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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of section of the aorta that is located in the abdomen. An abdominal aortic aneurysm almost always causes no warning signs except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is often fatal. An abdominal aortic aneurysm much less than 50 mm wide has a decreased risk of rupture. A surgery to take care of the aneurysm may be suggested if it is larger sized than 50 mm, as previously mentioned this size the probability of rupture raises. Individuals 65 years old and more are to be proposed a program scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the largest sized 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 section of an artery widens (balloons out). The wall of an aneurysm is weaker than a healthy artery wall. The tension of the blood in the artery can cause the weaker section of wall to balloon.

 

Aneurysms might take place in any artery, but they most typically happen in the aorta. Most aortic aneurysms occur in the area of the aorta that goes through the abdomen. These are identified as abdominal aortic aneurysms (AAAs). In some cases they occur in the section moving through the chest. These are known as thoracic aortic aneurysms.

The natural diameter 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 only about AAAs.

AAAs vary in size. As a rule, once you develop an AAA, it has a tendency gradually to obtain larger. The rate at which it becomes larger ranges from person to person. However, on average, an AAA leads to get larger by around 10% for each year.

What leads to an abdominal aortic aneurysm? In the majority of cases The actual cause why an aneurysm forms in the aorta in most cases is not well-defined. Most situations take place in aged people. An AAA is uncommon in people less than the age of 60. For that reason, getting old has a main role to play.

The wall of the aorta typically has levels of smooth muscle, and layers created from tissues known as elastin and collagen. Elastin and collagen are powerful encouraging tissues. What seems to happen is that a part of the aorta loses its normal toughness and elasticity in some people as they become older. Researches suggests that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical processes that cause 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 developing an AAA if one of your parents has, or had, one.

Atheroma may as well play a part. Atheroma is a fatty substance that stores within the inside of lining of arteries. Atheroma is sometimes termed furring of the arteries. Most AAAs are lined with some atheroma. Any person can develop atheroma, but it develops more often with raising age. Certain risk variables also increase the chance of atheroma forming. They include: tobacco use, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that raise the probability of atheroma forming in the heart (coronary) arteries, which can cause angina and heart attacks. In a minority of cases Rare causes of AAAs have injury or infection of the aorta. Additionally, certain unusual genetic conditions can affect the artery framework. In these unusual situations an aneurysm may develop at a rather young age.

How common 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. However, most people with an AAA are not careful that they have one. An AAA is unusual 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 weaker than a normal artery wall and may not be able to stand up to 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 signs 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 unless of course it becomes large sufficient to set up tension on nearby structures. If symptoms do occur, they are possible to be mild abdominal or backside discomfort. There are many causes of mild abdominal and back pain. For that reason, the medical diagnosis could be delayed except when the aneurysm is big enough to be felt by a medical professional when he or she examines your abdomen.

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

How is an abdominal aortic aneurysm diagnosed? Sometimes a medical professional senses the stick out of an aneurysm throughout a program exam of the abdomen. However, many AAAs are too small to feel.An X-ray of the abdomen (often executed for other purposes) will display calcium stores lining the wall of an AAA in some, but not almost all, scenarios.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is an uncomplicated test out. It is the exact same option 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 performed if your personal medical expert requires to know whether the aneurysm is influencing 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 know this information if they plan to operate.

What is the option of an abdominal aortic aneurysm rupturing? The opportunity of rupture is decreased if an AAA is small. As a rule, the risk of rupture increases with raising size. This is much like a balloon - the larger you blow it up, the greater the pressure, and the higher the chance it will burst. The size of an AAA can be assessed by an ultrasound diagnostic scan. The following gives over-all 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 increased in smokers, females, those with high blood pressure, and those with a relatives background of an AAA.

Should really everybody with an abdominal aortic aneurysm have surgery treatment? The simple answer is no. Surgical restoration of an AAA is a major treatment and provides risks. A small quantity of people will die throughout, or quickly after, the treatment. If you have a small AAA, the risk of dying caused by surgery is more significant than the danger of rupture. For this reason, surgical procedure is often not suggested if you have an AAA less than 50 mm broad. However, usual ultrasound tests will commonly be recommended to discover if it gets larger over time.

Surgery treatment is generally advised if you develop an AAA larger than 50 mm. For these larger aneurysms the probability of rupture is usually higher than the risk of surgery treatment. Even so, if your common state of health is bad, or if you have specific other medical related conditions, this could improve the danger if you have surgical treatment. So, in several scenarios the choice to operate may be a difficult one.

Urgent medical procedures is necessary if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the unexpected serious bleeding. Nevertheless, emergency surgery is lifesaving in some cases.

What operations are practiced? There are two types of surgical procedure to repair an AAA.

The traditional procedure is to cut out the negative piece of aorta and change it using an artificial element of artery (a graft). This is a main surgery and, as described, includes certain risk. Some people die while in this operation. On the other hand, it is productive in a lot of situations and the aneurysm is 100 % fixed. The long-term prospect is fine. The graft generally works well for the rest of your life.

A current procedure makes it possible for the aorta to be repaired by a technique termed endovascular repair. This has become a popular choice in recent years. In this technique 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 using metal clips. The benefit to this style of fix is that there is no abdominal surgery. This method is thus more secure than the traditional surgery, and you need to have to spend less time in medical center. A disadvantage is that certain individuals have to undergo an additional operation at a later stage to improve the initial procedure.

Medical tactics keep going to develop and improve. Your surgeon will recommend about the positives and disadvantages of surgical treatment, the different kinds of procedure, and the best method for you.

Other treatments could be necessary If you have an AAA, you are most likely to have a substantial amount of atheroma that lines the artery. For that reason, you are at threat of having substantial atheroma formation 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 some other vascular problems, such as a heart strike or stroke.

Therefore, you should think of doing what you can to minimize the chance of these disorders by other suggests. For example: Eat a healthy diet which includes keeping a low salt intake.</li>If you are able, exercise often.</li>Lose weight if you are overweight.</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 propose that a program ultrasound scan is worthwhile for all men aged 65. This is simply because most people with an AAA do not have symptoms. Following a program 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 published in 2009 predicted that if all men in their 60s and 70s were screened in England then this could save nearly 2,000 lives a year. However, there are some people who have worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.