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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 usually causes no indicators until it ruptures (bursts). A ruptured abdominal aortic aneurysm is quite often dangerous. An aorta abdominales less than 50 mm wide has a decreased risk of rupture. A procedure to take care of the aneurysm can be recommended if it is greater than 50 mm, as previously mentioned this size the probability of rupture raises. Males aged 65 and over are to be proposed 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 vulnerable than a healthy artery wall. The tension of the blood inside of 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 occur in any artery, but they most commonly occur in the aorta. Most aortic aneurysms take place in the segment of the aorta that passes through the abdomen. These are identified 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 area of the aorta within the abdomen is 30 mm or more in diameter.

The rest of this booklet is only about AAAs.

AAAs range in dimensions. As a rule, when you strengthen an AAA, it tends progressively to obtain bigger. The speed at which it becomes larger differs from person to person. However, on average, an AAA leads to get larger by around 10% every year.

What causes an abdominal aortic aneurysm?

In most cases

The exact cause why an aneurysm forms in the aorta in most cases is not well-defined. Most scenarios happen in aged people. An AAA is rare in people below the age of 60. Therefore, growing old has a significant factor to play.

The wall of the aorta normally has levels of smooth muscle, and layers built 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 natural strength and elasticity in some people as they grow older. Scientific tests recommends that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical processes that trigger these transformations. Some people are more susceptible than others to these changes.

Your hereditary 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 could as well play a part. Atheroma is a oily substance that stores within the inside of lining of arteries. Atheroma is sometimes called furring of the arteries. Most AAAs are layered with some atheroma. Anybody can develop atheroma, but it develops more often with growing age. Certain risk variables also enhance the chance of atheroma developing. They include: smoking cigarettes, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that enhance the chance 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. In addition, certain uncommon hereditary factors can affect the artery framework. In these abnormal situations an aneurysm may develop at a quite young age.

How regularly occurring 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 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 normal artery wall and may not be able to endure the force 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?

Quite often there are no 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 lead to any symptoms unless of course it becomes large sufficient to put tension on nearby structures. If signs do take place, they are possible to be mild abdominal or back aches and pains. There are many factors of mild abdominal and back pain. Therefore, the diagnosis may be postponed until the aneurysm is big enough to be sensed by a doctor 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 taken down the aorta and block a smaller artery further on. These blood clots are called emboli and can be damaging. For illustration, full blockage of an artery that delivers a foot may prospect to loss 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 generally soon followed by collapse as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed?

• Sometimes a medical professionsal feels the stick out of an aneurysm throughout 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 done for other purposes) will show calcium stores lining the wall of an AAA in a few, but not almost all, cases.
• An ultrasound diagnostic scan is the easiest way to detect an AAA. This is an uncomplicated test. It is the identical 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 accomplished if your personal medical expert demands to know whether the aneurysm is affecting any of the arteries that come off the aorta. For instance, if the aneurysm entails the section of the aorta where the arteries to the kidneys branch off, specialists need to find out this info 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 dimension. This is much like a balloon - the larger you blow it up, the greater the tension, and the larger the chance it will burst open. The dimension of an AAA can be tested by an ultrasound scan. The following gives overall 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 improved in smokers, females, those with high blood pressure, and those with a family history of an AAA.

Should really every person with an abdominal aortic aneurysm have surgical treatment?

The simple answer is no. Surgical restoration of an AAA is a significant treatment and includes dangers. A small quantity of people will die throughout, or quickly after, the surgery. If you have a small AAA, the probability of death triggered by surgery is greater than the threat of rupture. As a result, surgical treatment is usually not suggested if you have an AAA less than 50 mm broad. Even so, regular ultrasound scans will commonly be advised to see if it gets larger over time.

Surgery is normally 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 procedures. Nevertheless, if your common state of health is bad, or if you have specified other medical conditions, this may increase the danger if you have medical procedures. So, in several situations the decision to operate could be a really difficult one.

Urgent surgical procedure is required if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the unexpected severe bleeding. Even so, urgent surgery is lifesaving in some cases.

What procedures are executed?

There are two types of operative operation to repair an AAA.

The classic procedure is to cut out the negative piece of aorta and change it using an artificial part of artery (a graft). This is a major procedure and, as mentioned, includes certain danger. Some people die throughout this operation. Even so, it is productive in most scenarios and the aneurysm is 100 % fixed. The long-term view is good. The graft usually works nicely for the rest of your life.

A modern technique allows the aorta to be fixed by a technique termed endovascular repair. This has become a popular option in current 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 increased aneurysm and fixed to the good aorta wall applying metal clips. The advantage to this type of restoration is that there is no abdominal surgery. This method is thus safer than the classic procedure, and you need to spend less time in the hospital. A disadvantage is that certain patients have to undergo an additional procedure at a later stage to improve the early surgery.

Surgical techniques keep going to develop and improve. Your surgeon will suggest about the benefits and negative aspects of surgical treatment, the different types of operation, and the best solution for you.

Other treatment options may 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 probability 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 additional vascular disorders, such as a heart attack or stroke.

Therefore, you should think about doing what you can to decrease the threat of these factors by other suggests. For illustration:

• Eat a healthy diet which contains keeping a low salt intake.
• If you are able, exercise regularly.
• Lose excess weight if you are over weight.
• Do not smoke cigarettes.
• 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 leaflet called 'Preventing Cardiovascular Diseases' for more details.

Screening for abdominal aortic aneurysm

Research studies propose that a program ultrasound check out is beneficial for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a routine scan, surgery treatment can be provided 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 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 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. Nevertheless, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.