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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 mostly causes no warning signs except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually lethal. An abdominal aortic aneurysm much less than 50 mm wide has a minimal risk of rupture. A surgical procedure to fix the aneurysm can be proposed if it is larger sized than 50 mm, as earlier mentioned this size the probability of rupture grows. Males aged 65 and more are to be supplied a routine scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the major 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 less strong than a healthy artery wall. The force of the blood inside the artery causes the weaker section of wall to balloon.

 

Aneurysms might appear in any artery, but they most typically take place in the aorta. Most aortic aneurysms arise in the segment of the aorta that moves through the abdomen. These are known as abdominal aortic aneurysms (AAAs). In some cases they occur in the part going via the chest. These are known as thoracic aortic aneurysms.

The normal diameter 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 only about AAAs.

AAAs vary in dimensions. As a rule, once you strengthen an AAA, it leads gradually to get greater. The rate at which it obtains larger differs 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 most cases The actual factor why an aneurysm forms in the aorta in most cases is not well-defined. Most scenarios occur in older people. An AAA is extraordinary in people less than the age of 60. So, getting old has a major role to play.

The wall of the aorta commonly has layers of easy muscles, and layers made from tissues known as 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. Researching suggests 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 vulnerable 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 may also play a part. Atheroma is a fatty material that stores within the inside lining of arteries. Atheroma is sometimes named furring of the arteries. Most AAAs are lined with some atheroma. Anybody can develop atheroma, but it develops more typically with growing age. Several risk variables 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 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 have injury or infection of the aorta. In addition, certain uncommon inherited conditions can affect the artery structure. In these uncommon situations an aneurysm may develop at a quite 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 gets more regular with increasing 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 natural artery wall and may not be able to resist the tension 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 symptoms of an abdominal aortic aneurysm? 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 set up pressure on native structures. If signs or symptoms do appear, they are likely to be mild abdominal or backside aches and pains. There are many factors of mild abdominal and back pain. For this reason, the diagnosis may be delayed unless the aneurysm is big enough to be sensed by a doctor when he or she examines your abdomen.

Sometimes small blood clots form on the inside lining of an AAA. These may break up off and be transported down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be damaging. For illustration, total blockage of an artery that provides a foot may lead to reduction of blood to part of the foot, which can result in problems 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? Occasionally a medical doctor feels the stick out of an aneurysm while in a routine examination of the abdomen. Even so, many AAAs are too small to medium sized to feel.An X-ray of the abdomen (often carried out for different reasons) will display calcium mineral stores lining the wall of an AAA in a few, but not all, scenarios.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is an uncomplicated test. It is the identical kind 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 doctor demands to know whether the aneurysm is impacting on any of the arteries that come off the aorta. For illustration, if the aneurysm entails the section of the aorta where the arteries to the kidneys branch off, surgeons need to recognize this information if they plan to operate.

What is the danger of an abdominal aortic aneurysm rupturing? The chance of rupture is minimal if an AAA is minimal. As a rule, the risk of rupture raises with improving measurement. This is much like a balloon - the larger you blow it up, the greater the pressure, and the greater the chance it will burst. The diameter of an AAA can be assessed by an ultrasound check out. The following gives general threat 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 relatives historical past of an AAA.

Should certainly everyone with an abdominal aortic aneurysm have surgical procedure? The quick answer is no. Medical restoration of an AAA is a significant treatment and provides threats. A small amount of people will die throughout, or quickly after, the surgery. If you have a small AAA, the danger of dying generated by surgical procedure is more significant than the threat of rupture. Therefore, surgical procedure is usually not suggested if you have an AAA less than 50 mm broad. However, regular ultrasound verification will commonly be advised to discover if it gets larger over time.

Surgery treatment is generally suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the danger of rupture is often higher than the risk of surgical procedures. Even so, if your common state of wellness is weak, or if you have certain other healthcare conditions, this may improve the probability if you have surgical procedure. For that reason, in several situations the final decision to operate could be a really difficult one.

Emergency 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 sudden severe bleeding. Even so, crisis surgery is lifesaving in some scenarios.

What procedures are executed? There are 2 types of operative operation to restore an AAA.

The regular procedure is to cut out the bad part of aorta and change it with an artificial element of artery (a graft). This is a main procedure and, as mentioned, provides some threat. Some people die throughout this operation. Nevertheless, it is effective in the majority of scenarios and the aneurysm is totally fixed. The long-term prospect is good. The graft normally works nicely for the rest of your life.

A newer technique makes it possible for the aorta to be fixed by a procedure known as endovascular repair. This has become a popular option 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 repaired to the good aorta wall using metal clips. The edge to this specific style of repair is that there is no abdominal surgical procedure. This tactic is therefore less dangerous than the standard procedure, and you need to spend less time in hospital. A disadvantage is that certain patients have to undergo an additional procedure at a later stage to refine the early process.

Operative tactics keep going to develop and improve. Your doctor will suggest about the pros and cons of medical procedures, the different types of operation, and the best solution for you.

Other solutions may be necessary If you have an AAA, you are likely to have a significant amount of atheroma that lines the artery. As a result, you are at threat of having substantial 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 harm or stroke.

Therefore, you should think of doing what you can to minimize the threat of these conditions by other means. For illustration: Eat a healthy diet which includes keeping a low salt intake.</li>If you are able, exercise often.</li>Lose excess 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 leaflet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research studies recommend that a program ultrasound check is beneficial for all men aged 65. This is due to the fact most people with an AAA do not have symptoms. Following a routine scan, surgical procedure can be presented 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 common 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. Nevertheless, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.