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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 in most cases causes no indicators until it ruptures (bursts). A ruptured abdominal aortic aneurysm is quite often critical. An aneurisma abdominal less than 50 mm broad holds a minimal chance of rupture. A surgical procedure to take care of the aneurysm will be recommended if it is greater than 50 mm, as previously mentioned this size the danger of rupture grows. Individuals 65 years old and more are to be offered a program scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the biggest 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 weaker than a natural artery wall. The pressure of the blood inside the artery causes the weaker section of wall to balloon.

 

Aneurysms can appear in any artery, but they most commonly take place in the aorta. Most aortic aneurysms appear in the section of the aorta that goes through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). Frequently they occur in the area moving via the chest. These are known as thoracic aortic aneurysms.

The natural size of the aorta in the abdomen is related to 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 measurement. As a rule, when you develop an AAA, it leads gradually to get larger. The rate at which it obtains larger ranges from person to person. However, on average, an AAA tends to get larger by around 10% for each year.

What leads to 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 occur in older people. An AAA is extraordinary in people below the age of 60. So, growing old has a significant factor to play.

The wall of the aorta ordinarily has levels of sleek muscles, and layers built from tissues called elastin and collagen. Elastin and collagen are strong encouraging tissues. What seems to happen is that a part of the aorta loses its standard toughness and elasticity in some people as they get older. Scientific tests recommends that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that cause these modifications. Some people are more prone than others to these changes.

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

Atheroma may as well play a part. Atheroma is a oily substance that deposits within the inside lining of arteries. Atheroma is in some cases named furring of the arteries. Most AAAs are layered with some atheroma. Any individual can develop atheroma, but it develops more generally with raising age. Several risk aspects also increase the chance of atheroma forming. They include: smoking cigarettes, high blood tension, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that raise 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 have injury or infection of the aorta. As well, certain rare genetic circumstances can affect the artery structure. 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 common with growing age. In spite of this, most people with an AAA are not aware that they have one. An AAA is uncommon in people under 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 resist the force 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 warning signs of an abdominal aortic aneurysm? Quite often there are no warnings. 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 lead to any symptoms unless it gets large sufficient to put pressure on nearby structures. If symptoms do occur, they are possible to be mild abdominal or backside pains. There are many causes of mild abdominal and back pain. As a result, the identification may be postponed unless the aneurysm is big enough to be felt by a doctor when he or she inspects your abdomen.

From time to time 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 illustration, complete 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 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 crease as the internal bleeding causes a sharp drop in blood pressure.

The best way in which an abdominal aortic aneurysm is diagnosed? In some cases a medical professionsal feels the bulge of an aneurysm during a program checking of the abdomen. Even so, many AAAs are too compact to feel.An X-ray of the abdomen (often carried out for different purposes) will show calcium mineral stores lining the wall of an AAA in some, but not almost all, cases.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is a painless test. It is the similar option 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 medical expert needs to know whether the aneurysm is impacting on 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, surgeons need to know this info if they prepare to operate.

What is the chance of an abdominal aortic aneurysm rupturing? The opportunity of rupture is decreased if an AAA is compact. As a rule, the risk of rupture grows with increasing dimension. This is much like a balloon - the larger you blow it up, the greater the tension, and the greater the chance it will burst. The size of an AAA can be assessed by an ultrasound check. The following gives over-all 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 relatives historical past of an AAA.

Should everyone with an abdominal aortic aneurysm have surgery treatment? The short answer is no. Surgical restoration of an AAA is a significant procedure and provides risks. A small number of people will die throughout, or right after, the surgery. If you have a small AAA, the probability of death generated by surgery is higher than the risk of rupture. For this reason, surgery is normally not advised if you have an AAA less than 50 mm broad. Even so, standard ultrasound scanning will commonly be suggested to discover if it gets larger over time.

Medical procedures is normally recommended if you develop an AAA larger than 50 mm. For these larger aneurysms the danger of rupture is normally higher than the risk of surgical procedures. Even so, if your common state of health is bad, or if you have specified other health care issues, this may increase the chance if you have medical procedures. Therefore, in some cases the conclusion to operate may be a hard one.

Emergency surgical treatment 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 critical bleeding. Even so, crisis surgery is lifesaving in some conditions.

What treatments are practiced? There are a pair of types of operative operation to restore an AAA.

The traditional operation is to cut out the bad piece of aorta and replace it by using an synthetic element of artery (a graft). This is a major operation and, as pointed out, includes some threat. Some people die for the duration of this operation. On the other hand, it is productive in most cases and the aneurysm is fully fixed. The long-term outlook is fine. The graft generally works well for the rest of your life.

A newer procedure makes it possible for the aorta to be restored by a method named endovascular repair. This has become a popular option 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 increased aneurysm and repaired to the good aorta wall using metal clips. The benefit to this style of fix is that there is no abdominal surgical procedure. This tactic is thus more secure than the standard operation, and you need to spend less time in medical center. A negative aspect is that some persons have to undergo a further procedure at a later stage to improve the early process.

Surgery techniques keep going to develop and improve. Your doctor will suggest about the positives and disadvantages of surgical treatment, the various types of procedure, and the best method for you.

Other solutions could be necessary If you have an AAA, you are likely to have a substantial amount of atheroma that lines the artery. For this reason, you are at danger of having substantial atheroma 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 other vascular problems, such as a heart strike or stroke.

Therefore, you should think of doing what you can to decrease the danger of these factors by other means. For illustration: Eat a healthy diet which comes with keeping a low salt intake.</li>If you are able, exercise regularly.</li>Lose weight if you are overweight.</li>Do not smoke.</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 out is worthwhile for all men aged 65. This is due to the fact 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 governing administration 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 determined 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.