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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 usually leads to no symptoms unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually fatal. An aorta abdomen less than 50 mm broad carries a decreased risk of rupture. An operation to take care of the aneurysm may be recommended if it is larger than 50 mm, as earlier mentioned this dimension the danger of rupture improves. Individuals 65 years old and more 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 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 area of an artery widens (balloons out). The wall of an aneurysm is weaker than a normal artery wall. The pressure of the blood in the artery leads to the weaker section of wall to balloon.

 

Aneurysms can take place in any existing artery, but they most generally take place in the aorta. Most aortic aneurysms occur in the segment of the aorta that passes through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). Frequently they occur in the section going via the chest. These are known as thoracic aortic aneurysms.

The regular dimension of the aorta in the abdomen is around 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 size. As a rule, after you strengthen an AAA, it has a tendency progressively to obtain greater. The rate at which it obtains larger differs from person to person. However, on average, an AAA tends to get larger by around 10% every year.

What leads to an abdominal aortic aneurysm? In the majority of cases The actual cause why an aneurysm forms in the aorta in most cases is not well-defined. Most scenarios occur in older people. An AAA is extraordinary in people below the age of 60. Therefore, ageing has a significant factor to play.

The wall of the aorta commonly has layers of easy muscles, and layers made from tissues named elastin and collagen. Elastin and collagen are powerful assisting tissues. What seems to happen is that a part of the aorta loses its usual strength and flexibility in some people as they grow 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 processes 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 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 stores within the inside of lining of arteries. Atheroma is in some cases named furring of the arteries. Most AAAs are layered with some atheroma. Anyone can develop atheroma, but it develops more commonly with increasing age. A number of risk factors also improve the chance of atheroma developing. They include: cigarette smoking, high blood tension, 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 causes of AAAs have injury or infection of the aorta. Also, certain rare genetic conditions can affect the artery structure. In these uncommon 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 becomes more regular with increasing age. However, 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 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 warning signs of an abdominal aortic aneurysm? Usually there are no 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 unless of course it becomes large enough to set up tension on nearby structures. If signs do appear, they are possible to be mild abdominal or back aches and pains. There are many factors of mild abdominal and back pain. For this reason, the medical diagnosis may be postponed until the aneurysm is large enough to be felt by a medical expert 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 carried down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be threatening. For illustration, complete blockage of an artery that provides 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 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 doctor senses the stick out of an aneurysm during a program checking of the abdomen. However, many AAAs are too small to medium sized to feel.An X-ray of the abdomen (often performed for different causes) will indicate calcium deposits lining the wall of an AAA in some, but not almost all, situations.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is a painless test. It is the similar kind 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 doctor demands to know whether the aneurysm is affecting any of the arteries that come off the aorta. For illustration, if the aneurysm entails the section of the aorta where the arteries to the kidneys branch off, surgeons need to find out this info if they plan to operate.

What is the option of an abdominal aortic aneurysm rupturing? The chance of rupture is minimal if an AAA is compact. As a rule, the risk of rupture improves with improving sizing. This is much like a balloon - the larger you blow it up, the greater the pressure, and the larger the probability it will burst open. The size of an AAA can be measured by an ultrasound diagnostic 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.</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 family history of an AAA.

Should certainly everybody with an abdominal aortic aneurysm have surgical treatment? The simple answer is no. Medical repair of an AAA is a major procedure and includes threats. A small number of people will die while in, or quickly after, the operations. If you have a small AAA, the danger of loss of life triggered by surgery is higher than the threat of rupture. Therefore, surgical treatment is commonly not recommended if you have an AAA less than 50 mm wide. Even so, standard ultrasound scans will generally be suggested to see if it gets larger over time.

Surgical treatments is commonly advised if you develop an AAA larger than 50 mm. For these larger aneurysms the probability of rupture is often higher than the risk of surgical procedures. Nevertheless, if your common condition of health is bad, or if you have specific other health care issues, this may raise the threat if you have surgical procedure. So, in certain situations the choice to operate may be a difficult one.

Emergency surgical procedures is needed if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the rapid serious bleeding. Even so, urgent surgery is lifesaving in some scenarios.

What treatments are performed? There are two types of operative procedure to restore an AAA.

The regular surgery is to cut out the bad piece of aorta and change it using an man made element of artery (a graft). This is a main procedure and, as described, provides some threat. Some people die throughout this operation. On the other hand, it is productive in the majority of scenarios and the aneurysm is totally repaired. The long-term prospect is fine. The graft normally works well for the rest of your life.

A newer method allows the aorta to be fixed by a technique known as endovascular repair. This has become a popular solution in 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 increased aneurysm and fixed to the good aorta wall using metal clips. The edge to this style of repair is that there is no abdominal surgical procedure. This technique is thus more secure than the common surgery, and you need to spend less time in hospital. A negative aspect is that certain individuals have to undergo a further procedure at a later stage to refine the primary procedure.

Surgical tactics keep going to develop and improve. Your doctor will advise about the positives and negative aspects of surgical procedure, the different types of procedure, and the best method for you.

Other solutions may be important If you have an AAA, you are most likely to have a substantial amount of atheroma that lines the artery. For this reason, 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 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 conditions, such as a heart harm or stroke.

Therefore, you should think about doing what you can to greatly reduce the threat of these conditions by other suggests. For illustration: Eat a healthy diet which includes keeping a low salt intake.</li>If you are able, exercise regularly.</li>Lose excess weight if you are overweight.</li>Do not smoke.</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 studies propose that a program ultrasound scan is worthwhile for all men aged 65. This is because most people with an AAA do not have symptoms. Following a program scan, surgery can be presented to men found to have an aneurysm over 50 mm wide. Follow-up scans can be provided 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 typical in men than in women. One study published 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 worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.