LiliaSpinner697

Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a dilation (ballooning) of area of the aorta that is within the abdomen. An abdominal aortic aneurysm in most cases triggers no signs of illness unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is often lethal. An abdominal aortic aneurysm much less than 50 mm broad comes with a minimal expectation of rupture. A surgery to repair the aneurysm may be proposed if it is larger sized than 50 mm, as earlier mentioned this size the threat of rupture increases. Males aged 65 and over are to be offered a routine 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 part of an artery widens (balloons out). The wall of an aneurysm is vulnerable than a normal artery wall. The tension of the blood in the artery results in the weaker section of wall to balloon.

<div style="text-align:center<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"/></div>

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

The typical 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 leaflet is only about AAAs.

AAAs differ in dimensions. As a rule, after you strengthen an AAA, it leads gradually to get larger. The rate at which it obtains larger differs from person to person. However, on average, an AAA tends to get larger by about 10% per year.

What leads to an abdominal aortic aneurysm?

In most cases

The actual factor why an aneurysm figures in the aorta in most cases is not well-defined. Most situations happen in older people. An AAA is rare in people less than the age of 60. Therefore, getting old has a significant role to play.

The wall of the aorta normally has levels of sleek muscle mass, and layers made from tissues named elastin and collagen. Elastin and collagen are strong supporting tissues. What seems to happen is that a part of the aorta loses its natural toughness and elasticity in some people as they become older. Medical studies advises 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 transformations. Some people are more vulnerable than others to these changes.

Your hereditary make-up plays a part, as you have a significantly higher chance of getting an AAA if one of your parents has, or had, one.

Atheroma could as well play a part. Atheroma is a oily substance that deposits within the inside of lining of arteries. Atheroma is in some cases named furring of the arteries. Most AAAs are lined with some atheroma. Anybody can develop atheroma, but it develops more typically with raising age. Particular risk variables also increase the chance of atheroma growing. They include: smoking, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that raise the chance 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. Additionally, certain unusual genetic conditions can influence the artery framework. In these abnormal situations an aneurysm may develop at a quite 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 becomes more regular with raising age. Though, most people with an AAA are not aware that they have one. An AAA is uncommon in people under 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 stand up to the force 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 of an abdominal aortic aneurysm?

Quite often there are no warnings. 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 result in any symptoms unless it becomes large enough to put force on native structures. If symptoms do occur, they are likely to be mild abdominal or backside discomfort. There are many triggers of mild abdominal and back pain. For this reason, the identification could be delayed until the aneurysm is big enough to be sensed by a doctor 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 transported down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be threatening. For instance, full blockage of an artery that provides a foot may lead to reduction 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 crease as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed?

• Occasionally a medical professional senses the stick out of an aneurysm during a routine checking of the abdomen. However, many AAAs are too small to feel.
• An X-ray of the abdomen (often done for different reasons) will indicate calcium mineral stores lining the wall of an AAA in a few, but not all, cases.
• An ultrasound diagnostic scan is the easiest way to detect an AAA. This is a painless analyze. It is the exact same type 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 accomplished if your personal doctor requires to know whether the aneurysm is affecting any of the arteries that come off the aorta. For instance, 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 prepare to operate.

What is the threat of an abdominal aortic aneurysm rupturing?

The chance of rupture is decreased if an AAA is minimal. As a rule, the risk of rupture raises with raising measurement. This is much like a balloon - the larger you blow it up, the greater the pressure, and the greater the probability it will burst. The dimension of an AAA can be assessed by an ultrasound check out. The following gives general danger 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 historical past of an AAA.

Should everyone with an abdominal aortic aneurysm have surgical treatments?

The brief answer is no. Operative repair of an AAA is a major treatment and carries dangers. A small quantity of people will die while in, or right after, the operations. If you have a small AAA, the threat of loss of life generated by surgical procedure is more significant than the danger of rupture. For that reason, surgical procedures is often not recommended if you have an AAA less than 50 mm wide. However, common ultrasound verification will normally be suggested to discover if it gets larger over time.

Surgery treatment is normally proposed 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 treatments. In spite of this, if your basic state of wellness is bad, or if you have certain other clinical issues, this may raise the chance if you have surgical treatment. Therefore, in several scenarios the final decision 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 rapid severe bleeding. Nevertheless, urgent surgery is lifesaving in some conditions.

What surgical procedures are performed?

There are two types of surgery treatment to repair an AAA.

The traditional surgery is to cut out the negative piece of aorta and change it by using an man made element of artery (a graft). This is a main surgery and, as mentioned, brings certain threat. Some people die throughout this operation. However, it is productive in the majority of cases and the aneurysm is absolutely repaired. The long-term prospect is fine. The graft usually works well for the rest of your life.

A current method lets the aorta to be restored by a method named endovascular repair. This has become a popular alternative in recent years. In this method 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 repaired to the good aorta wall using metal clips. The advantage to this style of restoration is that there is no abdominal surgery. This tactic is thus less dangerous than the traditional operation, and you need to spend less time in hospital. A negative aspect is that certain patients have to undergo a further operation at a later stage to improve the early process.

Medical techniques continue to develop and improve. Your doctor will advise about the benefits and negatives of surgical procedure, the various kinds of surgery, and the best choice for you.

Other treatments may be important

If you have an AAA, you are probably to have a significant amount of atheroma that lines the artery. Therefore, you are at risk of having significant 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 some other vascular problems, such as a heart harm or stroke.

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

• Eat a healthy diet which contains keeping a low salt intake.
• If you are able, exercise often.
• 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 analyses advise that a program ultrasound scan is worthwhile for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a program scan, surgical procedure can be available 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 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 widespread in men than in women. One research 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. Nevertheless, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.