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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of part of the aorta that is inside of the abdomen. An abdominal aortic aneurysm in most cases triggers no indicators until it ruptures (bursts). A ruptured abdominal aortic aneurysm is quite often fatal. An aneurisma abdominal less than 50 mm broad comes with a below average expectation of rupture. A surgical procedure to fix the aneurysm can be recommended if it is larger than 50 mm, as above this dimension the probability of rupture increases. Individuals aged 65 and more are to be proposed a program scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the biggest 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 area of an artery widens (balloons out). The wall of an aneurysm is vulnerable than a natural artery wall. The force of the blood inside of the artery can cause the weaker section of wall to balloon.

 

Aneurysms can take place in any existing artery, but they most commonly occur in the aorta. Most aortic aneurysms take place in the area of the aorta that passes through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). In some cases they occur in the segment moving via the chest. These are known as thoracic aortic aneurysms.

The typical 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 leaflet is mainly about AAAs.

AAAs range in sizing. As a rule, when you strengthen an AAA, it tends progressively to obtain bigger. The speed at which it becomes larger varies from person to person. However, on average, an AAA tends to get larger by about 10% per year.

What causes an abdominal aortic aneurysm? In most cases The actual factor why an aneurysm figures in the aorta in most cases is not clear. Most cases take place in older people. An AAA is uncommon in people under the age of 60. For that reason, growing old has a major factor to play.

The wall of the aorta commonly has levels of smooth muscle, and layers created from tissues named elastin and collagen. Elastin and collagen are powerful assisting tissues. What seems to happen is that a part of the aorta loses its typical toughness and elasticity in some people as they grow older. Medical studies advises that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that trigger these modifications. Some people are more prone than others to these changes.

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

Atheroma may additionally play a part. Atheroma is a oily substance that deposits within the inside lining of arteries. Atheroma is in some cases called furring of the arteries. Most AAAs are lined with some atheroma. Anybody can develop atheroma, but it develops more often with raising age. Several risk variables 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 factors of AAAs contain injury or infection of the aorta. Additionally, certain uncommon hereditary conditions can influence the artery structure. In these uncommon situations an aneurysm may develop at a quite 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 gets more common with raising age. Though, most people with an AAA are not careful 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 could rupture (burst). The wall of the aneurysm is less strong than a usual artery wall and may not be able to endure 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 indicators of an abdominal aortic aneurysm? Usually there are no signals or 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 lead to any symptoms except when it gets large enough to set up tension on native structures. If signs do occur, they are possible to be mild abdominal or back pains. There are many causes of mild abdominal and back pain. For that reason, the identification may be postponed except when the aneurysm is big enough to be sensed 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 harmful. For instance, full blockage of an artery that provides 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 failure as the internal bleeding causes a sharp drop in blood pressure.

The best way in which an abdominal aortic aneurysm is diagnosed? Sometimes a medical professional feels the bulge of an aneurysm while in a program checking of the abdomen. Nevertheless, many AAAs are too compact to feel.An X-ray of the abdomen (often performed for different reasons) will display calcium mineral stores 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 check. It is the similar kind of diagnostic 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 demands to know whether the aneurysm is impacting on 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 know this information if they plan to operate.

What is the threat of an abdominal aortic aneurysm rupturing? The chance of rupture is low if an AAA is compact. As a rule, the risk of rupture raises with raising sizing. This is much like a balloon - the larger you blow it up, the greater the pressure, and the higher the probability it will burst open. The size of an AAA can be assessed by an ultrasound check. 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 increased in smokers, females, those with high blood pressure, and those with a relatives history of an AAA.

Should certainly every person with an abdominal aortic aneurysm have surgical procedure? The short answer is no. Surgical restoration of an AAA is a major treatment and includes threats. A small quantity of people will die throughout, or quickly after, the operations. If you have a small AAA, the danger of loss of life caused by surgical procedures is higher than the threat of rupture. Therefore, surgical treatment is usually not advised if you have an AAA less than 50 mm broad. Even so, standard ultrasound verification will normally be suggested to see if it gets larger over time.

Surgical treatments is normally proposed if you develop an AAA larger than 50 mm. For these larger aneurysms the danger of rupture is commonly higher than the risk of surgical treatment. In spite of this, if your common condition of wellness is bad, or if you have specific other health care issues, this may improve the probability if you have surgery. For that reason, in certain scenarios the decision to operate could be a not easy one.

Emergency surgical procedure is necessary if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the sudden severe bleeding. However, urgent surgery is lifesaving in some situations.

What treatments are practiced? There are 2 types of medical procedure to repair an AAA.

The classic operation is to cut out the bad part of aorta and change it with an man made piece of artery (a graft). This is a main operation and, as described, includes certain danger. Some people die while in this operation. On the other hand, it is effective in a lot of situations and the aneurysm is 100 % fixed. The long-term view is good. The graft normally works nicely for the rest of your life.

A modern procedure lets the aorta to be restored by a technique named endovascular repair. This has become a popular alternative in current years. In this procedure a tube is passed up from inside one of the leg arteries into the section of the aneurysm. This tube is then passed throughout the widened aneurysm and repaired to the good aorta wall applying metal clips. The edge to this type of repair is that there is no abdominal surgery. This technique is thus more secure than the classic procedure, and you require to spend less time in the hospital. A negative aspect is that some persons have to undergo an additional procedure at a later stage to perfect the early surgery.

Surgery techniques keep going to develop and improve. Your surgeon will advise about the positives and disadvantages of medical procedures, the various forms of procedure, and the best choice for you.

Other solutions may be necessary If you have an AAA, you are probably to have a significant amount of atheroma that lines the artery. For that reason, you are at risk of having significant atheroma 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 some other vascular problems, such as a heart strike or stroke.

Therefore, you should think about doing what you can to minimize the risk of these conditions by other means. For illustration: Eat a healthy diet which consists of keeping a low salt intake.</li>If you are able, exercise often.</li>Lose weight if you are over weight.</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 analyses propose that a routine ultrasound diagnostic scan is beneficial for all men aged 65. This is for the reason that most people with an AAA do not have symptoms. Following a program diagnostic scan, surgery can be offered 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 authorities 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 typical in men than in women. One study 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 fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.