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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of segment of the aorta that is inside of the abdomen. An abdominal aortic aneurysm mostly causes no warning signs unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is quite often critical. An aorta abdominales much less than 50 mm broad carries a minimal risk of rupture. A procedure to repair the aneurysm can be proposed if it is greater than 50 mm, as previously mentioned this dimension the probability of rupture increases. Individuals aged 65 and over are to be supplied 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 part of an artery widens (balloons out). The wall of an aneurysm is weaker than a healthy artery wall. The pressure of the blood inside the artery can cause the weaker section of wall to balloon.

 

Aneurysms could occur in any artery, but they most commonly take place in the aorta. Most aortic aneurysms appear in the segment of the aorta that goes through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). In some cases they occur in the segment moving through the chest. These are known as thoracic aortic aneurysms.

The normal diameter 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 differ in size. As a rule, at the time you develop an AAA, it has a tendency progressively to get larger. The speed at which it obtains larger differs from person to person. In spite of this, on average, an AAA tends to get larger by about 10% every year.

What causes an abdominal aortic aneurysm? In most cases The actual cause why an aneurysm forms in the aorta in most cases is not clear. Most scenarios take place in older people. An AAA is uncommon in people less than the age of 60. Therefore, growing older has a significant role to play.

The wall of the aorta usually has layers of smooth muscles, and layers created from tissues known as elastin and collagen. Elastin and collagen are powerful boosting tissues. What seems to happen is that a part of the aorta loses its regular strength and elasticity in some people as they become older. Researches advises that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical procedures that trigger these changes. 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 getting an AAA if one of your parents has, or had, one.

Atheroma may additionally 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 often with increasing age. Particular risk aspects also improve the chance of atheroma forming. They include: cigarette smoking, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that increase 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. As well, certain rare hereditary circumstances can influence the artery structure. In these uncommon 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 growing 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 less strong than a normal artery wall and may not be able to withstand 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 lead to any symptoms except when it becomes large enough to put tension on nearby structures. If signs or symptoms do happen, they are most likely to be mild abdominal or backside painful sensations. There are many triggers of mild abdominal and back pain. Therefore, the identification could be delayed unless the aneurysm is big enough to be felt 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 carried down the aorta and block a smaller artery further on. These blood clots are called emboli and can be dangerous. For illustration, complete blockage of an artery that provides a foot may prospect to loss of blood to part of the foot, which can cause problems 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 commonly soon followed by crease as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed? Sometimes a medical doctor senses the stick out of an aneurysm in the course of a program checking of the abdomen. However, many AAAs are too small to medium sized to feel.An X-ray of the abdomen (often done for other purposes) will show calcium deposits lining the wall of an AAA in some, but not all, situations.An ultrasound scan is the easiest way to detect an AAA. This is an uncomplicated test out. It is the same 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 done if your current doctor demands to know whether the aneurysm is influencing 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 know this info if they plan to operate.

What is the danger of an abdominal aortic aneurysm rupturing? The chance of rupture is low if an AAA is small. As a rule, the risk of rupture increases with improving measurement. 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 size of an AAA can be measured 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.</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 increased in smokers, females, those with high blood pressure, and those with a family background of an AAA.

Should certainly everyone with an abdominal aortic aneurysm have surgical procedure? The brief answer is no. Surgical repair of an AAA is a major procedure and includes risks. A small number of people will die throughout, or right after, the surgery. If you have a small AAA, the risk of loss of life generated by surgery is more significant than the risk of rupture. For that reason, medical procedures is often not suggested if you have an AAA less than 50 mm wide. Nevertheless, regular ultrasound scans will commonly be advised to observe if it gets larger over time.

Surgical treatments is usually advised if you develop an AAA larger than 50 mm. For these larger aneurysms the risk of rupture is usually higher than the risk of surgical procedures. However, if your common condition of wellness is poor, or if you have specified other health care problems, this may improve the chance if you have surgery. So, in several situations the decision to operate could be a really difficult one.

Emergency medical 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 rapid serious bleeding. However, emergency surgery is lifesaving in some conditions.

What surgical procedures are implemented? There are 2 types of surgical procedure to repair an AAA.

The regular operation is to cut out the negative piece of aorta and swap it using an artificial piece of artery (a graft). This is a major operations and, as pointed out, provides certain threat. Some people die while in this operation. Even so, it is productive in a lot of scenarios and the aneurysm is 100 % fixed. The long-term prospect is fine. The graft usually works well for the rest of your life.

A current procedure allows the aorta to be repaired by a procedure termed endovascular repair. This has become a popular solution in current 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 fixed to the good aorta wall using metal clips. The benefit to this style of repair is that there is no abdominal surgery. This method is thus more secure than the classic procedure, and you need to spend less time in the hospital. A negative aspect is that some persons have to undergo a further operation at a later stage to refine the primary process.

Surgical methods continue to develop and improve. Your doctor will advise about the advantages and disadvantages of surgery treatment, the various forms of procedure, and the best choice for you.

Other solutions could be important If you have an AAA, you are most likely to have a significant amount of atheroma that lines the artery. As a result, you are at danger of having substantial atheroma in other arteries, such as the coronary (heart) arteries and brain arteries. Therefore, you are likely to be at enhanced 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 attack or stroke.

Therefore, you should think of doing what you can to reduce the danger of these conditions by other suggests. For illustration: Eat a healthy diet which comes with keeping a low salt intake.</li>If you are able, exercise regularly.</li>Lose weight if you are over weight.</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 leaflet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research studies propose that a routine ultrasound diagnostic scan is beneficial for all men aged 65. This is for the reason that most people with an AAA do not have symptoms. Following a program scan, surgical treatment can be available to men found to have an aneurysm over 50 mm wide. Follow-up scans can be offered to monitor those with smaller aneurysms.

In early 2008, the government announced 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 research shared 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. However, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.