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Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a dilation (ballooning) of part of the aorta that is within the abdomen. An abdominal aortic aneurysm quite often leads to no indicators unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is often lethal. An abdominal aortic aneurysm less than 50 mm broad comes with a decreased expectation of rupture. A surgical procedure to repair the aneurysm can be recommended if it is larger sized than 50 mm, as earlier mentioned this dimension the risk of rupture raises. Individuals 65 years old and more are to be proposed a routine scan to screen for abdominal aortic aneurysm.

What is the aorta?

The aorta is the major 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 section of an artery widens (balloons out). The wall of an aneurysm is vulnerable than a natural artery wall. The pressure of the blood inside the artery can cause 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 appear in any artery, but they most generally take place in the aorta. Most aortic aneurysms appear in the section of the aorta that moves through the abdomen. These are known as abdominal aortic aneurysms (AAAs). In some cases they occur in the part moving via the chest. These are known as thoracic aortic aneurysms.

The regular diameter 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 only about AAAs.

AAAs differ in sizing. As a rule, when you strengthen an AAA, it leads progressively to obtain larger. The speed at which it becomes larger varies from person to person. However, on average, an AAA leads to get larger by about 10% per year.

What leads to an abdominal aortic aneurysm?

In the majority of cases

The actual explanation why an aneurysm forms in the aorta in most cases is not well-defined. Most scenarios happen in older people. An AAA is extraordinary in people less than the age of 60. Therefore, growing old has a significant role to play.

The wall of the aorta usually has levels of smooth muscle, and layers created from tissues named elastin and collagen. Elastin and collagen are strong encouraging tissues. What seems to happen is that a part of the aorta loses its natural toughness and flexibility in some people as they become older. Researching recommends that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that trigger these changes. Some people are more susceptible than others to these changes.

Your genetic make-up performs a part, as you have a significantly 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 material that stores within the inside of lining of arteries. Atheroma is sometimes termed furring of the arteries. Most AAAs are layered with some atheroma. Any individual can develop atheroma, but it develops more generally with growing age. Certain risk variables also increase the chance of atheroma growing. They include: smoking cigarettes, high blood pressure, 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 causes of AAAs contain injury or infection of the aorta. Also, certain rare inherited conditions can influence the artery structure. In these unusual situations an aneurysm may develop at a quite 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 will become more normal with increasing age. Though, most people with an AAA are not knowledgeable 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 could rupture (burst). The wall of the aneurysm is less strong than a natural artery wall and may not be able to resist 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 warning signs 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 of course it becomes large enough to put force on native structures. If signs or symptoms do happen, they are likely to be mild abdominal or backside aches and pains. There are many causes of mild abdominal and back pain. Therefore, the medical diagnosis could be delayed until the aneurysm is large enough to be felt by a medical expert when he or she examines your abdomen.

From time to time small blood clots form on the inside lining of an AAA. These may break up 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 example, full blockage of an artery that provides 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 without treatment.

If the aneurysm does rupture then you are likely to have sudden severe abdominal and/or back pain. This is commonly 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?

• Sometimes a medical professionsal feels the bulge of an aneurysm during a routine check-up of the abdomen. However, many AAAs are too small to medium sized to feel.
• An X-ray of the abdomen (often carried out for other causes) will display calcium 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 same type 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 done if your current medical expert needs to know whether the aneurysm is influencing 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, doctors need to recognize this info if they plan to operate.

What is the risk of an abdominal aortic aneurysm rupturing?

The opportunity of rupture is minimal if an AAA is small. As a rule, the risk of rupture grows with raising size. This is much like a balloon - the larger you blow it up, the greater the tension, and the greater the chance it will burst open. The size of an AAA can be tested by an ultrasound scan. 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 increased in smokers, females, those with high blood pressure, and those with a relatives historical past of an AAA.

Should everybody with an abdominal aortic aneurysm have surgery?

The quick answer is no. Surgery restoration of an AAA is a major operation and carries risks. A small quantity of people will die during, or quickly after, the operations. If you have a small AAA, the threat of loss of life triggered by surgical procedure is more significant than the danger of rupture. For that reason, surgery is normally not advised if you have an AAA less than 50 mm wide. However, regular ultrasound scans will generally be advised to discover if it gets larger over time.

Surgical procedures is generally suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the danger of rupture is often higher than the risk of surgical procedures. In spite of this, if your basic state of health is poor, or if you have specified other healthcare issues, this may improve the threat if you have surgery. So, in several cases the choice to operate may be a difficult one.

Urgent surgical procedures is important if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the immediate serious bleeding. Nevertheless, crisis surgery is lifesaving in some cases.

What treatments are practiced?

There are 2 types of medical operation to restore an AAA.

The classic operation is to cut out the negative piece of aorta and replace it with an artificial piece of artery (a graft). This is a main operations and, as mentioned, provides some threat. Some people die for the duration of this operation. Even so, it is effective in most cases and the aneurysm is fully repaired. The long-term outlook is fine. The graft normally works nicely for the rest of your life.

A current technique allows the aorta to be restored by a method called endovascular repair. This has become a popular choice in the latest years. In this procedure 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 benefit to this style of restoration is that there is no abdominal surgery. This technique is thus safer than the classic operation, and you need to have to spend less time in the hospital. A negative aspect is that certain persons have to undergo a further surgery at a later stage to refine the early procedure.

Operative tactics keep going to develop and improve. Your surgeon will suggest about the advantages and negatives of surgical procedure, the various types of surgery, and the best solution for you.

Other solutions could be necessary

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

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

• Eat a healthy diet which comes with 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 suggest that a routine ultrasound check out is worthwhile for all men aged 65. This is simply because most people with an AAA do not have symptoms. Following a routine diagnostic scan, surgery can be offered 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 governing administration released 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 common in men than in women. One study shared in 2009 estimated 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 fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.