads/2012/03/AAA.gif" alt="Abdominal Aortic Aneurysm"/> <img style="width:310px;height:263px;" src="http://www.abdominalaneurysm.net/wp-content/uploads/2012/03/abdominal-aortic-aneurysm.gif" alt="Diagram showing the main arteries of the body and details of an aortic aneurysm"/>

Aneurysms could appear in any existing artery, but they most typically occur in the aorta. Most aortic aneurysms appear in the section of the aorta that passes through the abdomen. These are known as abdominal aortic aneurysms (AAAs). Sometimes they occur in the section moving via the chest. These are known as thoracic aortic aneurysms.

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

The rest of this booklet is mainly about AAAs.

AAAs differ in sizing. As a rule, as soon as you strengthen an AAA, it leads gradually to obtain larger sized. The speed at which it gets larger varies from person to person. In spite of this, on average, an AAA leads to get larger by about 10% per year.

What leads to an abdominal aortic aneurysm?

In most cases

The exact cause why an aneurysm figures in the aorta in most cases is not well-defined. Most instances take place in older people. An AAA is rare in people below the age of 60. So, growing old has a significant role to play.

The wall of the aorta normally has levels of sleek muscle mass, and layers made from tissues called elastin and collagen. Elastin and collagen are powerful encouraging tissues. What seems to happen is that a part of the aorta loses its usual strength and elasticity in some people as they grow older. Medical studies suggests that this is due 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 happening an AAA if one of your parents has, or had, one.

Atheroma could additionally play a part. Atheroma is a oily material that deposits within the inside lining of arteries. Atheroma is from time to time termed furring of the arteries. Most AAAs are lined with some atheroma. Any person can develop atheroma, but it develops more typically with growing age. Several risk factors also increase the chance of atheroma forming. They include: cigarette smoking, high blood tension, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that raise the chance of atheroma forming in the heart (coronary) arteries, which can cause angina and heart attacks.

In a minority of cases

Rare factors of AAAs include injury or infection of the aorta. Also, certain unusual hereditary circumstances can affect the artery framework. In these unusual situations an aneurysm may develop at a relatively 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 normal with growing age. In spite of this, most people with an AAA are not careful that they have one. An AAA is unusual 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 less strong than a normal artery wall and may not be able to endure the tension 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 indicators of an abdominal aortic aneurysm?

Usually there are no warnings. 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 cause any symptoms unless it gets large enough to put pressure on nearby structures. If signs do take place, they are likely to be mild abdominal or back painful sensations. There are many causes of mild abdominal and back pain. As a result, the diagnosis may be delayed until the aneurysm is big enough to be felt by a medical professional when he or she inspects your abdomen.

In some cases small blood clots form on the inside lining of an AAA. These may break off and be carried down the aorta and block a smaller artery further on. These blood clots are called emboli and can be dangerous. For instance, full blockage of an artery that provides a foot may lead to loss 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?

• In some cases a medical professional feels the stick out of an aneurysm in the course of a routine check-up of the abdomen. Even so, many AAAs are too small to medium sized to feel.
• An X-ray of the abdomen (often performed for other reasons) will show calcium stores lining the wall of an AAA in some, but not almost all, scenarios.
• An ultrasound scan is the easiest way to detect an AAA. This is a painless test. It is the similar option of check out 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 accomplished if your personal doctor needs to know whether the aneurysm is affecting any of the arteries that come off the aorta. For instance, if the aneurysm entails the section of the aorta where the arteries to the kidneys branch off, specialists need to find out this information if they prepare to operate.

What is the option of an abdominal aortic aneurysm rupturing?

The opportunity of rupture is low if an AAA is compact. As a rule, the risk of rupture raises with increasing measurement. This is much like a balloon - the larger you blow it up, the greater the tension, and the larger the probability it will burst. The dimension of an AAA can be assessed by an ultrasound check. The following gives overall threat 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.
• 60 mm-69 mm: about a 15 in 100 chance of rupture per year.
• 70 mm-79 mm: about a 35 in 100 chance of rupture per year.
• 80 mm or more: about a 50 in 100 chance of rupture per year.

As a rule, for any given size, the risk of rupture is increased in smokers, females, those with high blood pressure, and those with a relatives historical past of an AAA.

Should everybody with an abdominal aortic aneurysm have surgical treatment?

The simple answer is no. Surgery restoration of an AAA is a significant procedure and includes risks. A small quantity of people will die during, or quickly after, the operation. If you have a small AAA, the risk of loss of life generated by surgical procedures is more significant than the threat of rupture. For this reason, surgery is often not recommended if you have an AAA less than 50 mm wide. Nevertheless, regular ultrasound verification will commonly be advised to observe if it gets larger over time.

Surgical procedure is usually advised if you develop an AAA larger than 50 mm. For these larger aneurysms the chance of rupture is usually higher than the risk of surgical procedures. In spite of this, if your general condition of wellness is bad, or if you have specified other medical related conditions, this may improve the threat if you have surgical treatment. For that reason, in a number of cases the conclusion to operate may be a problematic one.

Emergency surgical treatment 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 critical bleeding. Nevertheless, emergency surgery is lifesaving in some cases.

What surgical procedures are executed?

There are a pair of types of operative procedure to restore an AAA.

The traditional surgery is to cut out the bad piece of aorta and swap it by using an artificial piece of artery (a graft). This is a major operations and, as mentioned, provides some threat. Some people die throughout this operation. Nevertheless, it is effective in most scenarios and the aneurysm is completely repaired. The long-term view is fine. The graft generally works nicely for the rest of your life.

A modern method makes it possible for the aorta to be fixed by a method named endovascular repair. This has become a popular solution in recent years. In this procedure a tube is passed up from inside one of the leg arteries into the area of the aneurysm. This tube is then passed throughout the widened aneurysm and repaired to the good aorta wall using metal clips. The advantage to this type of fix is that there is no abdominal surgical procedure. This technique is thus less dangerous than the classic procedure, and you require to spend less time in hospital. A negative aspect is that certain persons have to undergo an additional procedure at a later stage to refine the primary surgery.

Operative methods keep going to develop and improve. Your doctor will suggest about the positives and disadvantages of medical procedures, the various kinds of surgery, and the best solution for you.

Other solutions could be important

If you have an AAA, you are likely to have a substantial amount of atheroma that lines the artery. For this reason, you are at risk of having significant atheroma structure in other arteries, such as the coronary (heart) arteries and brain arteries. Therefore, you are likely to be at improved 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 other vascular conditions, such as a heart harm or stroke.

Therefore, you should consider doing what you can to greatly reduce the risk of these conditions by other suggests. For illustration:

• Eat a healthy diet which consists of keeping a low salt intake.
• If you are able, exercise often.
• Lose weight if you are overweight.
• Do not smoke cigarettes.
• If you drink alcohol, do so in moderation.
• If you have high blood pressure, diabetes, or a high cholesterol level, they should be well controlled on treatment.
• You may be prescribed a statin drug to lower your cholesterol level and low-dose aspirin to help prevent blood clots from forming.

See separate booklet called 'Preventing Cardiovascular Diseases' for more details.

Screening for abdominal aortic aneurysm

Research studies advise that a program ultrasound check is beneficial for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a program diagnostic scan, surgical treatment can be presented to men found to have an aneurysm over 50 mm wide. Follow-up scans can be supplied to monitor those with smaller aneurysms.

In early 2008, the government released 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 research published in 2009 estimated 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 fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.