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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of area of the aorta that is located in the abdomen. An abdominal aortic aneurysm in most cases triggers no indicators except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually lethal. An aorta abdomen much less than 50 mm wide comes with a below average expectation of rupture. An operation to take care of the aneurysm can be advised if it is greater than 50 mm, as earlier mentioned this size the danger of rupture improves. Men aged 65 and over are to be proposed a routine scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the biggest 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 segment of an artery widens (balloons out). The wall of an aneurysm is less strong than a normal artery wall. The pressure of the blood inside of the artery triggers the weaker section of wall to balloon.

 

Aneurysms can take place in any artery, but they most commonly happen in the aorta. Most aortic aneurysms occur in the section of the aorta that moves through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). Sometimes they occur in the segment heading via the chest. These are known as thoracic aortic aneurysms.

The standard 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 booklet is mainly about AAAs.

AAAs range in dimensions. As a rule, as soon as you strengthen an AAA, it has a tendency progressively to obtain larger. The speed at which it gets larger differs from person to person. In spite of this, on average, an AAA leads to get larger by about 10% per year.

What leads to an abdominal aortic aneurysm? In most cases The particular cause why an aneurysm figures in the aorta in most cases is not clear. Most cases happen in aged people. An AAA is extraordinary in people less than the age of 60. So, growing old has a main role to play.

The wall of the aorta usually has levels of sleek muscle, and layers created 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 natural strength and elasticity in some people as they become older. Researching advises that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that cause these modifications. Some people are more susceptible than others to these changes.

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

Atheroma could additionally play a part. Atheroma is a oily material that stores within the inside of lining of arteries. Atheroma is in some cases called furring of the arteries. Most AAAs are lined with some atheroma. Any individual can develop atheroma, but it develops more commonly with raising age. Several risk variables also enhance the chance of atheroma growing. They include: tobacco use, high blood tension, 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 triggers of AAAs include injury or infection of the aorta. Additionally, certain rare inherited conditions can affect 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 gets more regular with raising age. However, most people with an AAA are not careful that they have one. An AAA is uncommon 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 natural artery wall and may not be able to resist 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 signs of an abdominal aortic aneurysm? Often 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 result in any symptoms unless of course it becomes large enough to set up force on native structures. If signs do appear, they are likely to be mild abdominal or back aches and pains. There are many factors of mild abdominal and back pain. As a result, the identification may be delayed unless the aneurysm is big enough to be felt by a medical professional when he or she examines your abdomen.

Sometimes small blood clots form on the inside lining of an AAA. These may break up off and be stocked down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be dangerous. For illustration, complete blockage of an artery that delivers a foot may lead to loss of blood to part of the foot, which can cause 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? Sometimes a medical doctor feels the bulge of an aneurysm while in a program check-up of the abdomen. However, many AAAs are too compact to feel.An X-ray of the abdomen (often executed for other purposes) will display calcium deposits lining the wall of an AAA in a few, but not all, cases.An ultrasound check is the easiest way to detect an AAA. This is a painless check. It is the identical type of capture 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 personal medical expert needs to know whether the aneurysm is impacting on 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, doctors need to know this information if they plan to operate.

What is the threat of an abdominal aortic aneurysm rupturing? The chance of rupture is low if an AAA is minimal. As a rule, the risk of rupture increases with improving size. This is much like a balloon - the larger you blow it up, the greater the pressure, and the larger the chance it will burst. The dimension of an AAA can be assessed by an ultrasound diagnostic scan. The following gives overall 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 background of an AAA.

Should everyone with an abdominal aortic aneurysm have surgery treatment? The quick answer is no. Surgery restoration of an AAA is a major treatment and provides dangers. A small number of people will die during, or quickly after, the surgery. If you have a small AAA, the threat of loss of life caused by surgery is greater than the danger of rupture. As a result, medical procedures is usually not advised if you have an AAA less than 50 mm wide. Even so, usual ultrasound tests will commonly be recommended to observe if it gets larger over time.

Medical procedures is usually advised if you develop an AAA larger than 50 mm. For these larger aneurysms the threat of rupture is normally higher than the risk of surgical procedure. Nevertheless, if your basic state of wellness is weak, or if you have specific other clinical problems, this may improve the chance if you have surgical treatment. So, in some situations the final decision to operate may be a difficult one.

Urgent situation 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 immediate significant bleeding. However, crisis surgery is lifesaving in some scenarios.

What operations are practiced? There are a pair of types of operative operation to fix an AAA.

The classic operation is to cut out the negative part of aorta and change it using an man made element of artery (a graft). This is a main procedure and, as pointed out, brings certain risk. Some people die while in this operation. Even so, it is successful in the majority of scenarios and the aneurysm is totally fixed. The long-term view is good. The graft usually works nicely for the rest of your life.

A current method lets the aorta to be repaired by a procedure known as 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 increased aneurysm and repaired to the good aorta wall using metal clips. The edge to this style of fix is that there is no abdominal surgical procedure. This tactic is thus safer than the traditional surgery, and you require to spend less time in clinic. A disadvantage is that some patients have to undergo a further operation at a later stage to perfect the primary procedure.

Medical tactics continue to develop and improve. Your surgeon will suggest about the pros and negatives of surgery treatment, the different types of procedure, and the best method for you.

Other treatment options may be important If you have an AAA, you are most likely to have a significant amount of atheroma that lines the artery. For this reason, you are at danger of having significant atheroma 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 some other vascular disorders, such as a heart harm or stroke.

Therefore, you should think about doing what you can to reduce the threat of these conditions by other suggests. For illustration: Eat a healthy diet which contains 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 analyses recommend that a program ultrasound check out is beneficial for all men aged 65. This is because most people with an AAA do not have symptoms. Following a program scan, surgery 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 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 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. However, there are some people who have concerns about screening for AAA; for example, see the paper by Johnson cited under 'References', below.