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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of area of the aorta that is inside of the abdomen. An abdominal aortic aneurysm in most cases triggers no signs of illness except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually lethal. An aorta abdomen much less than 50 mm wide carries a below average expectation of rupture. A surgical procedure to repair the aneurysm could be suggested if it is larger than 50 mm, as earlier mentioned this size the probability of rupture grows. Males 65 years old and over are to be offered a program scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the major 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 segment of an artery widens (balloons out). The wall of an aneurysm is vulnerable than a healthy artery wall. The pressure of the blood inside the artery leads to the weaker section of wall to balloon.

 

Aneurysms can take place in any existing artery, but they most usually occur in the aorta. Most aortic aneurysms occur in the area of the aorta that passes through the abdomen. These are known as abdominal aortic aneurysms (AAAs). Frequently they occur in the part moving through 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 vary in sizing. As a rule, at the time you develop an AAA, it has a tendency progressively to obtain greater. The rate at which it obtains larger differs from person to person. However, on average, an AAA leads to get larger by around 10% every 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 extraordinary in people below the age of 60. Therefore, getting old has a major factor to play.

The wall of the aorta commonly has layers of easy muscle mass, and layers built from tissues termed elastin and collagen. Elastin and collagen are strong supporting tissues. What seems to happen is that a part of the aorta loses its usual toughness and elasticity in some people as they grow older. Medical studies recommends that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical processes that cause these modifications. Some people are more susceptible than others to these changes.

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

Atheroma could as well play a part. Atheroma is a oily substance that deposits within the inside lining of arteries. Atheroma is from time to time called furring of the arteries. Most AAAs are lined with some atheroma. Any person can develop atheroma, but it develops more usually with growing age. A number of risk factors also increase the chance of atheroma growing. They include: tobacco use, high blood tension, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that enhance 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 contain injury or infection of the aorta. Additionally, certain uncommon inherited circumstances can influence the artery structure. In these abnormal situations an aneurysm may develop at a relatively 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 becomes more normal with raising age. Though, most people with an AAA are not aware that they have one. An AAA is not usual 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 normal artery wall and may not be able to withstand 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 signs of an abdominal aortic aneurysm? Often there are no signals or symptoms. At the time of medical 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 except when it becomes large enough to put tension on native structures. If symptoms do appear, they are possible to be mild abdominal or backside painful sensations. There are many factors of mild abdominal and back pain. Therefore, the diagnosis may be postponed except when the aneurysm is big enough to be sensed by a doctor 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 obstruct a smaller artery further on. These blood clots are called emboli and can be harmful. For instance, complete blockage of an artery that supplies 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 commonly soon followed by collapse as the internal bleeding causes a sharp drop in blood pressure.

The best way in which an abdominal aortic aneurysm is diagnosed? Sometimes a medical doctor senses the stick out of an aneurysm during a routine examination of the abdomen. However, many AAAs are too compact to feel.An X-ray of the abdomen (often done for different reasons) will indicate calcium deposits 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 test. It is the exact same type 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 doctor needs to know whether the aneurysm is impacting on any of the arteries that come off the aorta. For illustration, if the aneurysm involves the section of the aorta where the arteries to the kidneys branch off, surgeons need to find out this information if they plan to operate.

What is the threat of an abdominal aortic aneurysm rupturing? The opportunity of rupture is lower if an AAA is minimal. As a rule, the risk of rupture grows with improving size. This is much like a balloon - the larger you blow it up, the greater the force, and the higher the chance it will burst. The diameter of an AAA can be measured by an ultrasound check out. 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 increased in smokers, females, those with high blood pressure, and those with a family historical past of an AAA.

Should really everybody with an abdominal aortic aneurysm have surgery? The quick answer is no. Operative restoration of an AAA is a major treatment and provides threats. A small quantity of people will die throughout, or shortly after, the operation. If you have a small AAA, the risk of dying triggered by surgical procedure is more significant than the threat of rupture. Therefore, surgical treatment is normally not advised if you have an AAA less than 50 mm wide. Nevertheless, usual ultrasound tests will generally be recommended to discover if it gets larger over time.

Surgical procedure is commonly advised if you develop an AAA larger than 50 mm. For these larger aneurysms the probability of rupture is generally higher than the risk of surgical procedures. In spite of this, if your general state of wellness is poor, or if you have specific other medical related issues, this may increase the risk if you have surgery. For that reason, in several situations the choice to operate may be a really difficult one.

Urgent surgical procedures is needed if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the unexpected severe bleeding. Nevertheless, crisis surgery is lifesaving in some conditions.

What operations are implemented? There are a pair of types of surgery operation to repair an AAA.

The classic procedure is to cut out the negative piece of aorta and change it with an man made piece of artery (a graft). This is a main operation and, as described, carries some danger. Some people die for the duration of this operation. On the other hand, it is successful in a lot of scenarios and the aneurysm is 100 % fixed. The long-term prospect is fine. The graft generally works well for the rest of your life.

A current method allows the aorta to be repaired by a method termed endovascular repair. This has become a popular option in recent years. In this procedure a tube is passed up from inside one of the leg arteries into the section of the aneurysm. This tube is then passed across the widened aneurysm and fixed to the good aorta wall using metal clips. The advantage to this style of repair is that there is no abdominal surgical procedure. This method is thus safer than the common operation, and you need to have to spend less time in medical center. A disadvantage is that some individuals have to undergo a further procedure at a later stage to perfect the initial process.

Surgery methods keep going to develop and improve. Your surgeon will recommend about the pros and negatives of surgery, the different forms of procedure, and the best method for you.

Other treatment options could be necessary If you have an AAA, you are probably to have a significant amount of atheroma that lines the artery. As a result, you are at probability of having substantial 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 some other vascular conditions, such as a heart strike or stroke.

Therefore, you should think about doing what you can to greatly reduce the risk of these factors by other suggests. For illustration: Eat a healthy diet which comes with 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 analyses 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 offered to monitor those with smaller aneurysms.

In early 2008, the authorities 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 typical 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. Nevertheless, there are some people who have worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.