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Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a dilation (ballooning) of area of the aorta that is inside of the abdomen. An abdominal aortic aneurysm in most cases triggers no signs of illness unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually dangerous. An abdominal aortic aneurysm less than 50 mm wide has a below average chance of rupture. A surgery to fix the aneurysm may be proposed if it is larger than 50 mm, as earlier mentioned this dimension the chance of rupture grows. Individuals 65 years old and over are to be supplied a program 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 segment of an artery widens (balloons out). The wall of an aneurysm is weaker than a normal artery wall. The pressure of the blood inside the artery can cause the weaker section of wall to balloon.

<img style="width:294px;height:270px;float:left;" src="http://www.abdominalaneurysm.net/wp-content/uploads/2012/03/AAA.gif" alt="Abdominal Aortic Aneurysm"/> <img style="width:310px;height:263px;" src="http://www.abdominalaneurysm.net/wp-content/uploads/2012/03/abdominal-aortic-aneurysm.gif" alt="Diagram showing the main arteries of the body and details of an aortic aneurysm"/>

Aneurysms could appear in any existing artery, but they most commonly occur in the aorta. Most aortic aneurysms take place in the area of the aorta that moves through the abdomen. These are identified as abdominal aortic aneurysms (AAAs). Sometimes they occur in the part heading through the chest. These are known as thoracic aortic aneurysms.

The regular size of the aorta in the abdomen is about 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 only about AAAs.

AAAs differ in measurement. As a rule, when you develop an AAA, it leads progressively to obtain larger sized. The rate at which it obtains larger varies from person to person. In spite of this, on average, an AAA leads to get larger by around 10% for each year.

What leads to an abdominal aortic aneurysm?

In most cases

The particular factor why an aneurysm figures in the aorta in most cases is not clear. Most scenarios occur in older people. An AAA is uncommon in people under the age of 60. For that reason, growing older has a main factor to play.

The wall of the aorta normally has levels of smooth muscle mass, and layers created from tissues called elastin and collagen. Elastin and collagen are powerful boosting tissues. What seems to happen is that a part of the aorta loses its typical strength and elasticity in some people as they get older. Researches suggests that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical procedures that trigger these transformations. 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 raising an AAA if one of your parents has, or had, one.

Atheroma may additionally play a part. Atheroma is a oily substance that stores within the inside of lining of arteries. Atheroma is sometimes named furring of the arteries. Most AAAs are lined with some atheroma. Anyone can develop atheroma, but it develops more often with increasing age. Several risk factors also improve the chance of atheroma developing. They include: tobacco use, 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. As well, certain uncommon inherited conditions can affect the artery structure. In these abnormal situations an aneurysm may develop at a relatively 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 will become more typical with raising age. In spite of this, 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 might 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 indicators of an abdominal aortic aneurysm?

Often there are no warnings. 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 it gets large sufficient to set up tension on native structures. If symptoms do happen, they are possible to be mild abdominal or backside discomfort. There are many causes of mild abdominal and back pain. For this reason, the identification may be postponed unless the aneurysm is big enough to be sensed by a medical expert when he or she inspects your abdomen.

Sometimes small blood clots form on the inside lining of an AAA. These may break off and be taken down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be threatening. For illustration, total blockage of an artery that supplies 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 untreated.

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?

• In some cases a doctor feels the stick out of an aneurysm during a program exam of the abdomen. Even so, many AAAs are too small to medium sized to feel.
• An X-ray of the abdomen (often performed for other reasons) will show calcium stores lining the wall of an AAA in a few, but not almost all, cases.
• An ultrasound scan is the easiest way to detect an AAA. This is a painless test out. It is the similar type 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 requires to know whether the aneurysm is influencing 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, specialists need to know this info if they plan to operate.

What is the probability of an abdominal aortic aneurysm rupturing?

The chance of rupture is lower if an AAA is compact. As a rule, the risk of rupture grows with raising sizing. This is much like a balloon - the larger you blow it up, the greater the pressure, and the larger the chance it will burst open. The diameter of an AAA can be assessed by an ultrasound 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.
• 60 mm-69 mm: about a 15 in 100 chance of rupture per year.
• 70 mm-79 mm: about a 35 in 100 chance of rupture per year.
• 80 mm or more: about a 50 in 100 chance of rupture per year.

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 every person with an abdominal aortic aneurysm have surgical treatment?

The simple answer is no. Operative repair of an AAA is a major procedure and carries threats. A small amount of people will die while in, or right after, the operations. If you have a small AAA, the threat of loss of life triggered by surgical procedure is greater than the danger of rupture. Therefore, surgical treatment is usually not suggested if you have an AAA less than 50 mm wide. Even so, regular ultrasound tests will usually be recommended to discover if it gets larger over time.

Surgical procedures is commonly proposed if you develop an AAA larger than 50 mm. For these larger aneurysms the possibility of rupture is normally higher than the risk of surgical treatments. But, if your general state of health is weak, or if you have specific other healthcare conditions, this could raise the danger if you have surgical procedure. So, in a number of cases the final decision to operate may be a really difficult one.

Urgent situation surgical treatment is important 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 cases.

What procedures are executed?

There are a pair of types of operative treatment to repair an AAA.

The classic operation is to cut out the bad piece of aorta and change it with an artificial section of artery (a graft). This is a main procedure and, as pointed out, provides certain risk. Some people die during this operation. However, it is productive in most scenarios and the aneurysm is absolutely repaired. The long-term outlook is good. The graft normally works nicely for the rest of your life.

A current method lets the aorta to be restored by a procedure called endovascular repair. This has become a popular alternative in current 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 style of restoration is that there is no abdominal surgery. This technique is thus less dangerous than the standard surgery, and you need to have to spend less time in the hospital. A negative aspect is that some patients have to undergo a further surgery at a later stage to perfect the early process.

Surgery methods continue to develop and improve. Your surgeon will suggest about the benefits and cons of surgery treatment, the various kinds of operation, and the best option for you.

Other solutions could be important

If you have an AAA, you are most likely to have a significant amount of atheroma that lines the artery. Therefore, you are at probability of having significant atheroma 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 additional vascular disorders, such as a heart harm or stroke.

Therefore, you should consider doing what you can to reduce the risk of these factors by other suggests. For example:

• Eat a healthy diet which includes keeping a low salt intake.
• If you are able, exercise regularly.
• Lose excess weight if you are overweight.
• Do not smoke.
• If you drink alcohol, do so in moderation.
• If you have high blood pressure, diabetes, or a high cholesterol level, they should be well controlled on treatment.
• You may be prescribed a statin drug to lower your cholesterol level and low-dose aspirin to help prevent blood clots from forming.

See separate booklet called 'Preventing Cardiovascular Diseases' for more details.

Screening for abdominal aortic aneurysm

Research analyses advise that a program ultrasound scan is beneficial for all men aged 65. This is because most people with an AAA do not have symptoms. Following a routine diagnostic scan, surgical treatment can be available 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 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 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 fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.