Inhaltsverzeichnis

1 Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a dilation (ballooning) of section of the aorta that is within the abdomen. An abdominal aortic aneurysm in most cases causes no warning signs until it ruptures (bursts). A ruptured abdominal aortic aneurysm is usually critical. An aneurisma aortico less than 50 mm wide holds a below average chance of rupture. A surgery to repair the aneurysm will be suggested if it is greater than 50 mm, as previously mentioned this size the chance of rupture increases. Men aged 65 and more are to be supplied a routine scan to screen for abdominal aortic aneurysm.

What is the aorta?

The aorta is the most significant 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 area of an artery widens (balloons out). The wall of an aneurysm is weaker than a natural artery wall. The force of the blood inside the artery leads to the weaker section of wall to balloon.

Aneurysms might appear in any existing artery, but they most typically take place in the aorta. Most aortic aneurysms arise in the section of the aorta that moves through the abdomen. These are known as abdominal aortic aneurysms (AAAs). Sometimes they occur in the section moving through the chest. These are known as thoracic aortic aneurysms.

The standard dimension of the aorta in the abdomen is related to 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 booklet is only about AAAs.

AAAs range in size. As a rule, once you strengthen an AAA, it has a tendency progressively to get larger. The rate at which it obtains larger ranges 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 the majority of cases

The actual cause why an aneurysm figures in the aorta in most cases is not clear. Most situations happen in older people. An AAA is rare in people below the age of 60. For that reason, ageing has a major role to play.

The wall of the aorta typically has levels of sleek muscles, and layers made 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 normal strength and elasticity in some people as they grow 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 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 could also play a part. Atheroma is a oily material that stores within the inside of lining of arteries. Atheroma is in some cases called furring of the arteries. Most AAAs are lined with some atheroma. Anybody can develop atheroma, but it develops more commonly with increasing age. Several risk aspects also enhance the chance of atheroma developing. They include: cigarette smoking, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that raise 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 contain injury or infection of the aorta. In addition, certain unusual inherited circumstances can influence the artery structure. In these uncommon situations an aneurysm may develop at a quite 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 will become more regular with raising 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 might rupture (burst). The wall of the aneurysm is weaker than a natural artery wall and may not be able to withstand 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 symptoms and signs of an abdominal aortic aneurysm?

Quite often there are no signals or symptoms. At the time of diagnosis, 7 in 10 people with an AAA will not have had any symptoms due to the aneurysm. The ballooning of the aneurysm does not lead to any symptoms unless of course it gets large enough to put pressure on nearby structures. If symptoms do appear, they are most likely to be mild abdominal or back discomfort. There are many causes of mild abdominal and back pain. As a result, the identification may be postponed except when the aneurysm is large enough to be felt by a medical professional when he or she inspects your abdomen.

Sometimes 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 dangerous. For example, full blockage of an artery that delivers a foot may prospect to reduction 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 best way in which an abdominal aortic aneurysm is diagnosed?

Sometimes a medical doctor feels the stick out of an aneurysm during a routine exam of the abdomen. Even so, many AAAs are too small to medium sized to feel.
An X-ray of the abdomen (often carried out for other causes) will show calcium stores lining the wall of an AAA in a few, but not almost all, cases.
An ultrasound check is the easiest way to detect an AAA. This is an uncomplicated check. It is the exact same option of diagnostic scan 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 personal doctor requires to know whether the aneurysm is influencing any of the arteries that come off the aorta. For example, if the aneurysm involves the section of the aorta where the arteries to the kidneys branch off, doctors need to know this information if they prepare to operate.

What is the risk of an abdominal aortic aneurysm rupturing?

The chance of rupture is lower if an AAA is minimal. As a rule, the risk of rupture increases with increasing sizing. This is much like a balloon - the larger you blow it up, the greater the force, and the greater the chance it will burst open. The diameter of an AAA can be tested by an ultrasound check out. The following gives overall 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.
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 increased in smokers, females, those with high blood pressure, and those with a relatives history of an AAA.

Should really every person with an abdominal aortic aneurysm have surgical procedures?

The short answer is no. Surgery repair of an AAA is a major procedure and carries threats. A small number of people will die during, or right after, the operation. If you have a small AAA, the probability of loss of life triggered by surgical procedure is greater than the threat of rupture. For that reason, medical procedures is commonly not recommended if you have an AAA less than 50 mm wide. Nevertheless, standard ultrasound tests will normally be recommended to observe if it gets larger over time.

Surgical procedures is normally advised if you develop an AAA larger than 50 mm. For these larger aneurysms the threat of rupture is often higher than the risk of surgical treatments. In spite of this, if your basic state of wellness is weak, or if you have specific other medical conditions, this may raise the risk if you have surgical treatment. Therefore, in a number of situations the final decision to operate may be a hard one.

Urgent medical procedures is necessary if an AAA ruptures. On average, about 8 in 10 people who have a ruptured aortic aneurysm will die due to the rapid critical bleeding. Even so, urgent surgery is lifesaving in some scenarios.

What treatments are implemented?

There are 2 types of medical procedure to fix an AAA.

The regular surgery is to cut out the negative part of aorta and swap it with an man made element of artery (a graft). This is a major operations and, as described, includes certain risk. Some people die throughout this operation. However, it is successful in a lot of cases and the aneurysm is completely fixed. The long-term prospect is fine. The graft usually works well for the rest of your life.

A current procedure makes it possible for the aorta to be restored by a method known as endovascular repair. This has become a popular choice in recent 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 increased aneurysm and fixed to the good aorta wall applying metal clips. The advantage to this specific type of restoration is that there is no abdominal surgical procedure. This tactic is thus safer than the standard surgery, and you require to spend less time in the hospital. A negative aspect is that some patients have to undergo a further operation at a later stage to refine the primary process.

Surgical techniques continue to develop and improve. Your doctor will advise about the benefits and cons of surgical procedure, the various kinds of surgery, and the best option for you.

Other treatment options could 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 probability of having significant atheroma structure 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 disorders, such as a heart attack or stroke.

Therefore, you should consider doing what you can to reduce the threat of these conditions by other means. For illustration:

Eat a healthy diet which contains keeping a low salt intake.
If you are able, exercise often.
Lose excess weight if you are over weight.
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 recommend that a routine ultrasound check is worthwhile for all men aged 65. This is mainly because most people with an AAA do not have symptoms. Following a routine diagnostic scan, surgical treatment 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 authorities 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 widespread in men than in women. One study released 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. Nevertheless, there are some people who have worries about screening for AAA; for example, see the paper by Johnson cited under 'References', below.

NathaliaGreenleaf567