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What is abdominal aortic aneurysm (AAA)?
Figure : Abdominal Aortic Aneurysm
An abdominal aortic aneurysm is an enlargement of the lower part of the aorta that extends through the abdominal area (at times, the upper portion of the aorta in the chest can be enlarged). The aorta is the main blood vessel that carries blood from the heart to the rest of the body. Since arteries are elastic and are filled with blood under high pressure, the wall of the artery may become weakened and distended like a balloon. The analogy of a bubble in a garden hose would be appropriate in describing an aneurysm. Aneurysms are usually discovered before they produce symptoms, such as back pain, but like the weakened hose, they may rupture if they become too large. Since a ruptured aneurysm is extremely dangerous, causing life-threatening bleeding, aneurysms are best corrected by an operation before this happens.
Figure : Thoracic aortic aneurysm
Figure : Aortic Aneurysm
Aortic aneurysms can develop anywhere along the length of the aorta. The majority, however, are located along the abdominal aorta. Most (about 90%) of abdominal aneurysms are located below the level of the renal arteries, the vessels that leave the aorta to go to the kidneys. About two-thirds of abdominal aneurysms are not limited to just the aorta but extend from the aorta into one or both of the iliac arteries.
Physicians and researchers are not quite sure what actually causes an AAA to form in some people. The leading thought is that the aneurysm may be caused by inflammation in the aorta, which may cause its wall to weaken or break down. Some researchers believe that this inflammation can be associated with atherosclerosis (also called hardening of the arteries) or risk factors that contribute to atherosclerosis, such as high blood pressure (hypertension) and smoking. In atherosclerosis fatty deposits, called plaque, build up in an artery. Over time, this buildup causes the artery to narrow, stiffen and possibly weaken. Besides atherosclerosis, other factors that can increase your risk of AAA include:
Your risk of developing AAA increases as you age. AAA is more common in men than in women.
- Being a man older than 60 years
- Having an immediate relative, such as a mother or brother, who has had AAA
- Having high blood pressure
Aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Some aortic aneurysms enlarge slowly, increasing less than half an inch (1.2 centimeters) a year. Others expand at a faster rate, which increases the risk of rupture. How quickly an aortic aneurysm may grow is difficult to predict.
As an aortic aneurysm grows, some people may notice:
Aneurysms can develop anywhere along the aorta, but most occur in the abdomen and are called abdominal aortic aneurysms. Aneurysms that occur in the part of the aorta that's higher up in your chest are called thoracic aortic aneurysms.
- A pulsating feeling near the navel, if the aneurysm occurs in the abdomen
- Tenderness or pain in the abdomen or chest
- Back pain
Types Of Aneurysms
Most aneurysms occur in the abdomen. Abdominal aortic aneurysms occur most frequently in people over age 60 and most commonly at a point in the aorta just below the level of the kidneys. Men are more commonly affected by aneurysms than women.
- Abdominal aneurysm -- in an artery in the abdomen (mid-section)
- Thoracic aneurysm -- in an artery in the chest area
- Cerebral aneurysm-- in an artery in the brain (usually treated by neurosurgeons)
- Peripheral aneurysm-- in the large arteries that run down the legs and behind the knees, and occasionally arms
Very large or symptomatic aneurysms require treatment. There are two types of surgical treatments for large aneurysms.
Open Surgical Repair
This involves the surgeon making an incision to access the abdominal aortic aneurysm. The diseased portion of the aorta is replaced with a graft that acts as a replacement blood vessel. Open surgical repair is a proven procedure that has a good track record and acceptable risks. But it also involves a long recovery period. Average hospital stay ranges from 5 to 8 days. The time until return to normal activity ranges from 6 weeks to 3 months. As with any operation, open surgical repair has a risk of complications. You will want to discuss them thoroughly with your doctor.
"Endovascular " means "inside or within a blood vessel" -- and that is exactly how a small fabric tube that has metal stents attached to the fabric, called a stent-graft, is introduced into your body and moved into place. First, small incisions are made in each groin to get to arteries that carry blood from the aorta. The surgeon then moves the stent-graft up through these arteries until it is opened inside the diseased portion of aorta. The stent-graft reinforces the weakened part of the vessel from the inside and creates a new channel through which the blood flows, eliminating the risk of rupture. This procedure usually takes 1 to 3 hours and patients typically leave the hospital in 1 to 2 days. Return to normal activity ranges from 2 to 6 weeks. Like any medical procedure, endovascular repair has a risk of complications. It also involves regular routine follow-up visits with your doctor to evaluate the stent-graft. These regular follow-ups are extremely important and will require CT.
Aneurysms are often diagnosed by chance during exams or tests done for other reasons. In some cases, they are found during a screening test for aneurysms. Screening tests help your doctor look for a certain disease or condition before any symptoms appear. Experts recommend screening tests for aneurysms for men who are:
These men are more likely to have an aneurysm than are women or nonsmoking men.
- Ages 65 to 75 and have ever smoked.
- At least 60 years old and have a first-degree relative (for example, father or brother) who has had an aneurysm.
If your doctor thinks you have an aneurysm, you may have tests such as an ultrasound, a CT scan, or an MRI to find out where it is and how big it is.
Abdominal AAs can be diagnosed from your symptoms when they occur but this may be too late. They are usually found when you have a routine physical examination and chest and abdominal X-rays.
When your doctor examines you, he or she may feel a pulsating mass in your abdomen which may be tender if your AAA is large. If your doctor suspects an AAA, he or she will request tests including those below.
An ultrasound scan is the most common test to detect an aneurysm. It can also measure its size.
Other scans may also be performed before you have surgery. For example a CT scan uses X-rays to make three-dimensional images of the body. This is very useful for determining the exact position of your AAA.
At present there isn't a national screening programme to detect AAAs. However, the Government is considering plans to introduce a programme.
Rupture is a feared problem. Rupture of an abdominal aneurysm is a catastrophe. It is highly lethal and is usually preceded by excruciating pain in the lower abdomen and back, with tenderness of the aneurysm. Rupture of an abdominal aneurysm causes profuse bleeding and leads to shock. Death may rapidly follow. Half of all persons with untreated abdominal aortic aneurysms die of rupture within five years. Abdominal aortic aneurysms are the 13th leading cause of death in the U.S.
Peripheral embolization of clot within the aneurysm can occur when a piece of clot comes loose and travels further out in the arterial system. This clot fragment can lodge in a smaller artery and block the flow of blood. Infection of aneurysms can occur from turbulent blood flow from the rough inner surface of the affected aorta.
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