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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 causes no signs of illness except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually lethal. An aorta abdominales less than 50 mm broad carries a below average risk of rupture. A surgery to take care of the aneurysm could be recommended if it is greater than 50 mm, as earlier mentioned this dimension the threat of rupture increases. Individuals aged 65 and more are to be offered a routine scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the largest 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 healthy artery wall. The force of the blood inside of the artery triggers the weaker section of wall to balloon.

 

Aneurysms can occur in any artery, but they most typically occur in the aorta. Most aortic aneurysms appear in the area of the aorta that moves through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). Sometimes they occur in the segment heading 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 sizing. As a rule, once you strengthen an AAA, it has a tendency progressively to get greater. The rate at which it gets larger differs from person to person. In spite of this, on average, an AAA tends to get larger by around 10% every year.

What leads to an abdominal aortic aneurysm? In most cases The particular reason why an aneurysm figures in the aorta in most cases is not clear. Most instances occur in older people. An AAA is exceptional in people under the age of 60. Therefore, growing old has a significant factor to play.

The wall of the aorta commonly has levels of sleek muscle, and layers built from tissues termed elastin and collagen. Elastin and collagen are strong encouraging tissues. What seems to happen is that a part of the aorta loses its natural strength and flexibility in some people as they become older. Scientific tests advises that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical processes that lead to these modifications. Some people are more susceptible than others to these changes.

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

Atheroma may 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 commonly with raising age. Certain risk factors also increase the chance of atheroma forming. 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 include injury or infection of the aorta. As well, certain unusual hereditary factors can affect the artery framework. In these unusual 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 becomes more regular with raising age. Though, most people with an AAA are not knowledgeable 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 force 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 signs of an abdominal aortic aneurysm? Usually there are no symptoms. At the time of identification, 7 in 10 people with an AAA will not have had any symptoms due to the aneurysm. The ballooning of the aneurysm does not lead to any symptoms unless of course it becomes large enough to put tension on native structures. If symptoms do happen, they are likely to be mild abdominal or backside aches and pains. There are many causes of mild abdominal and back pain. Therefore, the identification could be postponed until the aneurysm is big enough to be felt by a doctor when he or she inspects your abdomen.

Occasionally 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 threatening. For example, complete blockage of an artery that provides a foot may prospect to reduction of blood to part of the foot, which can result in pain 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 commonly soon followed by collapse as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed? Occasionally a doctor feels the stick out of an aneurysm while in a routine check-up of the abdomen. However, many AAAs are too compact to feel.An X-ray of the abdomen (often done for other causes) will indicate calcium mineral stores lining the wall of an AAA in several, but not almost all, cases.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is a painless evaluation. It is the exact same kind of 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 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, doctors need to know this information if they prepare to operate.

What is the danger of an abdominal aortic aneurysm rupturing? The opportunity of rupture is decreased if an AAA is compact. As a rule, the risk of rupture raises with increasing size. This is much like a balloon - the larger you blow it up, the greater the force, and the greater the probability it will burst open. The diameter of an AAA can be measured by an ultrasound check. The following gives general 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.</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 certainly every person with an abdominal aortic aneurysm have surgery? The brief answer is no. Surgery restoration of an AAA is a significant operation and includes dangers. A small quantity of people will die throughout, or quickly after, the surgery. If you have a small AAA, the probability of loss of life generated by surgery is higher than the danger of rupture. For this reason, surgical procedure is often not suggested if you have an AAA less than 50 mm wide. However, usual ultrasound tests will usually be recommended to observe if it gets larger over time.

Surgical procedures is normally proposed if you develop an AAA larger than 50 mm. For these larger aneurysms the chance of rupture is usually higher than the risk of surgery. But, if your general condition of wellness is weak, or if you have specific other health care issues, this could increase the threat if you have surgical treatment. For that reason, in several situations the final decision to operate could be a hard one.

Emergency surgical procedure is needed if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the sudden serious bleeding. Nevertheless, crisis surgery is lifesaving in some situations.

What operations are practiced? There are 2 types of operative treatment to repair an AAA.

The regular surgery is to cut out the negative piece of aorta and swap it by using an man made element of artery (a graft). This is a major surgery and, as pointed out, provides certain risk. Some people die throughout this operation. However, it is productive in a lot of scenarios and the aneurysm is completely fixed. The long-term outlook is fine. The graft generally works well for the rest of your life.

A newer technique makes it possible for the aorta to be fixed by a method named endovascular repair. This has become a popular choice in latest years. In this technique 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 increased aneurysm and fixed to the good aorta wall using metal clips. The benefit to this type of fix is that there is no abdominal surgery. This tactic is thus more secure than the classic surgery, and you require to spend less time in medical center. A negative aspect is that some patients have to undergo a further surgery at a later stage to perfect the initial process.

Medical tactics keep going to develop and improve. Your doctor will advise about the benefits and negatives of surgical procedures, the different types of procedure, and the best option for you.

Other treatments could be important If you have an AAA, you are most likely to have a substantial amount of atheroma that lines the artery. For this reason, you are at danger 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 additional vascular problems, such as a heart harm or stroke.

Therefore, you should think about doing what you can to minimize the risk of these conditions by other means. For example: Eat a healthy diet which contains 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 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 advise that a program ultrasound diagnostic scan is beneficial for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a routine scan, surgery treatment can be provided 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 government 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 common 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. Nevertheless, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.