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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of part of the aorta that is located in the abdomen. An abdominal aortic aneurysm quite often triggers no symptoms until it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually dangerous. An abdominal aortic aneurysm much less than 50 mm wide has a low probability of rupture. A surgery to fix the aneurysm may be advised if it is greater than 50 mm, as above this size the danger of rupture raises. Individuals 65 years old and more are to be supplied a program scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the most significant 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 part 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 could take place in any artery, but they most commonly occur in the aorta. Most aortic aneurysms occur 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 area heading through the chest. These are known as thoracic aortic aneurysms.

The standard dimension of the aorta in the abdomen is about 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 leaflet is mainly about AAAs.

AAAs differ in size. As a rule, as soon as you strengthen an AAA, it has a tendency gradually to get larger sized. The speed at which it gets larger ranges 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 the majority of cases The actual cause why an aneurysm figures in the aorta in most cases is not clear. Most scenarios happen in older people. An AAA is unusual in people less than the age of 60. For that reason, growing older has a major role to play.

The wall of the aorta ordinarily has levels of easy muscle mass, and layers built from tissues named elastin and collagen. Elastin and collagen are powerful encouraging tissues. What seems to happen is that a part of the aorta loses its natural strength and elasticity in some people as they become older. Scientific tests advises that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical procedures that trigger these changes. Some people are more vulnerable than others to these changes.

Your hereditary 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 deposits within the inside lining of arteries. Atheroma is sometimes termed furring of the arteries. Most AAAs are layered with some atheroma. Any person can develop atheroma, but it develops more often with increasing age. A number of risk aspects also improve the chance of atheroma developing. They include: smoking, high blood tension, 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 triggers of AAAs have injury or infection of the aorta. Additionally, certain rare genetic circumstances can affect the artery structure. In these unusual situations an aneurysm may develop at a rather young age.

How typical 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 regular with growing age. However, most people with an AAA are not aware that they have one. An AAA is not usual 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 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 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 enough to set up force on native structures. If symptoms do occur, they are possible to be mild abdominal or backside painful sensations. There are many causes of mild abdominal and back pain. For this reason, the medical diagnosis may be postponed except when the aneurysm is large enough to be sensed 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 harmful. For instance, complete blockage of an artery that provides a foot may lead to reduction of blood to part of the foot, which can result in pain in the foot and gangrene if left untreated.

If the aneurysm does rupture then you are likely to have sudden severe abdominal and/or back pain. This is normally 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? Sometimes a medical professional feels the stick out of an aneurysm while in a routine exam of the abdomen. However, many AAAs are too small to feel.An X-ray of the abdomen (often done for other causes) will show calcium mineral deposits lining the wall of an AAA in some, but not almost all, situations.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is an uncomplicated check. It is the similar option of check out 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 executed if your current doctor needs to know whether the aneurysm is impacting on any of the arteries that come off the aorta. For example, if the aneurysm involves the section of the aorta where the arteries to the kidneys branch off, specialists need to know this information if they prepare to operate.

What is the risk of an abdominal aortic aneurysm rupturing? The opportunity of rupture is lower if an AAA is compact. 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 force, and the greater the probability it will burst. The size of an AAA can be tested by an ultrasound check. 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 family history of an AAA.

Should certainly everybody with an abdominal aortic aneurysm have surgical procedures? The simple answer is no. Surgical restoration of an AAA is a major treatment and includes threats. A small quantity of people will die while in, or right after, the operations. If you have a small AAA, the risk of dying caused by surgical procedures is higher than the danger of rupture. Therefore, surgical procedures is usually not advised if you have an AAA less than 50 mm wide. Nevertheless, regular ultrasound tests will usually 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 chance of rupture is typically higher than the risk of surgical treatments. Nevertheless, if your basic state of wellness is bad, or if you have specified other medical related problems, this may improve the threat if you have surgical procedure. Therefore, in several scenarios the decision to operate could 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 quick serious bleeding. Nevertheless, urgent surgery is lifesaving in some situations.

What surgical procedures are implemented? There are 2 types of surgical procedure to fix an AAA.

The regular procedure is to cut out the bad piece of aorta and swap it by using an synthetic part of artery (a graft). This is a major surgery and, as described, carries some risk. Some people die during this operation. Even so, it is productive in most scenarios and the aneurysm is fully repaired. The long-term outlook is good. The graft commonly works well for the rest of your life.

A current procedure lets the aorta to be fixed by a method called endovascular repair. This has become a popular option in latest years. In this technique a tube is passed up from inside one of the leg arteries into the area of the aneurysm. This tube is then passed throughout the widened aneurysm and fixed to the good aorta wall using metal clips. The advantage to this type of repair is that there is no abdominal surgical procedure. This tactic is therefore less dangerous than the standard procedure, and you require to spend less time in the hospital. A disadvantage is that some patients have to undergo an additional procedure at a later stage to perfect the early surgery.

Surgical tactics keep going to develop and improve. Your surgeon will advise about the benefits and negatives of surgical procedure, the different forms of operation, and the best solution for you.

Other treatment options could be necessary If you have an AAA, you are most likely to have a significant amount of atheroma that lines the artery. For this reason, you are at danger of having substantial atheroma structure 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 other vascular problems, such as a heart harm or stroke.

Therefore, you should consider doing what you can to greatly reduce the chance of these disorders by other suggests. For illustration: Eat a healthy diet which comes with keeping a low salt intake.</li>If you are able, exercise regularly.</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 booklet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research studies propose that a routine ultrasound scan is worthwhile for all men aged 65. This is for the reason that 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 offered to monitor those with smaller aneurysms.

In early 2008, the authorities 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 typical in men than in women. One research published 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. On the other hand, there are some people who have worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.