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Abdominal Aortic Aneurysm An abdominal aortic aneurysm is a dilation (ballooning) of part of the aorta that is inside of the abdomen. An abdominal aortic aneurysm quite often causes no signs of illness until it ruptures (bursts). A ruptured abdominal aortic aneurysm is quite often dangerous. An aneurisma abdominal less than 50 mm wide holds a minimal probability of rupture. A procedure to repair the aneurysm could be advised if it is larger than 50 mm, as earlier mentioned this size the probability of rupture grows. Males aged 65 and more are to be proposed 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 part of an artery widens (balloons out). The wall of an aneurysm is vulnerable than a normal artery wall. The tension of the blood inside the artery results in the weaker section of wall to balloon.

 

Aneurysms could occur in any existing artery, but they most generally occur in the aorta. Most aortic aneurysms take place in the section of the aorta that moves through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). In some cases they occur in the section going via the chest. These are known as thoracic aortic aneurysms.

The standard diameter of the aorta in the abdomen is related to 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 range in sizing. As a rule, as soon as you strengthen an AAA, it tends progressively to obtain greater. The rate at which it gets larger varies from person to person. In spite of this, on average, an AAA tends to get larger by about 10% for each year.

What leads to an abdominal aortic aneurysm? In most cases The particular explanation why an aneurysm figures in the aorta in most cases is not well-defined. Most instances take place in older people. An AAA is unusual in people below the age of 60. Therefore, ageing has a major role to play.

The wall of the aorta normally has layers of sleek muscle, and layers created from tissues known as elastin and collagen. Elastin and collagen are powerful encouraging tissues. What seems to happen is that a part of the aorta loses its standard toughness and elasticity in some people as they become older. Scientific tests advises that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical procedures that lead to these modifications. Some people are more susceptible than others to these changes.

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

Atheroma could additionally play a part. Atheroma is a oily substance that stores within the inside of lining of arteries. Atheroma is sometimes termed furring of the arteries. Most AAAs are lined with some atheroma. Any person can develop atheroma, but it develops more typically with increasing age. Certain risk factors 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 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 contain injury or infection of the aorta. Additionally, certain uncommon hereditary factors can influence the artery framework. In these unusual situations an aneurysm may develop at a rather 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 not usual 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 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 and 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 cause any symptoms except when it gets large sufficient to put tension on native structures. If symptoms do appear, they are most likely to be mild abdominal or back pains. There are many causes of mild abdominal and back pain. As a result, the diagnosis could be postponed until the aneurysm is large enough to be felt by a medical expert 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 taken down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be harmful. For illustration, full blockage of an artery that provides a foot may lead 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 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 professionsal feels the bulge of an aneurysm during a routine examination of the abdomen. Nevertheless, many AAAs are too small to feel.An X-ray of the abdomen (often done for other reasons) will display calcium mineral stores lining the wall of an AAA in some, but not almost all, situations.An ultrasound diagnostic scan is the easiest way to detect an AAA. This is a painless test out. It is the similar kind 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 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 information if they plan to operate.

What is the option of an abdominal aortic aneurysm rupturing? The opportunity of rupture is lower if an AAA is compact. As a rule, the risk of rupture improves with increasing measurement. This is much like a balloon - the larger you blow it up, the greater the force, and the higher the probability it will burst. The diameter of an AAA can be measured by an ultrasound diagnostic scan. The following gives over-all 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 improved in smokers, females, those with high blood pressure, and those with a family history of an AAA.

Should really everybody with an abdominal aortic aneurysm have surgery treatment? The quick answer is no. Surgery restoration of an AAA is a significant procedure and provides dangers. A small quantity of people will die during, or shortly after, the treatment. If you have a small AAA, the danger of loss of life caused by surgical procedure is greater than the threat of rupture. For that reason, surgical procedures is often not advised if you have an AAA less than 50 mm broad. However, regular ultrasound scans will generally be recommended to observe if it gets larger over time.

Surgical treatments is normally proposed if you develop an AAA larger than 50 mm. For these larger aneurysms the threat of rupture is often higher than the risk of surgery. But, if your common condition of wellness is bad, or if you have specific other health care issues, this may raise the danger if you have surgical procedure. So, in certain cases the conclusion to operate could be a not easy one.

Emergency surgical treatment is important if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the quick significant bleeding. Even so, crisis surgery is lifesaving in some conditions.

What surgical procedures are practiced? There are a pair of types of surgery procedure to repair an AAA.

The regular surgery is to cut out the negative part of aorta and change it using an man made section of artery (a graft). This is a major operations and, as described, carries certain threat. Some people die for the duration of this operation. Nevertheless, it is successful in the majority of scenarios and the aneurysm is absolutely repaired. The long-term view is good. The graft normally works nicely for the rest of your life.

A current procedure makes it possible for the aorta to be restored by a method called endovascular repair. This has become a popular choice in the latest years. In this technique 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 applying metal clips. The advantage to this type of repair is that there is no abdominal surgical procedure. This tactic is thus more secure than the common operation, and you require to spend less time in clinic. A disadvantage is that certain persons have to undergo a further surgery at a later stage to perfect the initial process.

Surgery methods continue to develop and improve. Your doctor will suggest about the pros and cons of medical procedures, the different types of procedure, and the best choice for you.

Other treatment options could be necessary If you have an AAA, you are most likely to have a significant amount of atheroma that lines the artery. Therefore, you are at threat of having substantial atheroma formation 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 think of doing what you can to greatly reduce the danger of these factors by other means. For example: Eat a healthy diet which contains 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 booklet called Preventing Cardiovascular Diseases for more details.

Screening for abdominal aortic aneurysm Research studies advise that a program ultrasound diagnostic scan is worthwhile for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a program scan, surgery can be available 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 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 study released 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 worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.