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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 almost always triggers no symptoms except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually fatal. An aorta abdominales less than 50 mm wide comes with a below average risk of rupture. A surgical procedure to fix the aneurysm could be proposed if it is greater than 50 mm, as earlier mentioned this dimension the threat of rupture raises. Males 65 years old and over are to be supplied a routine scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the largest 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 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 the artery leads to the weaker section of wall to balloon.

 

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

The regular diameter of the aorta in the abdomen is related to 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 mainly about AAAs.

AAAs vary in sizing. As a rule, after you develop an AAA, it leads gradually to obtain larger. The speed at which it gets larger differs from person to person. In spite of this, on average, an AAA tends to get larger by about 10% every year.

What leads to an abdominal aortic aneurysm? In the majority of cases The exact cause why an aneurysm forms in the aorta in most cases is not clear. Most situations occur in older people. An AAA is uncommon in people under the age of 60. Therefore, growing older has a significant role to play.

The wall of the aorta normally has levels of easy muscle, and layers built from tissues termed 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 become older. Medical studies suggests that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical procedures that lead to these transformations. Some people are more susceptible than others to these changes.

Your hereditary 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 additionally play a part. Atheroma is a oily substance that stores within the inside of lining of arteries. Atheroma is in some cases called furring of the arteries. Most AAAs are layered with some atheroma. Any person can develop atheroma, but it develops more commonly with growing age. Several risk factors also improve the chance of atheroma forming. They include: tobacco use, high blood tension, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that enhance 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 include injury or infection of the aorta. As well, certain rare hereditary factors can affect the artery framework. 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 will become more normal with raising age. In spite of this, most people with an AAA are not aware that they have one. An AAA is unusual in people less than 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 withstand 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 symptoms of an abdominal aortic aneurysm? Usually there are no signals or symptoms. At the time of identification, 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 except when it becomes large sufficient to put pressure on nearby structures. If signs or symptoms do happen, they are possible to be mild abdominal or backside painful sensations. There are many factors of mild abdominal and back pain. Therefore, the identification may be postponed until the aneurysm is large enough to be felt by a medical professional when he or she inspects your abdomen.

In some cases small blood clots form on the inside lining of an AAA. These may break off and be transported down the aorta and block a smaller artery further on. These blood clots are called emboli and can be threatening. For illustration, total blockage of an artery that provides a foot may prospect 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 failure as the internal bleeding causes a sharp drop in blood pressure.

The way in which an abdominal aortic aneurysm is diagnosed? Sometimes a medical professional feels the bulge of an aneurysm in the course of a program check-up of the abdomen. However, many AAAs are too compact to feel.An X-ray of the abdomen (often performed for other causes) will indicate calcium deposits lining the wall of an AAA in a few, but not all, situations.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is an uncomplicated evaluation. It is the identical 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 performed if your personal medical expert demands to know whether the aneurysm is affecting 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 recognize this info if they plan to operate.

What is the risk of an abdominal aortic aneurysm rupturing? The opportunity of rupture is low if an AAA is small. As a rule, the risk of rupture improves with growing sizing. This is much like a balloon - the larger you blow it up, the greater the pressure, and the higher the chance it will burst open. The size of an AAA can be assessed by an ultrasound check out. The following gives general 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 improved in smokers, females, those with high blood pressure, and those with a relatives history of an AAA.

Should everybody with an abdominal aortic aneurysm have surgical treatments? The short answer is no. Surgical restoration of an AAA is a major operation and includes dangers. A small number of people will die throughout, or right after, the operations. If you have a small AAA, the risk of loss of life triggered by surgical procedure is more significant than the danger of rupture. For that reason, surgery is normally not suggested if you have an AAA less than 50 mm broad. Nevertheless, usual ultrasound scanning will commonly be suggested to discover if it gets larger over time.

Surgery treatment is commonly proposed if you develop an AAA larger than 50 mm. For these larger aneurysms the chance of rupture is generally higher than the risk of surgical treatments. But, if your general condition of health is bad, or if you have specific other clinical conditions, this may raise the threat if you have medical procedures. Therefore, in certain situations the decision to operate may be a problematic one.

Emergency 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. However, emergency surgery is lifesaving in some situations.

What procedures are performed? There are a pair of types of surgery operation to fix an AAA.

The classic surgery is to cut out the bad piece of aorta and replace it using an man made part of artery (a graft). This is a major procedure and, as described, includes certain risk. Some people die during this operation. On the other hand, it is successful in most scenarios and the aneurysm is totally repaired. The long-term prospect is fine. The graft usually works nicely for the rest of your life.

A modern procedure lets the aorta to be fixed by a method named endovascular repair. This has become a popular alternative 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 using metal clips. The edge to this specific style of fix is that there is no abdominal surgery. This method is thus more secure than the traditional procedure, and you require to spend less time in the hospital. A negative aspect is that certain persons have to undergo a further procedure at a later stage to refine the early process.

Medical tactics continue to develop and improve. Your doctor will advise about the advantages and cons of medical procedures, the different forms of procedure, and the best option for you.

Other solutions may be important If you have an AAA, you are probably to have a significant amount of atheroma that lines the artery. For that 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 some other vascular conditions, such as a heart strike or stroke.

Therefore, you should think about doing what you can to decrease the danger of these conditions by other suggests. For example: Eat a healthy diet which consists of keeping a low salt intake.</li>If you are able, exercise often.</li>Lose excess weight if you are overweight.</li>Do not smoke cigarettes.</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 analyses suggest that a program ultrasound check out is worthwhile for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a routine 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 governing administration 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 common in men than in women. One study released 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. However, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.