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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 in most cases leads to no warning signs except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is quite often lethal. An aneurisma abdominal less than 50 mm wide holds a below average chance of rupture. A surgery to take care of the aneurysm may be recommended if it is greater than 50 mm, as earlier mentioned this dimension the chance of rupture increases. Individuals aged 65 and over are to be offered a program 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 less strong than a natural artery wall. The pressure of the blood inside of the artery results in the weaker section of wall to balloon.

 

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

The standard size 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 mainly about AAAs.

AAAs range in dimensions. As a rule, when you develop an AAA, it tends progressively to get greater. The speed at which it becomes larger ranges from person to person. However, on average, an AAA leads to get larger by around 10% for each year.

What leads to an abdominal aortic aneurysm? In the majority of cases The particular factor why an aneurysm forms in the aorta in most cases is not clear. Most situations happen in aged people. An AAA is exceptional in people under the age of 60. So, growing old has a major role to play.

The wall of the aorta usually has levels of easy muscle mass, and layers built from tissues termed elastin and collagen. Elastin and collagen are strong supporting tissues. What seems to happen is that a part of the aorta loses its typical toughness and flexibility in some people as they become older. Medical studies advises that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that trigger these modifications. Some people are more prone than others to these changes.

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

Atheroma could also play a part. Atheroma is a oily substance that deposits 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 generally with increasing age. A number of risk aspects also enhance the chance of atheroma developing. They include: smoking, high blood pressure, 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 factors of AAAs have injury or infection of the aorta. Additionally, certain unusual hereditary factors can affect the artery framework. In these unusual situations an aneurysm may develop at a relatively 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 normal with growing age. Though, most people with an AAA are not knowledgeable that they have one. An AAA is rare in people below 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 usual artery wall and may not be able to stand up to the pressure 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 indicators of an abdominal aortic aneurysm? Often 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 result in any symptoms except when it becomes large enough to put tension on native structures. If signs or symptoms do happen, they are likely to be mild abdominal or backside discomfort. There are many triggers of mild abdominal and back pain. Therefore, the identification may be postponed unless the aneurysm is big enough to be sensed by a medical professional when he or she inspects your abdomen.

Occasionally 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 threatening. For illustration, full blockage of an artery that provides a foot may lead to loss of blood to part of the foot, which can result in 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 normally soon followed by crease as the internal bleeding causes a sharp drop in blood pressure.

The way in which an abdominal aortic aneurysm is diagnosed? Occasionally a medical professional senses the bulge of an aneurysm throughout a program check-up of the abdomen. Even so, many AAAs are too small to feel.An X-ray of the abdomen (often executed for different reasons) will show calcium deposits lining the wall of an AAA in some, but not all, scenarios.An ultrasound scan is the easiest way to detect an AAA. This is an uncomplicated evaluation. It is the same kind 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 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 know this information if they plan to operate.

What is the threat of an abdominal aortic aneurysm rupturing? The chance of rupture is decreased if an AAA is minimal. As a rule, the risk of rupture grows with raising sizing. This is much like a balloon - the larger you blow it up, the greater the force, and the larger the probability it will burst. The dimension of an AAA can be assessed by an ultrasound check out. 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 every person with an abdominal aortic aneurysm have surgery? The brief answer is no. Medical repair of an AAA is a major operation and provides risks. A small amount of people will die throughout, or right after, the operation. If you have a small AAA, the risk of dying generated by surgical procedures is greater than the threat of rupture. As a result, surgery is often not advised if you have an AAA less than 50 mm broad. Even so, standard ultrasound tests will usually be suggested to see if it gets larger over time.

Medical procedures is usually suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the possibility of rupture is typically higher than the risk of surgical procedures. In spite of this, if your general state of wellness is poor, or if you have certain other healthcare issues, this may improve the danger if you have medical procedures. For that reason, in several situations the decision to operate could be a difficult one.

Urgent situation surgery is needed if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the quick serious bleeding. Even so, crisis surgery is lifesaving in some situations.

What treatments are implemented? There are 2 types of surgical procedure to restore an AAA.

The regular procedure is to cut out the negative part of aorta and replace it with an synthetic section of artery (a graft). This is a major operation and, as described, includes some threat. Some people die while in this operation. However, it is effective in the majority of cases and the aneurysm is fully repaired. The long-term outlook is fine. The graft usually works nicely for the rest of your life.

A modern procedure lets the aorta to be repaired by a technique named endovascular repair. This has become a popular solution in current years. In this procedure 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 restoration is that there is no abdominal surgical procedure. This tactic is therefore less dangerous than the common operation, and you require to spend less time in clinic. A disadvantage is that certain patients have to undergo a further surgery at a later stage to perfect the primary process.

Medical techniques keep going to develop and improve. Your doctor will suggest about the positives and negative aspects of medical procedures, the different forms of operation, and the best solution for you.

Other solutions may be necessary 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 probability 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 other vascular problems, such as a heart harm or stroke.

Therefore, you should consider doing what you can to minimize the chance of these disorders by other suggests. For illustration: Eat a healthy diet which consists of 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 leaflet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research analyses propose that a routine ultrasound diagnostic scan is worthwhile for all men aged 65. This is simply because most people with an AAA do not have symptoms. Following a routine scan, surgical procedure can be presented 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 government released 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 research shared 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.