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Abdominal Aortic Aneurysm
An abdominal aortic aneurysm is a dilation (ballooning) of segment of the aorta that is located in the abdomen. An abdominal aortic aneurysm mostly triggers no indicators except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually fatal. An aneurisma abdominal less than 50 mm wide carries a low chance of rupture. An operation to take care of the aneurysm can be advised if it is larger sized than 50 mm, as above this size the threat of rupture raises. Individuals 65 years old and over are to be proposed a program 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 vulnerable than a natural artery wall. The pressure of the blood inside the artery triggers the weaker section of wall to balloon.
Aneurysms could occur in any existing artery, but they most typically happen in the aorta. Most aortic aneurysms take place in the segment of the aorta that moves through the abdomen. These are identified as abdominal aortic aneurysms (AAAs). In some cases they occur in the part heading through the chest. These are known as thoracic aortic aneurysms.
The standard dimension of the aorta in the abdomen is around 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 range in size. As a rule, when you develop an AAA, it has a tendency gradually to get larger sized. The rate at which it becomes larger varies from person to person. In spite of this, on average, an AAA leads to get larger by about 10% for each year.
What causes an abdominal aortic aneurysm?
In most cases
The particular cause why an aneurysm forms in the aorta in most cases is not well-defined. Most situations take place in older people. An AAA is exceptional in people under the age of 60. Therefore, growing old has a significant role to play.
The wall of the aorta usually has levels of smooth muscle mass, and layers made from tissues known as elastin and collagen. Elastin and collagen are powerful boosting tissues. What seems to happen is that a part of the aorta loses its usual toughness and elasticity in some people as they get older. Medical studies recommends 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 transformations. Some people are more vulnerable than others to these changes.
Your genetic 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 additionally play a part. Atheroma is a fatty substance that stores within the inside lining of arteries. Atheroma is from time to time termed furring of the arteries. Most AAAs are lined with some atheroma. Anyone can develop atheroma, but it develops more commonly with growing age. Particular risk aspects also enhance the chance of atheroma growing. They include: cigarette smoking, 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 triggers of AAAs contain injury or infection of the aorta. As well, certain uncommon inherited factors can affect the artery structure. In these uncommon situations an aneurysm may develop at a relatively 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 raising age. In spite of this, most people with an AAA are not careful that they have one. An AAA is unusual in people under 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 pressure 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 indicators of an abdominal aortic aneurysm?
Quite often there are no signals or symptoms. At the time of 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 result in any symptoms except when it gets large sufficient to put force on nearby structures. If signs or symptoms do happen, they are likely to be mild abdominal or backside pains. There are many triggers of mild abdominal and back pain. As a result, the medical diagnosis may be postponed unless the aneurysm is large enough to be sensed by a doctor 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 taken down the aorta and block a smaller artery further on. These blood clots are called emboli and can be damaging. For instance, total blockage of an artery that supplies 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 failure as the internal bleeding causes a sharp drop in blood pressure.
The best way in which an abdominal aortic aneurysm is diagnosed?
- Occasionally a medical doctor senses the stick out of an aneurysm during a routine checking of the abdomen. Even so, many AAAs are too small to feel.
- An X-ray of the abdomen (often carried out for other causes) will display calcium stores lining the wall of an AAA in some, but not all, cases.
- An ultrasound check is the easiest way to detect an AAA. This is a painless check. It is the same kind of check out 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 performed if your current doctor needs to know whether the aneurysm is influencing 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 find out this information if they prepare to operate.
What is the danger of an abdominal aortic aneurysm rupturing?
The chance of rupture is low if an AAA is compact. As a rule, the risk of rupture increases with raising dimensions. This is much like a balloon - the larger you blow it up, the greater the force, and the larger the probability it will burst open. The diameter of an AAA can be measured by an ultrasound diagnostic scan. The following gives overall 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.
- 60 mm-69 mm: about a 15 in 100 chance of rupture per year.
- 70 mm-79 mm: about a 35 in 100 chance of rupture per year.
- 80 mm or more: about a 50 in 100 chance of rupture per year.
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 history of an AAA.
Should certainly everyone with an abdominal aortic aneurysm have surgery treatment?
The quick answer is no. Medical restoration of an AAA is a major treatment and provides threats. A small quantity of people will die while in, or shortly after, the surgery. If you have a small AAA, the probability of loss of life triggered by surgery is more significant than the risk of rupture. Therefore, surgical treatment is usually not advised if you have an AAA less than 50 mm wide. Even so, usual ultrasound scanning will usually be recommended to discover if it gets larger over time.
Surgical treatments is commonly advised if you develop an AAA larger than 50 mm. For these larger aneurysms the possibility of rupture is typically higher than the risk of surgical treatments. In spite of this, if your basic condition of wellness is bad, or if you have specified other medical related problems, this may increase the probability if you have surgical procedure. So, in several cases the final decision to operate could be a difficult one.
Urgent situation surgery 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. However, crisis surgery is lifesaving in some scenarios.
What surgical procedures are implemented?
There are 2 types of operative operation to restore an AAA.
The classic surgery is to cut out the negative piece of aorta and swap it using an synthetic element of artery (a graft). This is a major surgery and, as mentioned, includes some danger. Some people die while in this operation. On the other hand, it is effective in most cases and the aneurysm is totally fixed. The long-term outlook is fine. The graft commonly works nicely for the rest of your life.
A current technique allows the aorta to be fixed by a method termed 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 across the increased aneurysm and repaired to the good aorta wall using metal clips. The advantage to this specific style of repair is that there is no abdominal surgery. This tactic is therefore less dangerous than the common operation, and you need to have to spend less time in clinic. A negative aspect is that some persons have to undergo an additional operation at a later stage to refine the early surgery.
Surgical methods continue to develop and improve. Your doctor will suggest about the pros and disadvantages of surgical procedures, the different forms of operation, and the best method for you.
Other treatment options may be necessary
If you have an AAA, you are probably to have a significant amount of atheroma that lines the artery. Therefore, 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 increased 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 conditions, such as a heart strike or stroke.
Therefore, you should think of doing what you can to reduce the danger of these disorders by other means. For illustration:
- Eat a healthy diet which includes keeping a low salt intake.
- If you are able, exercise often.
- Lose weight if you are over weight.
- Do not smoke cigarettes.
- If you drink alcohol, do so in moderation.
- If you have high blood pressure, diabetes, or a high cholesterol level, they should be well controlled on treatment.
- You may be prescribed a statin drug to lower your cholesterol level and low-dose aspirin to help prevent blood clots from forming.
See separate leaflet called 'Preventing Cardiovascular Diseases' for more details.
Screening for abdominal aortic aneurysm
Research studies suggest that a routine ultrasound check is beneficial for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a routine diagnostic scan, surgical procedure can be available to men found to have an aneurysm over 50 mm wide. Follow-up scans can be provided 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 typical in men than in women. One research published 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 fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.