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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of segment of the aorta that is within the abdomen. An abdominal aortic aneurysm mostly causes no warning signs until it ruptures (bursts). A ruptured abdominal aortic aneurysm is often fatal. An aorta abdomen less than 50 mm wide has a minimal expectation of rupture. An operation to repair the aneurysm will be advised if it is larger sized than 50 mm, as previously mentioned this dimension the probability of rupture raises. Males 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 less strong than a healthy artery wall. The force of the blood inside the artery leads to the weaker section of wall to balloon.

 

Aneurysms could 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 known as abdominal aortic aneurysms (AAAs). Frequently they occur in the part heading via the chest. These are known as thoracic aortic aneurysms.

The standard size of the aorta in the abdomen is related to 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 differ in sizing. As a rule, once you strengthen an AAA, it has a tendency gradually to get larger. The rate at which it obtains larger differs 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 exact cause why an aneurysm figures in the aorta in most cases is not clear. Most instances occur in older people. An AAA is unusual in people less than the age of 60. For that reason, growing old has a major role to play.

The wall of the aorta ordinarily has levels of smooth muscle, and layers built from tissues termed elastin and collagen. Elastin and collagen are strong assisting tissues. What seems to happen is that a part of the aorta loses its normal toughness and elasticity in some people as they get older. Researches recommends that this is because of 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 susceptible than others to these changes.

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

Atheroma could additionally play a part. Atheroma is a fatty material that stores within the inside of lining of arteries. Atheroma is sometimes named furring of the arteries. Most AAAs are layered with some atheroma. Any individual can develop atheroma, but it develops more often with raising age. Several risk aspects also increase the chance of atheroma developing. They include: smoking, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that increase the probability 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. As well, certain rare inherited conditions can influence the artery structure. In these unusual situations an aneurysm may develop at a relatively 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 gets more regular with growing age. In spite of this, most people with an AAA are not aware 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 weaker than a natural artery wall and may not be able to resist 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 symptoms and 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 result in any symptoms except when it gets large sufficient to put pressure on nearby structures. If symptoms do take place, they are most likely to be mild abdominal or back painful sensations. There are many causes of mild abdominal and back pain. For this reason, the diagnosis could be postponed until the aneurysm is big enough to be felt by a medical expert when he or she inspects your abdomen.

In some cases 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 threatening. For example, complete blockage of an artery that provides a foot may prospect to reduction of blood to part of the foot, which can cause 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 failure 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 doctor senses the bulge of an aneurysm while in a routine checking of the abdomen. Even so, many AAAs are too compact to feel.An X-ray of the abdomen (often carried out for different reasons) will display calcium stores lining the wall of an AAA in a few, but not almost all, situations.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is a painless test. It is the exact same option 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 executed if your personal doctor demands to know whether the aneurysm is affecting 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 find out this information if they plan to operate.

What is the option of an abdominal aortic aneurysm rupturing? The chance of rupture is low if an AAA is minimal. As a rule, the risk of rupture increases with improving dimension. This is much like a balloon - the larger you blow it up, the greater the tension, and the higher the chance it will burst open. The size of an AAA can be assessed by an ultrasound check. The following gives over-all 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 improved in smokers, females, those with high blood pressure, and those with a family historical past of an AAA.

Should certainly every person with an abdominal aortic aneurysm have surgical treatments? The brief answer is no. Surgery repair of an AAA is a major operation and carries dangers. A small number of people will die throughout, or shortly after, the treatment. If you have a small AAA, the danger of death triggered by surgical procedure is higher than the threat of rupture. Therefore, surgery is usually not advised if you have an AAA less than 50 mm wide. Even so, standard ultrasound verification will normally be advised to discover if it gets larger over time.

Surgery is generally advised 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 general condition of health is weak, or if you have certain other medical related problems, this may raise the danger if you have surgical procedure. Therefore, in a number of situations the conclusion to operate may be a difficult one.

Urgent 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. Nevertheless, urgent surgery is lifesaving in some conditions.

What treatments are performed? There are two types of surgical operation to fix an AAA.

The classic procedure is to cut out the negative part of aorta and replace it by using an synthetic section of artery (a graft). This is a major surgery and, as described, carries certain threat. Some people die throughout this operation. However, it is successful in the majority of cases and the aneurysm is 100 % repaired. The long-term outlook is fine. The graft normally works well for the rest of your life.

A newer method lets the aorta to be fixed by a procedure called endovascular repair. This has become a popular solution in the latest 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 throughout the increased aneurysm and fixed to the good aorta wall using metal clips. The benefit to this specific style of restoration is that there is no abdominal surgical procedure. This method is thus more secure than the common operation, and you require to spend less time in hospital. A negative aspect is that certain individuals have to undergo an additional operation at a later stage to perfect the initial surgery.

Surgery methods keep going to develop and improve. Your surgeon will advise about the benefits and cons of medical procedures, the various types of surgery, 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 risk of having significant atheroma formation in other arteries, such as the coronary (heart) arteries and brain arteries. Therefore, you are likely to be at improved 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 decrease the chance of these conditions 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 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 analyses recommend that a routine 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 scan, surgical procedure can be offered to men found to have an aneurysm over 50 mm wide. Follow-up scans can be offered 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 released 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. However, there are some people who have concerns about screening for AAA; for example, see the paper by Johnson cited under 'References', below.