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Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a dilation (ballooning) of segment of the aorta that is inside of the abdomen. An abdominal aortic aneurysm almost always causes no symptoms unless it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually lethal. An aorta abdominales much less than 50 mm wide carries a minimal expectation of rupture. A surgical procedure to repair the aneurysm may be proposed if it is larger than 50 mm, as above this size the risk of rupture improves. Men 65 years old and more are to be proposed a program 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 part of an artery widens (balloons out). The wall of an aneurysm is weaker than a healthy artery wall. The tension of the blood inside of the artery leads to the weaker section of wall to balloon.

<img style="width:294px;height:270px;float:left;" src="http://www.abdominalaneurysm.net/wp-content/uploads/2012/03/AAA.gif" alt="Abdominal Aortic Aneurysm"/> <img style="width:310px;height:263px;" src="http://www.abdominalaneurysm.net/wp-content/uploads/2012/03/abdominal-aortic-aneurysm.gif" alt="Diagram showing the main arteries of the body and details of an aortic aneurysm"/>

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

The typical 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 leaflet is mainly about AAAs.

AAAs range in size. As a rule, when you strengthen an AAA, it has a tendency progressively to obtain larger sized. The speed at which it obtains larger varies from person to person. In spite of this, on average, an AAA leads to get larger by about 10% every year.

What leads to an abdominal aortic aneurysm?

In the majority of cases

The particular explanation why an aneurysm forms in the aorta in most cases is not clear. Most instances take place in older people. An AAA is unusual in people below the age of 60. So, ageing has a major factor to play.

The wall of the aorta ordinarily has layers of easy muscles, and layers created from tissues named elastin and collagen. Elastin and collagen are powerful boosting tissues. What seems to happen is that a part of the aorta loses its natural strength and flexibility in some people as they grow older. Medical studies advises that this is due to changes in the elastin, collagen and smooth muscle tissues. There seem to be complicated biochemical processes that cause these modifications. Some people are more susceptible than others to these changes.

Your genetic make-up performs a part, as you have a significantly higher chance of happening 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 layered with some atheroma. Any person can develop atheroma, but it develops more generally with raising age. Several risk factors also enhance the chance of atheroma developing. They include: cigarette smoking, high blood tension, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that enhance the probability 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 hereditary circumstances 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 will become more typical with raising age. In spite of this, most people with an AAA are not careful 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 less strong than a usual artery wall and may not be able to withstand 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 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 result in any symptoms unless it becomes large sufficient to put tension on native structures. If signs do take place, they are most likely to be mild abdominal or back aches and pains. There are many factors of mild abdominal and back pain. As a result, the diagnosis may be postponed until the aneurysm is large enough to be felt by a medical professional when he or she examines your abdomen.

Occasionally small blood clots form on the inside lining of an AAA. These may break off and be stocked down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be damaging. For instance, total blockage of an artery that delivers 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 commonly soon followed by failure as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed?

• Occasionally a medical professionsal feels the stick out of an aneurysm in the course of a routine check-up of the abdomen. However, many AAAs are too small to feel.
• An X-ray of the abdomen (often performed for different purposes) will indicate calcium mineral stores lining the wall of an AAA in some, but not all, cases.
• An ultrasound check is the easiest way to detect an AAA. This is an uncomplicated analyze. It is the exact same option of check out 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 accomplished if your current doctor requires to know whether the aneurysm is impacting on 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, specialists need to recognize this info 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 small. As a rule, the risk of rupture raises with growing dimension. This is much like a balloon - the larger you blow it up, the greater the force, and the greater the probability it will burst. The size of an AAA can be measured by an ultrasound diagnostic scan. The following gives overall risk 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.
• 60 mm-69 mm: about a 15 in 100 chance of rupture per year.
• 70 mm-79 mm: about a 35 in 100 chance of rupture per year.
• 80 mm or more: about a 50 in 100 chance of rupture per year.

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 relatives historical past of an AAA.

Should everyone with an abdominal aortic aneurysm have surgical treatments?

The short answer is no. Surgery repair of an AAA is a significant treatment and carries risks. A small amount of people will die throughout, or shortly after, the operations. If you have a small AAA, the danger of dying caused by surgical procedure is greater than the risk of rupture. Therefore, surgery is usually not advised if you have an AAA less than 50 mm broad. Nevertheless, common ultrasound verification will commonly be suggested to discover if it gets larger over time.

Medical procedures is commonly suggested if you develop an AAA larger than 50 mm. For these larger aneurysms the danger of rupture is commonly higher than the risk of surgical treatments. In spite of this, if your general state of wellness is weak, or if you have certain other healthcare problems, this may increase the probability if you have surgical treatment. Therefore, in certain scenarios the decision to operate could be a really difficult one.

Emergency surgery 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 conditions.

What procedures are performed?

There are 2 types of medical treatment to repair an AAA.

The traditional procedure is to cut out the bad piece of aorta and change it with an artificial section of artery (a graft). This is a main procedure and, as pointed out, brings certain threat. Some people die while in this operation. Nevertheless, it is successful in most situations and the aneurysm is totally fixed. The long-term outlook is fine. The graft generally works nicely for the rest of your life.

A current procedure lets the aorta to be fixed by a technique termed endovascular repair. This has become a popular alternative in the 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 repaired to the good aorta wall applying metal clips. The benefit to this specific type of fix is that there is no abdominal surgery. This tactic is therefore safer than the classic surgery, and you require to spend less time in the hospital. A disadvantage is that some individuals have to undergo an additional operation at a later stage to improve the initial surgery.

Medical methods keep going to develop and improve. Your surgeon will advise about the benefits and cons of surgery, the different kinds of procedure, and the best solution for you.

Other treatment options could be important

If you have an AAA, you are likely to have a significant amount of atheroma that lines the artery. For this reason, you are at danger of having substantial 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 conditions, such as a heart harm or stroke.

Therefore, you should think about doing what you can to decrease the threat of these factors by other suggests. For example:

• Eat a healthy diet which contains keeping a low salt intake.
• If you are able, exercise regularly.
• Lose excess weight if you are overweight.
• Do not smoke.
• If you drink alcohol, do so in moderation.
• If you have high blood pressure, diabetes, or a high cholesterol level, they should be well controlled on treatment.
• You may be prescribed a statin drug to lower your cholesterol level and low-dose aspirin to help prevent blood clots from forming.

See separate leaflet called 'Preventing Cardiovascular Diseases' for more details.

Screening for abdominal aortic aneurysm

Research analyses advise that a program ultrasound check is worthwhile for all men aged 65. This is for the reason that most people with an AAA do not have symptoms. Following a program 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 governing administration 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 study published 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. On the other hand, there are some people who have concerns about screening for AAA; for example, see the paper by Johnson cited under 'References', below.