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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of section of the aorta that is inside of the abdomen. An abdominal aortic aneurysm quite often leads to no indicators except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is quite often dangerous. An abdominal aortic aneurysm less than 50 mm wide has a decreased risk of rupture. A surgery to take care of the aneurysm will be advised if it is larger than 50 mm, as earlier mentioned this size the chance of rupture improves. Men 65 years old and more are to be supplied 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 area of an artery widens (balloons out). The wall of an aneurysm is weaker than a healthy artery wall. The pressure of the blood inside of the artery causes the weaker section of wall to balloon.

 

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

The standard size of the aorta in the abdomen is around 20 mm. An abdominal 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 only about AAAs.

AAAs differ in dimensions. As a rule, as soon as you strengthen an AAA, it tends progressively to obtain greater. The rate at which it gets larger differs from person to person. However, on average, an AAA tends to get larger by around 10% per year.

What leads to an abdominal aortic aneurysm? In the majority of cases The particular reason why an aneurysm figures in the aorta in most cases is not clear. Most instances occur in aged people. An AAA is uncommon in people below the age of 60. For that reason, growing older has a major factor to play.

The wall of the aorta commonly has levels of sleek muscle, and layers built 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 typical toughness and elasticity in some people as they become older. Scientific tests advises that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical procedures that trigger these modifications. Some people are more susceptible than others to these changes.

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

Atheroma could also play a part. Atheroma is a fatty material that deposits within the inside lining of arteries. Atheroma is in some cases called furring of the arteries. Most AAAs are lined with some atheroma. Any individual can develop atheroma, but it develops more often with raising age. Several risk factors also enhance the chance of atheroma forming. They include: smoking, high blood pressure, 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. As well, certain uncommon inherited circumstances can influence the artery structure. In these uncommon situations an aneurysm may develop at a relatively young age.

How common 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 increasing age. However, most people with an AAA are not knowledgeable that they have one. An AAA is uncommon in people less than the age of 60.

What is the concern about an abdominal aortic aneurysm? The main concern is that the aneurysm might rupture (burst). The wall of the aneurysm is weaker than a normal artery wall and may not be able to resist 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 warning signs of an abdominal aortic aneurysm? Quite often there are no signals or 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 it gets large enough to put force on native structures. If signs or symptoms do take place, they are likely to be mild abdominal or backside aches and pains. There are many factors of mild abdominal and back pain. For that reason, the diagnosis could be postponed except when the aneurysm is big enough to be sensed by a medical expert when he or she examines 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 block a smaller artery further on. These blood clots are called emboli and can be dangerous. For example, total blockage of an artery that supplies a foot may prospect to reduction of blood to part of the foot, which can result in 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 commonly 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 doctor senses the stick out of an aneurysm during a program check-up of the abdomen. Nevertheless, many AAAs are too small to medium sized to feel.An X-ray of the abdomen (often carried out for different reasons) will indicate calcium mineral deposits lining the wall of an AAA in some, but not all, scenarios.An ultrasound check is the easiest way to detect an AAA. This is a painless test out. It is the identical 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 done if your doctor demands 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, surgeons need to recognize this information if they prepare to operate.

What is the danger of an abdominal aortic aneurysm rupturing? The chance of rupture is decreased if an AAA is small. As a rule, the risk of rupture improves with growing dimension. This is much like a balloon - the larger you blow it up, the greater the pressure, and the larger the chance it will burst. The dimension of an AAA can be assessed by an ultrasound check. The following gives over-all 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 improved in smokers, females, those with high blood pressure, and those with a family historical past of an AAA.

Should everybody with an abdominal aortic aneurysm have surgical treatment? The brief answer is no. Surgical repair of an AAA is a significant procedure and provides dangers. A small amount of people will die throughout, or right after, the operations. If you have a small AAA, the threat of loss of life generated by surgical procedures is greater than the threat of rupture. As a result, surgical procedures is commonly not advised if you have an AAA less than 50 mm broad. Even so, regular ultrasound verification will usually be suggested to see if it gets larger over time.

Medical procedures is commonly recommended 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 procedure. Even so, if your common condition of wellness is poor, or if you have specific other healthcare conditions, this could improve the chance if you have surgical procedure. For that reason, in certain scenarios the conclusion to operate may be a problematic one.

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

What operations are implemented? There are 2 types of medical procedure to fix an AAA.

The classic operation is to cut out the bad piece of aorta and swap it with an synthetic part of artery (a graft). This is a main operation and, as pointed out, carries certain threat. Some people die throughout this operation. However, it is effective in most cases and the aneurysm is 100 % fixed. The long-term prospect is good. The graft usually works nicely for the rest of your life.

A newer technique lets the aorta to be fixed by a procedure known as 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 across the increased aneurysm and repaired to the good aorta wall using metal clips. The edge to this type of fix is that there is no abdominal surgery. This technique is therefore less dangerous than the standard surgery, and you require to spend less time in clinic. A disadvantage is that some individuals have to undergo a further surgery at a later stage to perfect the initial surgery.

Medical techniques keep going to develop and improve. Your surgeon will advise about the advantages and disadvantages of surgical procedures, the various forms of operation, and the best choice for you.

Other treatment options could be important If you have an AAA, you are most likely to have a significant amount of atheroma that lines the artery. Therefore, you are at risk 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 consider doing what you can to minimize the danger of these disorders by other suggests. For example: Eat a healthy diet which contains keeping a low salt intake.</li>If you are able, exercise regularly.</li>Lose 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 leaflet 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 for the reason that most people with an AAA do not have symptoms. Following a program diagnostic scan, surgery can be available 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 study shared 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 concerns about screening for AAA; for example, see the paper by Johnson cited under 'References', below.