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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 leads to no warning signs unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is often fatal. An aneurisma abdominal less than 50 mm wide has a below average risk of rupture. A surgery to repair the aneurysm could be advised if it is larger than 50 mm, as previously mentioned this size the chance of rupture grows. Males 65 years old and more are to be offered a routine 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 leads to the weaker section of wall to balloon.

 

Aneurysms can occur in any existing artery, but they most typically happen 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). In some cases they occur in the segment heading through the chest. These are known as thoracic aortic aneurysms.

The natural size of the aorta in the abdomen is around 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, after you strengthen an AAA, it has a tendency progressively to get bigger. 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% 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 well-defined. Most situations happen in older people. An AAA is exceptional in people below the age of 60. Therefore, growing old has a significant factor to play.

The wall of the aorta commonly has layers of smooth muscle mass, and layers built from tissues named elastin and collagen. Elastin and collagen are powerful supporting tissues. What seems to happen is that a part of the aorta loses its normal strength and flexibility in some people as they grow older. Scientific tests advises that this is due 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 prone than others to these changes.

Your genetic 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 could additionally play a part. Atheroma is a oily substance that deposits within the inside lining of arteries. Atheroma is from time to time called furring of the arteries. Most AAAs are lined with some atheroma. Anyone can develop atheroma, but it develops more usually with growing age. Particular 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 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 have injury or infection of the aorta. In addition, certain rare genetic circumstances can influence 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 typical with increasing age. Though, most people with an AAA are not knowledgeable that they have one. An AAA is not usual 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 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 of an abdominal aortic aneurysm? Quite often there are no symptoms. 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 cause any symptoms except when it becomes large sufficient to put tension on nearby structures. If symptoms do take place, they are possible to be mild abdominal or backside painful sensations. There are many factors of mild abdominal and back pain. For that reason, the identification may be postponed except when the aneurysm is large enough to be felt by a medical professional when he or she inspects your abdomen.

In some cases small blood clots form on the inside lining of an AAA. These may break off and be transported down the aorta and block a smaller artery further on. These blood clots are called emboli and can be harmful. For instance, full blockage of an artery that supplies a foot may prospect to reduction 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.

The best way in which an abdominal aortic aneurysm is diagnosed? In some cases a medical professionsal senses the stick out of an aneurysm while in a program examination of the abdomen. Even so, many AAAs are too compact to feel.An X-ray of the abdomen (often done for different causes) will display calcium mineral stores lining the wall of an AAA in several, but not all, situations.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is a painless test. It is the same type of capture 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 medical expert demands to know whether the aneurysm is affecting any of the arteries that come off the aorta. For illustration, if the aneurysm involves the section of the aorta where the arteries to the kidneys branch off, surgeons 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 decreased if an AAA is minimal. As a rule, the risk of rupture increases with improving dimensions. This is much like a balloon - the larger you blow it up, the greater the force, and the higher the chance it will burst open. The dimension of an AAA can be measured by an ultrasound check out. 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 family history of an AAA.

Should really everybody with an abdominal aortic aneurysm have surgical treatments? The short answer is no. Medical repair of an AAA is a major operation and includes risks. A small quantity of people will die during, or shortly after, the operations. If you have a small AAA, the threat of death caused by surgical procedure is more significant than the risk of rupture. For that reason, surgical procedures is normally not recommended if you have an AAA less than 50 mm broad. Even so, usual ultrasound tests will normally be advised to see if it gets larger over time.

Medical procedures is commonly advised if you develop an AAA larger than 50 mm. For these larger aneurysms the chance of rupture is normally higher than the risk of surgical procedure. Even so, if your general state of wellness is weak, or if you have certain other clinical issues, this may improve the chance if you have medical procedures. So, in certain scenarios the choice to operate could be a not easy one.

Urgent situation surgical procedures is required if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the immediate significant bleeding. Even so, urgent surgery is lifesaving in some conditions.

What surgical procedures are implemented? There are two types of surgical treatment to fix an AAA.

The regular procedure is to cut out the negative piece of aorta and change it using an synthetic section of artery (a graft). This is a major operations and, as described, carries some threat. Some people die for the duration of this operation. However, it is effective in a lot of cases and the aneurysm is totally repaired. The long-term prospect is good. The graft generally works well for the rest of your life.

A modern procedure lets the aorta to be restored by a method termed endovascular repair. This has become a popular solution in latest 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 throughout the widened aneurysm and repaired to the good aorta wall using metal clips. The benefit to this specific type of fix is that there is no abdominal surgery. This method is thus less dangerous than the traditional surgery, and you need to spend less time in medical center. A disadvantage is that certain persons have to undergo a further procedure at a later stage to improve the initial procedure.

Surgical methods continue to develop and improve. Your surgeon will advise about the advantages and negative aspects of surgical treatment, the different forms of operation, and the best method for you.

Other solutions could be necessary If you have an AAA, you are probably to have a substantial amount of atheroma that lines the artery. For that reason, you are at probability of having substantial atheroma structure in other arteries, such as the coronary (heart) arteries and brain arteries. Therefore, you are likely to be at higher 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 conditions, such as a heart harm or stroke.

Therefore, you should think of doing what you can to decrease the risk of these disorders by other means. For example: Eat a healthy diet which includes keeping a low salt intake.</li>If you are able, exercise regularly.</li>Lose excess 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 advise that a program ultrasound check is worthwhile for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a routine diagnostic scan, surgical treatment can be provided 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 announced 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 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 concerns about screening for AAA; for example, see the paper by Johnson cited under 'References', below.