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Contenido 1 Abdominal Aortic Aneurysm 1.1 What is the aorta? 1.2 What is an aneurysm and an abdominal aortic aneurysm? 1.3 What causes an abdominal aortic aneurysm? 1.3.1 In most cases 1.3.2 In a minority of cases 1.4 How typical are abdominal aortic aneurysms? 1.5 What is the concern about an abdominal aortic aneurysm? 1.6 What are the indicators of an abdominal aortic aneurysm? 1.7 How is an abdominal aortic aneurysm diagnosed? 1.8 What is the chance of an abdominal aortic aneurysm rupturing? 1.9 Should certainly everyone with an abdominal aortic aneurysm have surgical treatments? 1.10 What procedures are practiced? 1.11 Other solutions could be important 1.12 Screening for abdominal aortic aneurysm

Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a dilation (ballooning) of segment of the aorta that is located in the abdomen. An abdominal aortic aneurysm usually leads to no signs of illness except when it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually critical. An aorta abdomen much less than 50 mm wide has a below average expectation of rupture. An operation to fix the aneurysm can be advised if it is greater than 50 mm, as earlier mentioned this size the risk of rupture grows. Men 65 years old 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 section of an artery widens (balloons out). The wall of an aneurysm is less strong than a healthy artery wall. The tension of the blood inside the artery can cause the weaker section of wall to balloon.

Aneurysms can occur in any existing artery, but they most commonly take place in the aorta. Most aortic aneurysms occur in the area of the aorta that moves through the abdomen. These are recognized as abdominal aortic aneurysms (AAAs). Sometimes they occur in the segment moving through the chest. These are known as thoracic aortic aneurysms.

The natural size 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 leaflet is only about AAAs.

AAAs range in size. As a rule, at the time you strengthen an AAA, it tends gradually to obtain larger sized. The speed at which it becomes larger differs from person to person. However, on average, an AAA tends to get larger by around 10% per year.

What causes an abdominal aortic aneurysm?

In most cases

The particular factor why an aneurysm figures in the aorta in most cases is not clear. Most instances occur in aged people. An AAA is unusual in people under the age of 60. For that reason, getting old has a main role to play.

The wall of the aorta ordinarily has levels of sleek muscle, and layers created from tissues termed elastin and collagen. Elastin and collagen are strong encouraging tissues. What seems to happen is that a part of the aorta loses its usual strength and flexibility in some people as they become older. Medical studies recommends that this is because of to changes in the elastin, collagen and smooth muscle tissues. There seem to be difficult biochemical processes that cause these changes. Some people are more vulnerable than others to these changes.

Your genetic make-up plays a part, as you have a considerably 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 substance that deposits within the inside of lining of arteries. Atheroma is sometimes termed furring of the arteries. Most AAAs are lined with some atheroma. Anyone can develop atheroma, but it develops more typically with raising age. Particular risk factors also increase 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 probability of atheroma forming in the heart (coronary) arteries, which can cause angina and heart attacks.

In a minority of cases

Rare triggers of AAAs include injury or infection of the aorta. In addition, certain unusual inherited factors can affect 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 becomes more regular with raising age. Though, most people with an AAA are not careful that they have one. An AAA is not usual in people less than 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 weaker than a normal artery wall and may not be able to stand up to the pressure 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 indicators of an abdominal aortic aneurysm?

Quite 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 cause any symptoms unless it becomes large enough to put pressure on native structures. If symptoms do take place, 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 delayed until the aneurysm is big enough to be sensed 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 up off and be stocked down the aorta and obstruct a smaller artery further on. These blood clots are called emboli and can be harmful. For instance, complete 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 without treatment.

If the aneurysm does rupture then you are likely to have sudden severe abdominal and/or back pain. This is generally soon followed by failure as the internal bleeding causes a sharp drop in blood pressure.

How is an abdominal aortic aneurysm diagnosed?

• Sometimes a medical doctor senses the stick out of an aneurysm in the course of a routine checking of the abdomen. Even so, many AAAs are too compact to feel.
• An X-ray of the abdomen (often carried out for other causes) will show calcium mineral stores lining the wall of an AAA in a few, but not all, situations.
• An ultrasound check is the easiest way to detect an AAA. This is an uncomplicated analyze. 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 accomplished if your medical expert demands to know whether the aneurysm is affecting any of the arteries that come off the aorta. For illustration, if the aneurysm involves the section of the aorta where the arteries to the kidneys branch off, surgeons need to find out this info if they plan to operate.

What is the chance of an abdominal aortic aneurysm rupturing?

The chance of rupture is low if an AAA is small. 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 tension, and the greater the chance it will burst open. The size of an AAA can be assessed by an ultrasound 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 certainly everyone with an abdominal aortic aneurysm have surgical treatments?

The simple answer is no. Surgery repair of an AAA is a significant treatment and includes dangers. A small amount of people will die while in, or right after, the treatment. If you have a small AAA, the danger of death generated by surgical procedure is greater than the risk of rupture. As a result, medical procedures is normally not suggested if you have an AAA less than 50 mm broad. Even so, standard ultrasound scanning will generally be suggested to observe if it gets larger over time.

Surgical procedure is normally advised if you develop an AAA larger than 50 mm. For these larger aneurysms the probability of rupture is usually higher than the risk of surgery treatment. Nevertheless, if your general condition of wellness is poor, or if you have specified other medical related conditions, this could raise the threat if you have surgery. For that reason, in a number of situations the decision to operate could be a problematic one.

Emergency surgical procedure is needed if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the unexpected significant bleeding. Nevertheless, urgent surgery is lifesaving in some conditions.

What procedures are practiced?

There are two types of surgical treatment to repair an AAA.

The classic surgery is to cut out the bad piece of aorta and swap it using an synthetic piece of artery (a graft). This is a main procedure and, as pointed out, brings certain danger. Some people die during this operation. Even so, it is successful in the majority of situations and the aneurysm is fully repaired. The long-term view is good. The graft usually works well for the rest of your life.

A newer procedure makes it possible for the aorta to be repaired by a technique called 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 section of the aneurysm. This tube is then passed throughout the widened aneurysm and fixed to the good aorta wall using metal clips. The advantage to this style of repair is that there is no abdominal surgical procedure. This tactic is thus less dangerous than the classic procedure, and you need to spend less time in clinic. A negative aspect is that certain individuals have to undergo a further operation at a later stage to perfect the initial procedure.

Medical methods keep going to develop and improve. Your doctor will suggest about the advantages and negatives of surgical procedure, the different types of procedure, and the best solution for you.

Other solutions could be important

If you have an AAA, you are likely to have a substantial amount of atheroma that lines the artery. Therefore, you are at danger of having significant atheroma structure 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 some other vascular disorders, such as a heart attack or stroke.

Therefore, you should consider doing what you can to reduce the threat of these disorders by other suggests. For example:

• Eat a healthy diet which comes with keeping a low salt intake.
• If you are able, exercise often.
• Lose excess weight if you are over weight.
• Do not smoke cigarettes.
• 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 suggest that a routine ultrasound scan is worthwhile for all men aged 65. This is for the reason that 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 offered 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 published 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. 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.