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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 in most cases causes no warning signs unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is quite often fatal. An This external link was removed for your protection much less than 50 mm wide has a minimal chance of rupture. An operation to fix the aneurysm can be proposed if it is greater than 50 mm, as earlier mentioned this size the threat of rupture raises. Individuals 65 years old and more are to be supplied a program scan to screen for abdominal aortic aneurysm.

What is the aorta? The aorta is the largest 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 weaker than a natural artery wall. The pressure of the blood in the artery causes the weaker section of wall to balloon.

 

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

The regular dimension of the aorta in the abdomen is about 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 leaflet is mainly about AAAs.

AAAs vary in size. As a rule, when you develop an AAA, it leads progressively to obtain larger. The rate at which it obtains larger varies 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 explanation why an aneurysm figures in the aorta in most cases is not well-defined. Most cases take place in older people. An AAA is exceptional in people below the age of 60. So, ageing has a significant role to play.

The wall of the aorta normally has levels of smooth muscle, and layers created from tissues termed elastin and collagen. Elastin and collagen are powerful assisting tissues. What seems to happen is that a part of the aorta loses its standard toughness and elasticity in some people as they get older. Medical studies advises that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical procedures 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 much higher chance of getting an AAA if one of your parents has, or had, one.

Atheroma may as well play a part. Atheroma is a fatty material that stores within the inside lining of arteries. Atheroma is from time to time termed furring of the arteries. Most AAAs are lined with some atheroma. Anyone can develop atheroma, but it develops more usually with raising age. A number of risk factors also improve the chance of atheroma growing. They include: cigarette smoking, high blood tension, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that increase the probability of atheroma forming in the heart (coronary) arteries, which can cause angina and heart attacks. In a minority of cases Rare causes of AAAs include injury or infection of the aorta. In addition, certain rare genetic factors can affect the artery framework. In these uncommon situations an aneurysm may develop at a relatively young age.

How ordinary 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 typical with growing age. Though, 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 stand up to 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? Quite often there are no warnings. 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 trigger any symptoms except when it gets large enough to put force on native structures. If symptoms do happen, they are most likely to be mild abdominal or back discomfort. There are many triggers of mild abdominal and back pain. For that reason, the medical diagnosis may be postponed unless the aneurysm is large enough to be sensed by a doctor 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 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 example, complete blockage of an artery that provides a foot may prospect to reduction 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 generally soon followed by crease as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed? In some cases a doctor senses the stick out of an aneurysm during a routine exam of the abdomen. However, many AAAs are too small to feel.An X-ray of the abdomen (often executed for other purposes) will show calcium stores lining the wall of an AAA in a few, but not almost all, scenarios.An ultrasound check is the easiest way to detect an AAA. This is an uncomplicated test. It is the identical type of capture that pregnant 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 executed if your personal medical expert demands to know whether the aneurysm is influencing any of the arteries that come off the aorta. For instance, if the aneurysm involves the section of the aorta where the arteries to the kidneys branch off, doctors need to find out this info if they prepare to operate.

What is the threat of an abdominal aortic aneurysm rupturing? The chance of rupture is lower if an AAA is small. 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 force, and the higher the chance it will burst open. The size of an AAA can be assessed by an ultrasound diagnostic scan. The following gives over-all 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 relatives history of an AAA.

Should really everyone with an abdominal aortic aneurysm have surgical treatments? The simple answer is no. Surgical repair of an AAA is a major procedure and includes dangers. A small amount of people will die while in, or quickly after, the procedure. If you have a small AAA, the probability of dying triggered by surgery is higher than the danger of rupture. For that reason, surgical procedure is normally not recommended if you have an AAA less than 50 mm broad. Nevertheless, regular ultrasound tests will normally be recommended to discover if it gets larger over time.

Surgery is generally suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the risk of rupture is normally higher than the risk of surgical treatments. Nevertheless, if your basic state of health is bad, or if you have specific other health care problems, this could raise the risk if you have surgery. So, in a number of cases the final decision to operate may be a problematic one.

Urgent surgical treatment is required if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the sudden significant bleeding. However, crisis surgery is lifesaving in some scenarios.

What operations are implemented? There are a pair of types of surgery operation to fix an AAA.

The traditional surgery is to cut out the negative part of aorta and replace it using an man made piece of artery (a graft). This is a major surgery and, as described, brings some danger. Some people die for the duration of this operation. Even so, it is productive in most cases and the aneurysm is completely fixed. The long-term outlook is good. The graft generally works nicely for the rest of your life.

A current procedure allows the aorta to be fixed by a procedure known as endovascular repair. This has become a popular option in latest 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 throughout the widened aneurysm and fixed to the good aorta wall applying metal clips. The edge to this specific style of fix is that there is no abdominal surgical procedure. This method is therefore less dangerous than the common procedure, and you require to spend less time in hospital. A negative aspect is that certain individuals have to undergo a further procedure at a later stage to improve the primary surgery.

Surgical tactics keep going to develop and improve. Your doctor will recommend about the advantages and negatives of medical procedures, the different kinds 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 danger of having significant atheroma formation in other arteries, such as the coronary (heart) arteries and brain arteries. Therefore, you are likely to be at higher 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 disorders, such as a heart strike or stroke.

Therefore, you should think about doing what you can to greatly reduce the threat of these conditions by other suggests. For example: Eat a healthy diet which includes keeping a low salt intake.</li>If you are able, exercise often.</li>Lose excess 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 suggest that a routine ultrasound check is beneficial for all men aged 65. This is due to the fact 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 provided 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 study 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. However, there are some people who have concerns about screening for AAA; for example, see the paper by Johnson cited under 'References', below.