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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of part of the aorta that is located in the abdomen. An abdominal aortic aneurysm mostly triggers no symptoms until it ruptures (bursts). A ruptured abdominal aortic aneurysm is often lethal. An abdominal aortic aneurysm less than 50 mm broad holds a below average chance of rupture. A procedure to repair the aneurysm may be proposed if it is greater than 50 mm, as above this size the threat of rupture improves. Men aged 65 and over are to be supplied a routine scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the largest sized 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 less strong than a natural artery wall. The force of the blood inside of the artery triggers the weaker section of wall to balloon.

 

Aneurysms might occur in any existing artery, but they most typically happen in the aorta. Most aortic aneurysms take place in the section of the aorta that goes through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). Frequently they occur in the area heading through the chest. These are known as thoracic aortic aneurysms.

The typical diameter of the aorta in the abdomen is around 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 booklet is only about AAAs.

AAAs vary in dimensions. As a rule, after you strengthen an AAA, it leads progressively to get bigger. The rate at which it gets larger varies from person to person. However, on average, an AAA tends to get larger by about 10% for each year.

What causes an abdominal aortic aneurysm? In the majority of cases The exact reason why an aneurysm forms in the aorta in most cases is not clear. Most scenarios take place in aged people. An AAA is rare in people less than the age of 60. So, growing old has a significant role to play.

The wall of the aorta ordinarily has levels of easy muscles, and layers created from tissues called elastin and collagen. Elastin and collagen are powerful encouraging tissues. What seems to happen is that a part of the aorta loses its normal strength and flexibility in some people as they grow older. Scientific tests suggests that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that cause these transformations. Some people are more prone than others to these changes.

Your genetic 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 also play a part. Atheroma is a fatty 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 typically with growing age. Particular risk aspects also enhance the chance of atheroma forming. They include: smoking cigarettes, high blood tension, 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 factors of AAAs contain injury or infection of the aorta. In addition, certain rare genetic circumstances can affect the artery structure. In these abnormal situations an aneurysm may develop at a rather young age.

How regularly occurring 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 typical with increasing age. Though, most people with an AAA are not aware that they have one. An AAA is not usual in people under 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 stand up to 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 warning signs of an abdominal aortic aneurysm? Quite 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 cause any symptoms except when it gets large sufficient to put tension on nearby structures. If signs or symptoms do appear, they are most likely to be mild abdominal or backside discomfort. There are many factors of mild abdominal and back pain. As a result, the diagnosis may be delayed until the aneurysm is large enough to be felt by a medical professional when he or she inspects your abdomen.

From time to time small blood clots form on the inside lining of an AAA. These may break off and be stocked down the aorta and block a smaller artery further on. These blood clots are called emboli and can be harmful. For illustration, total blockage of an artery that supplies a foot may prospect to reduction of blood to part of the foot, which can cause 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 crease as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed? Occasionally a medical doctor feels the bulge of an aneurysm in the course of a routine checking of the abdomen. However, many AAAs are too compact to feel.An X-ray of the abdomen (often carried out for other causes) will indicate calcium stores 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 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 accomplished if your personal doctor 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 know this information if they prepare to operate.

What is the option of an abdominal aortic aneurysm rupturing? The chance of rupture is lower if an AAA is minimal. As a rule, the risk of rupture grows with growing dimension. This is much like a balloon - the larger you blow it up, the greater the tension, and the higher the chance it will burst. The size of an AAA can be measured by an ultrasound diagnostic scan. The following gives overall 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 increased in smokers, females, those with high blood pressure, and those with a family historical past of an AAA.

Should really everyone with an abdominal aortic aneurysm have surgical procedures? The brief answer is no. Medical restoration of an AAA is a major procedure and carries risks. A small amount of people will die while in, or right after, the surgery. If you have a small AAA, the risk of death caused by surgical procedure is more significant than the danger of rupture. For this reason, surgical treatment is commonly not suggested if you have an AAA less than 50 mm broad. However, usual ultrasound scanning will generally be advised to observe if it gets larger over time.

Surgical treatments is normally suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the possibility of rupture is commonly higher than the risk of surgical treatment. In spite of this, if your common state of wellness is bad, or if you have certain other medical related problems, this could improve the risk if you have surgery. For that reason, in certain cases the choice to operate may be a hard 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 unexpected critical bleeding. However, emergency surgery is lifesaving in some scenarios.

What operations are executed? There are two types of operative operation to restore an AAA.

The regular procedure is to cut out the bad part of aorta and change it using an synthetic element of artery (a graft). This is a major operations and, as mentioned, includes some threat. Some people die during this operation. Even so, it is successful in the majority of cases and the aneurysm is 100 % fixed. The long-term outlook is fine. The graft generally works nicely for the rest of your life.

A newer method lets the aorta to be repaired by a method named endovascular repair. This has become a popular option in the latest 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 across the increased aneurysm and repaired to the good aorta wall using metal clips. The benefit to this specific style of fix is that there is no abdominal surgery. This method is thus less dangerous than the classic operation, and you require to spend less time in hospital. A negative aspect is that some individuals have to undergo a further surgery at a later stage to perfect the primary procedure.

Surgical techniques keep going to develop and improve. Your surgeon will advise about the pros and cons of surgical procedures, the different forms of surgery, and the best solution for you.

Other treatment options may be necessary If you have an AAA, you are most likely to have a substantial amount of atheroma that lines the artery. As a result, you are at risk of having significant 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 other vascular problems, such as a heart attack or stroke.

Therefore, you should consider doing what you can to decrease the risk of these factors by other suggests. For example: Eat a healthy diet which contains keeping a low salt intake.</li>If you are able, exercise regularly.</li>Lose excess weight if you are over weight.</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 leaflet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research analyses advise that a routine ultrasound check out is beneficial for all men aged 65. This is due to the fact most people with an AAA do not have symptoms. Following a program scan, surgical treatment can be provided 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 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 typical in men than in women. One research shared in 2009 predicted that if all men in their 60s and 70s were screened in England then this could save nearly 2,000 lives a year. Nevertheless, there are some people who have fears about screening for AAA; for example, see the paper by Johnson cited under 'References', below.