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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of section of the aorta that is within the abdomen. An abdominal aortic aneurysm quite often causes 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 carries a below average probability of rupture. An operation to repair the aneurysm may be suggested if it is greater than 50 mm, as earlier mentioned this dimension the probability of rupture raises. Individuals aged 65 and more are to be offered a program scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the largest sized 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 healthy artery wall. The force of the blood inside of the artery leads to the weaker section of wall to balloon.

 

Aneurysms can occur in any artery, but they most generally occur in the aorta. Most aortic aneurysms arise in the segment of the aorta that passes through the abdomen. These are identified as abdominal aortic aneurysms (AAAs). In some cases they occur in the section heading via the chest. These are known as thoracic aortic aneurysms.

The natural diameter of the aorta in the abdomen is around 20 mm. An abdominal 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 leaflet is only about AAAs.

AAAs vary in dimensions. As a rule, once you develop an AAA, it tends progressively to obtain larger. The speed at which it obtains larger ranges from person to person. In spite of this, on average, an AAA leads to get larger by around 10% per year.

What causes an abdominal aortic aneurysm? In the majority of cases The exact cause why an aneurysm figures in the aorta in most cases is not well-defined. Most cases take place in aged people. An AAA is uncommon in people less than the age of 60. So, ageing has a significant factor to play.

The wall of the aorta normally has levels of sleek muscle, and layers made from tissues termed elastin and collagen. Elastin and collagen are powerful supporting 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. Medical studies suggests that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical procedures that lead to these transformations. Some people are more prone than others to these changes.

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

Atheroma could as well play a part. Atheroma is a fatty substance that stores within the inside 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 often with raising age. A number of risk variables also improve the chance of atheroma forming. They include: smoking, high blood tension, 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 causes of AAAs include injury or infection of the aorta. Additionally, certain unusual hereditary circumstances can affect the artery structure. In these uncommon situations an aneurysm may develop at a rather 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 normal with increasing age. In spite of this, most people with an AAA are not knowledgeable that they have one. An AAA is uncommon in people below 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 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 signs of an abdominal aortic aneurysm? Quite often there are no signals or 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 trigger any symptoms except when it gets large sufficient to put pressure on nearby structures. If signs or symptoms do take place, they are possible to be mild abdominal or back aches and pains. There are many causes of mild abdominal and back pain. For that reason, the diagnosis may be postponed except when the aneurysm is big enough to be felt by a doctor when he or she inspects your abdomen.

Occasionally small blood clots form on the inside lining of an AAA. These may break up off and be stocked down the aorta and block a smaller artery further on. These blood clots are called emboli and can be dangerous. For example, complete blockage of an artery that provides a foot may prospect to loss 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 generally soon followed by failure as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed? Occasionally a doctor senses the stick out of an aneurysm during a program checking of the abdomen. Nevertheless, many AAAs are too small to medium sized to feel.An X-ray of the abdomen (often executed for different causes) will display calcium deposits lining the wall of an AAA in a few, but not all, situations.An ultrasound scan is the easiest way to detect an AAA. This is a painless test. It is the identical 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 done if your personal medical expert needs to know whether the aneurysm is influencing 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, specialists need to find out this info if they prepare to operate.

What is the option of an abdominal aortic aneurysm rupturing? The chance of rupture is decreased if an AAA is minimal. As a rule, the risk of rupture increases with raising dimension. 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 dimension of an AAA can be tested by an ultrasound 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.</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 family history of an AAA.

Should certainly everyone with an abdominal aortic aneurysm have surgery? The quick answer is no. Surgical restoration of an AAA is a significant operation and includes risks. A small amount of people will die throughout, or shortly after, the surgery. If you have a small AAA, the danger of death generated by surgical procedures is greater than the risk of rupture. As a result, surgical treatment is normally not advised if you have an AAA less than 50 mm wide. However, regular ultrasound scans will normally be recommended to observe if it gets larger over time.

Surgical procedure is generally suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the risk of rupture is typically higher than the risk of medical procedures. In spite of this, if your common state of health is poor, or if you have certain other clinical conditions, this may raise the danger if you have medical procedures. So, in some cases the final decision to operate could be a hard one.

Urgent situation medical procedures is important if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the sudden significant bleeding. Even so, crisis surgery is lifesaving in some cases.

What treatments are executed? There are two types of surgical procedure to repair an AAA.

The traditional procedure is to cut out the bad part of aorta and replace it by using an synthetic element of artery (a graft). This is a main surgery and, as pointed out, brings certain risk. Some people die during this operation. Even so, it is successful in a lot of situations and the aneurysm is totally repaired. The long-term outlook is good. The graft normally works nicely for the rest of your life.

A modern procedure lets the aorta to be fixed by a procedure termed endovascular repair. This has become a popular solution in recent 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 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 tactic is therefore safer than the classic operation, and you need to spend less time in clinic. A negative aspect is that certain individuals have to undergo an additional procedure at a later stage to refine the primary procedure.

Surgery techniques keep going to develop and improve. Your doctor will suggest about the pros and negatives of surgical procedures, the different kinds of procedure, and the best solution for you.

Other solutions may be necessary If you have an AAA, you are 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 some other vascular disorders, such as a heart attack or stroke.

Therefore, you should think about doing what you can to minimize the risk of these factors by other suggests. For illustration: Eat a healthy diet which includes keeping a low salt intake.</li>If you are able, exercise often.</li>Lose 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 propose that a program ultrasound scan 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 treatment can be presented 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 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 worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.