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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 leads to no warning signs unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually lethal. An abdominal aortic aneurysm much less than 50 mm broad holds a minimal chance of rupture. An operation to repair the aneurysm could be advised if it is larger sized than 50 mm, as earlier mentioned this dimension the threat of rupture increases. Males 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 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 part of an artery widens (balloons out). The wall of an aneurysm is less strong than a natural artery wall. The force of the blood inside the artery leads to the weaker section of wall to balloon.

 

Aneurysms could happen in any existing artery, but they most usually happen in the aorta. Most aortic aneurysms take place in the segment of the aorta that goes through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). Frequently they occur in the area heading through the chest. These are known as thoracic aortic aneurysms.

The typical size 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 booklet is mainly about AAAs.

AAAs vary in dimensions. As a rule, as soon as you strengthen an AAA, it leads gradually to obtain bigger. 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 about 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 cases happen in older people. An AAA is unusual in people less than the age of 60. Therefore, growing old has a main factor to play.

The wall of the aorta typically has levels of sleek muscles, and layers made from tissues called elastin and collagen. Elastin and collagen are powerful assisting tissues. What seems to happen is that a part of the aorta loses its natural strength and elasticity in some people as they grow older. Medical studies advises that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical procedures that trigger these modifications. Some people are more vulnerable than others to these changes.

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

Atheroma may additionally play a part. Atheroma is a oily substance that deposits within the inside of lining of arteries. Atheroma is from time to time named furring of the arteries. Most AAAs are layered with some atheroma. Anybody can develop atheroma, but it develops more typically with increasing age. Certain risk factors also increase the chance of atheroma developing. They include: tobacco use, 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 contain injury or infection of the aorta. In addition, certain unusual hereditary circumstances can affect the artery structure. 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 becomes more regular with growing age. In spite of this, 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 weaker than a natural artery wall and may not be able to stand up to 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 symptoms and signs of an abdominal aortic aneurysm? Quite often 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 result in any symptoms except when it gets large sufficient to put tension on nearby structures. If signs do occur, they are likely to be mild abdominal or back aches and pains. There are many triggers of mild abdominal and back pain. For that reason, the diagnosis could be postponed until the aneurysm is large enough to be sensed by a medical professional when he or she inspects your abdomen.

Sometimes small blood clots form on the inside lining of an AAA. These may break off and be stocked down the aorta and block a smaller artery further on. These blood clots are called emboli and can be threatening. For instance, total blockage of an artery that supplies a foot may prospect to loss of blood to part of the foot, which can cause 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 generally soon followed by collapse as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed? Sometimes a doctor feels the stick out of an aneurysm in the course of a routine checking of the abdomen. Even so, many AAAs are too small to feel.An X-ray of the abdomen (often done for different reasons) will display calcium stores lining the wall of an AAA in a few, but not all, situations.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is an uncomplicated 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 requires to know whether the aneurysm is affecting any of the arteries that come off the aorta. For example, if the aneurysm entails the section of the aorta where the arteries to the kidneys branch off, doctors need to find out this info if they plan to operate.

What is the probability of an abdominal aortic aneurysm rupturing? The opportunity of rupture is minimal 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 pressure, and the higher the chance it will burst open. The size of an AAA can be assessed by an ultrasound diagnostic scan. The following gives overall danger 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 historical past of an AAA.

Should really everybody with an abdominal aortic aneurysm have surgical treatments? The brief answer is no. Operative restoration of an AAA is a major procedure and provides threats. 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 caused by surgery is more significant than the threat of rupture. For this reason, surgical procedures is usually not suggested if you have an AAA less than 50 mm broad. However, regular ultrasound verification will usually be advised to see if it gets larger over time.

Surgical procedures is usually 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 treatment. Nevertheless, if your common state of health is bad, or if you have certain other health care problems, this could raise the threat if you have surgical procedure. So, in certain cases the final decision to operate could be a hard one.

Emergency surgical treatment is necessary if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the quick critical bleeding. Nevertheless, emergency surgery is lifesaving in some cases.

What treatments are practiced? There are two types of surgery procedure to fix an AAA.

The regular procedure is to cut out the negative piece of aorta and swap it using an artificial piece of artery (a graft). This is a major operation and, as described, carries some threat. Some people die while in this operation. However, it is successful in a lot of cases and the aneurysm is absolutely repaired. The long-term outlook is good. The graft normally works nicely for the rest of your life.

A modern technique makes it possible for the aorta to be repaired by a method named endovascular repair. This has become a popular solution in the latest years. In this method a tube is passed up from inside one of the leg arteries into the section 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 repair is that there is no abdominal surgery. This tactic is therefore safer than the traditional surgery, and you require to spend less time in clinic. A disadvantage is that certain persons have to undergo an additional surgery at a later stage to refine the initial process.

Surgical techniques keep going to develop and improve. Your doctor will advise about the positives and cons of surgery treatment, the different types of procedure, and the best method for you.

Other treatment options could be important If you have an AAA, you are probably to have a substantial 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 enhanced 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 disorders, such as a heart harm or stroke.

Therefore, you should think of doing what you can to greatly reduce the threat of these disorders 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 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 leaflet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research studies propose that a routine ultrasound check is worthwhile for all men aged 65. This is because most people with an AAA do not have symptoms. Following a routine scan, surgery treatment 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 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 common in men than in women. One research 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. Nevertheless, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.