Abdominal Aortic Aneurysm

1 What is an Abdominal Aortic Aneurysm?

What is an Abdominal Aortic Aneurysm?

Abdominal aortic aneurysm refers to an enlargement or swelling in the abdominal part of the aorta, the large blood vessel that carries blood from the heart to different parts of the body.

Aneurysms may form in different parts of the aorta, but abdominal aortic aneurysms are the most common form.  It can be a life-threatening situation if the swelling breaks open, resulting in internal bleeding.

How big are they?

The aneurysm may range from small (about 1.6 inches) to large (more than 2.2 inches). The swelling may remain the same without any changes, but in some it may grow rapidly and start leaking.

Treatment depends on the size and growth of the aneurysm. 

2 Symptoms

Abdominal aneurysms may not show symptoms until it becomes large and patients may not be aware of its existence.

But as the aneurysms grow, it results in symptoms including:

• Pulsating feeling in the abdominal region, often near the navel

• Persistent back pain and/or abdominal pain

• A dull, persistent, throbbing pain on the sides of the abdomen

• Pain in the groin, which is not relieved with pain killers

Ruptured aneurysm

Rupture of aneurysms is characterized by sudden onset of pain. It also leads to loss of consciousness or shock, depending on the loss of blood due to internal bleeding.

Other symptoms of a ruptured aneurysm in the abdomen include: 

• Sweating

• Rapid heart beat

• Difficulty in breathing

Dizziness

Rupture of aortic aneurysm is a medical emergency and surgery is required.

3 Causes

The actual causes of Abdominal Aortic Aneurysm are not known.

As a large amount of blood flows through the aorta, weakened walls of the blood vessel bulge outwards forming aneurysms. A normal aorta is around 2 cm wide and with a large aneurysm it may grow up to 5.5 cm.

Infection and inflammation of the aorta may weaken the wall of the blood vessel, leading to enlargement.

Accumulation of fatty tissues within the blood vessel, called atherosclerosis, is also a possible cause of abdominal aortic aneurysm. Smoking may expedite the enlargement of the aneurysms. High blood pressure also speeds up wall damage.

4 Making a Diagnosis

Making a diagnosis of abdominal aortic aneurysms is often done during a routine physical examination or during screening for another disease or condition.

Abdominal ultrasounds, CT scans, and MRIs are the confirming tests for these aneurysms.

Are you at risk?

People who are at increased risk of developing this condition are recommended to have abdominal ultrasound as a screening test.

All men above the age of 55 years with a family history of abdominal aortic aneurysms should have abdominal ultrasound to rule out the possibility of enlargement in aorta. Angiograms are helpful in the detection and treatment of aneurysms in the abdomen.

5 Treatment

Treatment of this condition is based on the size and growth of the aneurysm.

Watchful waiting is the recommended treatment for small aneurysms in the range of 1.6 inches. Patients should have an ultrasound scan, once every 6 months, for review of symptoms and to observe the growth of the aneurysm. In general, surgery is not recommended for small aneurysms.

Aneurysms that are in the range of 1.6 to 2.1 inches may also not need a surgery. Watchful waiting is often recommended as the risk of surgery is more when compared to that of the aneurysms.

Large aneurysms that are growing fast need a surgical repair of the wall. Large aneurysms are more than 2.2 inches in size and grow more than 0.5 cm within six months. Surgery replaces the weak portion of the aorta with a graft that prevents rupture.

Surgery

The two common types of surgical methods are:

• Open surgical repair – in this procedure, the surgeon replaces the damaged portion of the aorta with a graft through open surgery. This method has a good success rate, but the recovery period is long. Patients return to normal activities within 2 to 3 months after the surgery.

• Endovascular surgical repair – it is a less invasive procedure when compared to open surgery. In this method a synthetic graft is placed in the damaged portion of the aorta using a catheter. Recovery time for this procedure is shorter.
The type of surgery depends on a number of factors like age, other complications, and location of the aneurysm.

6 Prevention

Having a healthy heart is the best way to prevent abdominal aortic aneurysm.

Lifestyle modification

Avoid cardiovascular risk factors like smoking, and follow a healthy diet and exercise regimen to keep blood vessels safe and sound.

One should also control cardiovascular risk factors like hypertension, diabetes, and high cholesterol levels.

If one has any of the predisposing factors of this condition, regular screening for the presence of aneurysms, particularly after the age of 65 years, is very helpful in detection and treatment of aortic aneurysms.

7 Lifestyle and Coping

A healthy lifestyle is the best home remedy for controlling and coping with aortic aneurysms.

• Quit smoking

• Treat hypertension and high cholesterol levels

• Regular exercise

• Balanced diet

8 Risks and Complications

There are several common factors that increase the risk and affect complications of abdominal aortic aneurysms. Risks include:

• Smoking

• Family history

• Infection/injury

• High blood pressure

• Atherosclerosis

Complications

The most common complication arising from an aortic aneurysm is the rupture of aneurysm wall resulting in internal bleeding. This is a life-threatening condition.

The risk of rupture increases with the size of the aneurysm. Blood clots may also be produced due to enlargement of the blood vessel.

Small blood clots that develop near the area of weakened aortic wall, may break off and move through the blood vessel.

These clots result in pain and also hinder the flow of blood in other parts of the body like legs, kidneys and other organs.

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