10 Interesting Facts of Abdominal Aortic Aneurysm (AAA)
- What is abdominal aortic aneurysm? An abdominal aortic aneurysm is the swelling and bulging of the abdomen part of the aorta, which is the largest and the main blood vessel in the body. This aorta carries blood from your heart to other regions of your body.
- Any risk factors for abdominal aortic aneurysm? Men are 6 times more prone compared to women. Older age group of 60 and above are at increased risk of this AAA.
- Is an abdominal aortic aneurysm serious? – Yes, when you have a large aneurysm, it could be very fatal. There are greater chances of rupture if the wall of your aorta becomes very weak. The prognosis is very low. It is absolutely not serious if you have a small aneurysm. It is highly recommended to monitor and check if the aneurysm getting larger.
- Is it mandatory to get tested for abdominal aortic aneurysm? – Usually no symptoms until the aneurysm bursts or ruptures, hence anyone who are having the risk factors need to get basic investigations done to diagnose this condition
- AAA more likely develops in smokers, persons with high blood pressure and family history of abdominal aortic aneurysm.
- A large aneurysm will be detected only in 1 in 100 men who are screened for AAA
- Most of the men diagnosed with a small aneurysm do not require treatment.
- Surgery is needed if the aneurysm is larger than 5 cm (2 inches).
- Any aneurysm which are smaller than 5 cm can be treated with medicines
- It is recommended to get investigated for AAA, usually an ultrasound test once in a few years, once a year, or every 3–6 months
What is the term Abdominal Aortic Aneurysm (AAA)?
The word Aneurysm is an abnormal bulging of an artery (which is a blood vessel) like a balloon due to the weakening of a portion in the blood vessel. If the aneurysm develops in the abdominal part of aorta, which is the main blood vessel in the body, it is called as an Abdominal Aortic Aneurysm, in short AAA.
Abdominal Aorta is a long blood vessel which travels from the chest into the abdomen. This blood vessel carries blood from the heart to the rest of the parts of the body and supplies blood to the pelvis, stomach and legs.
When this Abdominal Aortic Aneurysm progresses into a very large swelling, the aorta may tear or burst.
What are the symptoms and signs of an Abdominal Aortic Aneurysm (AAA)?
Normally persons with AAA are symptom free during the earlier stages and even as the aneurysm progresses. Majority of the aneurysms develop slowly. The patients may have the below listed symptoms only after the aneurysm leaks or bursts
- The first and foremost symptoms of AAA is pain in your abdomen. The other common regions in the body such as the groin, lower back, legs or buttocks. This pain is often sudden in nature.
- Skin becomes cool and clammy
- Occasional Vomiting and Nausea
- Sometimes discomfort in the abdomen due to unusual stiffness in your abdominal muscles
- Feeling faint
- You may feel stomach full even after eating lesser quantities of food
- Usually a portion of your abdomen may be swollen or you might notice a bulge in one or two places in the abdomen. This swelling may be pulsatile.
What are the risk factors of an Abdominal Aortic Aneurysm (AAA)?
There are certain factors listed below which increases the risk of developing this condition.
For better understanding, lets divide the risk categories into modifiable and non modifiable.
Non Modifiable risk factors are the ones which are irreversible, here is the list
- Male Gender
- Elderly age group (above 60 years) are at increased risk
- Genetic diseases like Marfan syndrome, which is a disorder of the connective tissues in the body
- Abdominal Trauma
- Caucasians are more prone
- Family History of Aneurysms
Few risk factors can be reversed by early identification and prevention, hence they are Modifiable risk factors, below listed
- Arteriosclerosis, which is the accumulation of the fat and few chemicals in the walls of the blood vessels resulting in the thickening of the blood vessels (arteries)
- Infections caused by bacteria such as Staphylococcus, Syphilis.
- Arteritis, which is the inflammation (swelling) of the walls of an artery
- Infectious Aortitis, which is the infection in the wall of the aorta
- High Blood Pressure (Hypertension)
- Overweight or Obese
- High Cholesterol levels conditions such as Hypercholesterolemia and Dyslipidemia
- Tobacoo Use
- History of chronic obstructive pulmonary disease (COPD).
- Lung Diseases like Emphysema
Causes of an Abdominal Aortic Aneurysm (AAA)
Research says that the exact cause of AAA is unknown.
What are the tests to Diagnose AAA?
If you have any of the high risk factors or if you do have the symptoms of AAA, consult your physician immediately. Majority of the abdominal aortic aneurysms are often diagnosed during routine examinations and investigations or during examination of other diseases as the unruptured abdominal aortic aneurysms normally asymptomatic.
Listed are the methods to diagnose AAA:
- A physical examination at your doctor consultation. At the time of the exam, your physician will identify any throbbing pain in your abdomen. The blood flow in your abdomen can also be listened to assess if there is abnormal sounds.
- Here are the investigations:
- Screening with an Ultrasound of abdomen – This is a device which displays an image of your organs in the abdomen with the help of sound waves passing through your body. Ultrasound of abdomen can assess and measure the exact size of your aorta to identify if there is any aneurysm
- CT scan abdomen
- Any blockage or damage in the blood vessels can be identified by an investigation called Angiogram
Treatment of Abdominal Aortic Aneurysm (AAA)
The treatment options depends on the following factors
Factor 1: Size of the aneurysm
Faster growing and larger aneurysms, will definitely need surgery.
Smaller Aneurysms (less than 2 inches or 5 cms) just need monitoring with regular ultrasound investigation especially if you are a male and also a smoker to know if the size is increasing. The frequency of the ultrasound test depends on the size and the speed of the progression Medication is not necessarily required for smaller aneurysms, they are often given only to treat the high blood pressure, reduce pain, and prevent any infection.
Factor 2: Age of the person
Higher the age group, lower the prognosis of the condition and the treatment options
Multiple Risk factors which may result in rupture
When is an Abdominal Aortic Aneurysm usually repaired?
Surgical repair of an Abdominal Aortic Aneurysm is generally considered for aortas larger than 5 cm in caliber or for aortas that are symptomatic or display rapid growth.
When is endovascular aneurysm repair (EVAR) favored over open surgical repair?
EVAR is preferred over operative repair when the surgical operative risk is higher because of comorbidities and older age. EVAR has been shown in studies to have lower short-term rates of death and complications, although the survival curves merge in the long term.
Generally, open surgical repair is preferred for younger, healthier patients, in whom longer term durability is a primary concern. EVAR versus open repair is essentially a matter of proper patient selection based on physiologic and anatomic risk factors and is often a matter of patient preference for less invasive therapy.
What is the traditional open surgical repair of AAA
With the patient under general anesthesia, a vascular surgeon makes an incision in the abdominal wall and exposes the aorta and the aneurysm.
The incision is either down the center of the abdomen from immediately below the sternum to below the umbilicus or across the abdomen from underneath the left arm across to the center of the abdomen and down to below the umbilicus.
Clamps are placed above and below the aneurysm to arrest blood flow; the surgeon then butterflies the aneurysm and removes blood clots and plaque.
A surgical tube graft is sewn to the healthy sections of the aorta connecting both ends of the aorta together. The clamps are removed, the wall of the aneurysm is wrapped around the graft, and the incision is closed. Recovery from AAA surgery is typically 7 to 10 days.
What are the findings on preprocedure imaging of AAA that may preclude a patient from undergoing EVAR
A major preclusion to EVAR is proximal neck complexity or lack of a suitable landing zone just below the renal arteries to ensure fixation and seal of the stent graft. A short neck is defined as one that is less than 10 cm from immediately below the renal arteries to the beginning of the aneurysmal zone.
An angulated neck is defined as greater than 45 degrees from immediately below the renal arteries to the beginning of the aneurysmal zone. A wide neck is greater than 32 mm.
A neck that flares immediately below the renal arteries or an aneurysm that extends into and above the renal arteries (juxtarenal) would also preclude safe landing of a stent graft. Another contraindication is complex iliac arteries.
The arteries may be tortuous or calcified, precluding passage of the delivery catheter, or they may be aneurysmal in which case it may be difficult to achieve fixation and seal of the iliac “legs” of a bifurcated stent graft.
Lower profile delivery systems, branched and fenestrated grafts, and more flexible and conformable designs are under development to attempt to solve some of these contraindications to EVAR.
What are the common queries you might have to ask Your Doctor
- What lifestyle modifications do I need to implement to prevent AAA?
- Is AAA recurrent if I already have one?
- Do I need to visit a specialist?
- Are there any patient educational materials or websites available to know more on AAA?
- What is to be done if my pain abdomen gets worse?
- Is watchful waiting recommended?
- Are there chances for the rupture of AAA?
- Are there any complications of AAA?
Complications of AAA
Most of the aneurysms may not cause problems.
Rupture of Aneurysms
The major issue with an abdominal aortic aneurysm is that it bursts
After the tear of the aneurysm, that blood flows between the layers of the wall of the aorta.
These two conditions can be life-threatening as they may cause bleeding inside the body if not diagnosed and treated in the right time.
Prevention of Aneurysms
- Avoid Alcohol
- Quit Smoking and stop using nicotine or tobacco products, including cigarettes and e-cigarettes. Seek the help of rehabilitation organizations to quit smoking
- Monitor your blood pressure make sure its within normal limits, that is less than 120/80
- Keep a check on your blood pressure
- Discuss with your physician the ways to control your blood pressure
- If you are a diabetic, maintain your blood sugar levels within normal range which needs to be less than 100 mg/dl
- Make sure your cholesterol levels must be within target levels of less than 200 mg/dl
- Healthy weight maintenance
- Regular Exercise
- Talk to your physician about the exercise regimen which suits you the most and how often you need to exercise
Healthy Diet Habits
- Stop cholesterol and saturated fats rich diet such as red meat and dairy
- If you have high blood pressure, reduce salt intake in the diet as excessive salt elevates the blood pressure
- Practice the diet with low quantities of sugars
- Consume high fibre foods such as fruits, vegetables and whole grains which helps to lower cholesterol and blood pressure
When to consult a doctor?
- If you experience pain in your abdomen, buttocks, or lower back which is throbbing in nature.
- You are having risk factors of AAA .
- Family history of aneurysms.
Contact the emergency immediately if you experience the listed symptoms:
- Clammy, sweaty skin
- Difficulty in breathing
- Sudden high grade fever
- Pain in your abdomen or lower back which is sudden and severe in nature
- Nausea or vomiting
- Feeling Light headedness
- Urination problems
- Increased heart rate
Additional Info on abdominal aortic aneurysm
- Stone in either ureter can mimic an abdominal aortic aneurysm
- Consideration of abdominal aortic aneurysm should be especially high in patients older than 60 years with new-onset flank pain
- Abdominal aortic aneurysm should be ruled out with ultrasonography or CT imaging if severe back or flank symptoms are present without evidence of hydronephrosis or ureteral stone. Consider ruling out abdominal aortic aneurysm even if a stone is noted
- Differentiate with CT
- Noncontrast CT of abdomen and pelvis reveals hydroureteronephrosis to the level of an obstructing stone in nephrolithiasis
- IV contrast material is needed for greatest delineation of abdominal aortic aneurysm. Contrast-enhanced CT visualizes focal dilation of aorta, and contained ruptures are marked by an indistinct posterior aortic wall
Seek Additional information:
Abdominal Aortic Aneurysm by GR Upchurch, Jr., M.D. and TA Schaub, M.D. ( 04/01/06, http://www.aafp.org/afp/20060401/1198.html )