Abdominal Aortic Aneurysm

Definition

The term aneurysm means dilatation (like an inflated balloon) of a blood vessel, when it affects the abdominal aorta it is called abdominal aortic aneurysm (AAA). Usually males between 65 and 70 years are affected.  Apart from pain in the abdomen, back or in the legs, there are no other symptoms. The most dangerous complication is rupture (bursting) of the aneurysm and spillage of large amount of blood in the abdomen. The success of emergency repair of rupture in the hospital is low (about 10 to 30%). Treatment options are periodic monitoring of the aneurysm and surgery (when the bulging is greater than 5.5cm).

Symptoms

Usually the abdominal aortic aneurysm is asymptomatic as these bulges are mostly small and grow slowly or not at all. However, sometimes AAA grow faster with chance of rupture. It is not possible to predict the fate of abdominal aortic aneurysm.

The most common symptoms are :

  • Pulsation felt at the level of naval
  • Pain at the abdomen or back
  • Pain in the leg (due to reduced blood flow to the legs)

Ultimately the enlarged aneurysm may rupture leading to features of shock due to huge blood loss. The symptoms of a ruptured abdominal aortic aneurysm includes :

  • Sudden intense pain in abdomen and chest
  • Dizziness
  • Rapid pulse rate
  • Low blood pressure
  • Breathing trouble
  • Fainting
  • Cold, clammy limbs
  • Sweating

Causes

Aorta (largest artery of the body) arises from the left chamber (left ventricle) of the heart and moves downwards through the chest (thoracic aorta), abdomen (abdominal aorta) and finally to the legs (as terminal iliac arteries). According to the location of the ballooning (aneurysm) different names are given, like thoracic aortic aneurysm or  abdominal aortic aneurysm. AAA can occur at different levels most commonly below the level of kidney (infra renal) but at (pararenal) or above (suprarenal) locations are also possible.

The exact cause of AAA is not known but there are some contributing factors like :

  • Tobacco smoking (more than 90% patients of AAA have history of smoking)
  • Genetic factors: Family history of AAA, connective tissue disorders (Marfan’s syndrome) are strongly associated with AAA.
  • Atherosclerosis: fatty deposits weakening the aortic wall.
  • Infection
  • Trauma

Risk factors

  • Age (between 60 to 75 years).
  • Males are more prone.
  • Cigarette smoking.
  • High blood pressure (poorly controlled).
  • Ethnicity.
  • Family history of abdominal aortic aneurysm.
  • Trauma.

Treatment

Treatment options are conservative management with regular follow-up, planned surgery and emergency surgery on rupture of the aneurysm.

  • Conservative management with regular follow-up is recommended for aneurysms under 5.5 cm. A rapidly growing or leaking aneurysm requires surgery irrespective of the size.
  • Surgery can be either open abdominal or endovascular surgery.
  • Emergency surgery is required when there is rupture of the aneurysm.

An aneurysm is dangerous and patients who have been diagnosed with an abdominal aortic aneurysm need to be aware of the dangers of the condition despite the lack of symptoms. Contact sports, activities that can place sudden and excessive force on the abdomen and just the effects of time can all contribute to a rupture. Patients should therefore avoid risky activities and ensure they go in for regular screening to avoid life threatening complications.

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