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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 usually leads to no indicators unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is often dangerous. An aneurisma abdominal less than 50 mm wide holds a decreased probability of rupture. An operation to fix the aneurysm may be proposed if it is larger sized than 50 mm, as earlier mentioned this size the risk of rupture improves. Males aged 65 and more are to be supplied a routine scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the largest sized 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 part 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 triggers the weaker section of wall to balloon.

 

Aneurysms could take place in any artery, but they most generally occur in the aorta. Most aortic aneurysms occur in the section of the aorta that passes through the abdomen. These are identified as abdominal aortic aneurysms (AAAs). Frequently they occur in the part moving via the chest. These are known as thoracic aortic aneurysms.

The standard dimension of the aorta in the abdomen is related to 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 size. As a rule, as soon as you develop an AAA, it has a tendency progressively to obtain greater. The speed at which it becomes larger ranges from person to person. In spite of this, on average, an AAA tends to get larger by about 10% for each year.

What causes an abdominal aortic aneurysm? In the majority of cases The actual reason why an aneurysm figures in the aorta in most cases is not clear. Most scenarios occur in aged people. An AAA is uncommon in people under the age of 60. Therefore, growing older has a major role to play.

The wall of the aorta commonly has levels of smooth muscle mass, and layers created from tissues known as elastin and collagen. Elastin and collagen are powerful encouraging tissues. What seems to happen is that a part of the aorta loses its regular toughness and elasticity in some people as they get older. Medical studies 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 vulnerable than others to these changes.

Your hereditary make-up plays a part, as you have a significantly 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 sometimes named furring of the arteries. Most AAAs are lined with some atheroma. Any individual can develop atheroma, but it develops more often with growing age. Several risk aspects also improve the chance of atheroma growing. They include: smoking cigarettes, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that increase 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. As well, certain unusual inherited circumstances can influence the artery structure. In these abnormal situations an aneurysm may develop at a quite young age.

How typical 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 regular with raising age. Though, most people with an AAA are not aware that they have one. An AAA is unusual 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 weaker than a natural artery wall and may not be able to resist the tension 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 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 cause any symptoms except when it becomes large sufficient to put pressure on native structures. If signs or symptoms do take place, they are most likely to be mild abdominal or back painful sensations. There are many triggers of mild abdominal and back pain. Therefore, the medical diagnosis may be delayed until the aneurysm is large enough to be felt by a medical expert when he or she examines your abdomen.

From time to time small blood clots form on the inside lining of an AAA. These may break off and be taken down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be damaging. For example, full blockage of an artery that delivers 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 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 crease 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 doctor feels the bulge of an aneurysm while in a program check-up of the abdomen. However, many AAAs are too compact to feel.An X-ray of the abdomen (often performed for other reasons) will indicate calcium deposits lining the wall of an AAA in several, but not all, scenarios.An ultrasound check is the easiest way to detect an AAA. This is an uncomplicated test. It is the same kind of scan that expecting a baby 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 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, doctors need to find out this information if they prepare to operate.

What is the threat of an abdominal aortic aneurysm rupturing? The opportunity of rupture is minimal if an AAA is compact. As a rule, the risk of rupture raises with raising dimension. This is much like a balloon - the larger you blow it up, the greater the force, and the greater the probability it will burst. The dimension of an AAA can be measured by an ultrasound check. 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 improved in smokers, females, those with high blood pressure, and those with a relatives background of an AAA.

Should really everyone with an abdominal aortic aneurysm have surgery? The simple answer is no. Operative restoration of an AAA is a significant treatment and carries risks. A small amount of people will die throughout, or quickly after, the operation. If you have a small AAA, the threat of death triggered by surgical procedure is more significant than the risk of rupture. As a result, surgical procedure is often not suggested if you have an AAA less than 50 mm broad. Nevertheless, usual ultrasound scans will commonly be recommended to discover if it gets larger over time.

Surgical treatments is usually suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the threat of rupture is generally higher than the risk of surgical procedures. Even so, if your common condition of wellness is bad, or if you have certain other healthcare problems, this could raise the probability if you have surgical treatment. For that reason, in some scenarios the choice to operate could be a really difficult 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 rapid severe bleeding. Nevertheless, urgent surgery is lifesaving in some scenarios.

What procedures are performed? There are a pair of types of surgery treatment to fix an AAA.

The regular operation is to cut out the negative piece of aorta and replace it using an artificial part of artery (a graft). This is a major operations and, as mentioned, provides some risk. Some people die for the duration of this operation. Even so, it is successful in most cases and the aneurysm is totally fixed. The long-term outlook is good. The graft commonly works nicely for the rest of your life.

A modern technique allows the aorta to be fixed by a method known as endovascular repair. This has become a popular solution in current 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 widened aneurysm and fixed to the good aorta wall applying metal clips. The advantage to this type of restoration is that there is no abdominal surgery. This method is therefore safer than the classic procedure, and you need to spend less time in hospital. A negative aspect is that certain persons have to undergo a further surgery at a later stage to perfect the primary surgery.

Surgery methods keep going to develop and improve. Your surgeon will advise about the positives and disadvantages of surgery treatment, the various kinds of procedure, and the best method for you.

Other solutions could be important If you have an AAA, you are most likely to have a substantial amount of atheroma that lines the artery. For that reason, you are at threat of having significant 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 additional vascular disorders, such as a heart attack or stroke.

Therefore, you should consider doing what you can to decrease the risk of these conditions by other means. For example: 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 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 recommend that a routine ultrasound check out is worthwhile for all men aged 65. This is because most people with an AAA do not have symptoms. Following a program scan, surgical treatment can be presented 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 released 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. On the other hand, there are some people who have worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.