Abdominal Aortic Aneurysms AAA

Bulges (dilations) in the wall of the aorta in the section that goes through the belly are known as abdominal aortic aneurysms AAA (abdominal aorta). Aortic aneurysms in the abdomen usually grow slowly before rupturing.

Aneurysms can induce a pulsing sensation in the belly, as well as deep, terrible pain, low blood pressure, and death if they rupture.

An aneurysm is frequently discovered by doctors during a routine examination or imaging technique.

Aneurysms that are large or developing are treated by surgery or a treatment that involves inserting a stent inside the aneurysm.

The aorta is the body’s biggest artery. It takes oxygen-rich blood from the heart and distributes it to the rest of the body via smaller arteries that branch off. The section of the aorta that goes through the abdominal cavity is known as the abdominal aorta.

Abdominal aortic aneurysms can happen at any age, but they are most frequent in males between the ages of 50 and 80. Aortic aneurysms in the abdomen can run in families and are more common in those with high blood pressure, especially smokers. Aneurysms in the abdomen rupture in about 20% of cases.

An abdominal aortic aneurysm is frequently caused by atherosclerosis, which weakens the artery’s wall. Infection of the aorta wall, which can be a consequence of endocarditis or body-wide infection (sepsis), as well as blood vessel inflammation (vasculitis), can cause the artery wall to weaken.

Abdominal Aortic Aneurysm Symptoms

The majority of persons with an abdominal aortic aneurysm have no symptoms, however, some do notice a pulsing sensation in their belly. Aneurysms can produce pain, which is usually a deep, penetrating discomfort in the back. If the aneurysm is leaking, the discomfort can be severe and unrelenting.

The first indication of an aneurysm rupture is usually intense pain in the lower abdomen and back, as well as soreness over the aneurysm. If the internal bleeding is substantial, the victim may go into shock quickly. If left untreated, a ruptured abdominal aortic aneurysm is almost invariably deadly.

Abdominal Aortic Aneurysms Diagnosis

Abdominal ultrasonography or computed tomography (CT).
Pain can be a good indicator, although it often does not appear until an aneurysm has grown large or is near to burst. Many persons with aneurysms, on the other hand, have no symptoms and are found by chance when a normal physical examination or imaging technique of the abdomen (such as x-rays, CT scans, or ultrasonography) is performed for another reason.

A pulsing mass in the center of the abdomen may be felt by doctors. Doctors may hear a whooshing sound (bruit) as blood rushes through the aneurysm with a stethoscope positioned in the middle of the belly. Even big aneurysms may not be identified in obese patients. When squeezed during an abdominal examination, rapidly expanding aneurysms that are about to rupture usually pain or feel tender.

An abdominal x-ray may occasionally reveal an aneurysm with calcium deposits in its wall, but this test provides little additional information. Other diagnostic tests are more effective at detecting and determining the size of aneurysms. Ultrasonography, in most cases, can clearly demonstrate the size of an aneurysm. If an aneurysm is found, ultrasonography may be performed every few months to see if the aneurysm is enlarging and how quickly it is enlarging.

CT of the abdomen can assess the size and shape of an abdominal aortic aneurysm more accurately than ultrasonography, especially if done after a contrast agent is administered intravenously, although it exposes the patient to radiation.

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Abdominal Aortic Aneurysms and Their Treatment

An artificial graft is used to replace the aneurysm. Aortic aneurysms in the abdomen that are less than 2 inches (5 cm) in diameter rarely rupture. Antihypertensive medicines to control blood pressure, cholesterol therapy, and aspirin to lessen atherosclerosis risks, and smoking cessation may be the only treatments necessary. Quitting smoking is extremely crucial for smokers.

Imaging procedures are used to determine the rate of expansion and when correction is required. Procedures are performed every 3 to 6 months at first, then at different intervals depending on how quickly the aneurysm enlarges.

Aneurysms that are broader than 2 to 212 inches (5 to 5.5 cm) are more likely to burst, thus doctors normally advocate surgery unless the patient is too hazardous. Aneurysms in patients with Marfan syndrome are more likely to rupture at smaller diameters, thus aneurysms may be repaired earlier when the diameter at the aortic root (the section of the aorta closest to the heart) is around 112 inches (4.5 cm).

An artificial tube (graft) is inserted into the aneurysm during surgery. There are two methods:

  • Surgery as it has always been done
  • Repair of an endovascular stent graft

General anesthesia is administered, and an incision is made from below the breastbone to just below the navel in traditional surgery. The graft is stitched into place in the aorta, and the aneurysm walls are wrapped around it. The incision is then closed. This treatment takes 3 to 6 hours and requires a 5- to 8-day stay in the hospital. The chance of dying during graft surgery is roughly 2 to 5%, although it can be higher if the patient has other critical medical issues.

Endovascular stent-graft repair is a less invasive procedure that is now employed in more than 70% of instances. A localized (epidural) anesthetic is given, which induces numbness from the waist down but no loss of consciousness. A long, thin guide wire is run through the femoral artery into the aorta to the aneurysm using a specific puncture needle. The stent-graft (which resembles a meshed, collapsible straw) is conducted over the wire and positioned into the aneurysm using a tube (catheter). The stent graft is then opened, providing a stable blood flow channel. This treatment takes 2 to 5 hours, with a 1 to 2-day stay in the hospital.

Many factors influence which an aneurysm repair approach is used, including the patient’s age and overall health, as well as the structure of the aorta and the aneurysm. In general, open surgery may be done for younger, healthier people because the outcomes may last for at least ten years in patients who survive that long. The endovascular stent grafting method is performed for those who are older or in poor condition who would not be able to survive an open surgical surgery.

A burst abdominal aortic aneurysm is treated.

An abdominal aortic aneurysm that has ruptured or is about to rupture necessitates emergent open surgery or the insertion of an endovascular stent-graft. During an emergency repair of a ruptured aneurysm, there is a 50% chance of mortality. Endovascular stent-graft insertion may reduce the risk of death by 20 to 30%. The kidneys may be harmed when an aneurysm ruptures because their blood supply is interrupted or because blood loss causes shock. If a renal failure occurs after a ruptured aneurysm is repaired, the chances of life are slim.