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What is Abdominal Aortic Aneurysm

Blood is distributed to the entire body via the largest vessel of the body which is the Aorta. An abdominal aortic aneurysm is the consequence of abnormal dilatation of the aorta.


Causes

The exact etiology of an aneurysm is unknown however there are contributing factors that may make a a person at risk of development of weakness of the wall of the aorta:

• Smoking
• High blood pressure
• Male gender
• Genetic factors

An abdominal aortic aneurysm usually occurs in males above the age of 60 yrs with associated risk factors. The risk of rupture of the aneurysm increases as the size goes up. Such patients need to be closely observed and followed up yearly with CT Scan to see the evolution of it and assess the need for timely surgery to reduce complications and improve outcomes.

Symptoms

Aneurysms may be asymptomatic and get picked up on routine imaging being done for some other problem or can present with symptoms due to compression of surrounding structures of acutely due to rupture.

• Acute onset of pain in the stomach over the site of rupture which might radiate to the back, legs depending on which structures are getting compressed.
• Feeling faint or greying out spells due to fall in blood pressures
• Cold Clammy skin
• Nausea and vomiting
• Palpitations due to increase in heart beats
• Shock

Exams and Tests

After examining you your health care provider may find the following in your abdomen :

• A lump (mass) in the abdomen
• Pulsating sensation in the abdomen
• Stiff or rigid abdomen

You may have an abdominal aortic aneurysm that is not causing any symptoms. Your provider may find this problem by doing the following tests:

• Ultrasound of the abdomen when the abdominal aneurysm is first suspected
• CT scan of the abdomen to confirm the size of the aneurysm
• CTA (computed tomographic angiogram) to help with surgical planning
Any one of these tests may be done when you are having symptoms.

Treatment




If you have bleeding inside your body from an aortic aneurysm, it is a surgical emergency and immediate attention is required.


If the aneurysm is small and there are no symptoms:

• Surgery is rarely done but a follow up to see its expansion and evolution..


• You and your doctor must decide if the risk of having surgery is smaller than the risk of bleeding if you do not have surgery.

• Your doctor may want to check the size of the aneurysm with ultrasound tests every 6 months.

Most of the time, surgery is done if the aneurysm is bigger than 2 inches (5.5 cm) across or growing quickly or causing compression of surrounding structures leading to reduction in blood supply. The goal is to do surgery before complications develop.

There are 2 types of surgery:

• Open repair: A large cut is made in your abdomen. The abnormal vessel is replaced with a graft made of man-made material.
• Endovascular stent grafting: This procedure can be done without making a large cut in your abdomen, so you may recover more quickly. This may be a safer approach if you have certain other medical problems or are older adults. Endovascular repair can sometimes be done for a leaking or bleeding aneurysm.

The outcome is often good if you have surgery to repair the aneurysm before it ruptures. When an abdominal aortic aneurysm begins to tear or ruptures, it is a surgical emergency. Only about 1 in 5 people survive a ruptured abdominal aneurysm.

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