Aneurysms

What is an abdominal aortic aneurysm (AAA)?

The aorta is the body’s largest artery and carries oxygen-rich blood pumped from your heart to the rest of your body. The thoracic aorta runs from the heart through your chest and becomes the abdominal aorta when it passes through the diaphragm. In the lower part of the abdomen the aorta splits into two branches,  the iliac arteries, which carry blood into each leg.

An aneurysm is caused by a defect in the arterial wall which dilates and gradually becomes larger and larger like a balloon. It is a dangerous condition as the artery eventually bursts leading to death from bleeding.

Aneurysms can occur in any artery but most commonly occur in the abdominal aorta. An abdominal aortic aneurysm (AAA) is most often the result of atherosclerosis. It is sometimes hereditary (and runs in families) or associated with congenital conditions such as Marfan’s syndrome but may also be due to infection or injury.

It is most common in men over the age of 65.

What are the symptoms?

Most abdominal aneurysms cause no symptoms until they are well advanced which is why this is such a dangerous condition. Often the first sign is rupture and death.

If you develop symptoms, you may experience one or more of the following:

  • A throbbing in your abdomen, usually above the kidney region, similar to a heartbeat
  • Severe, sudden pain in your back, side or lower abdomen. If this is the case, your aneurysm may be about to burst
  • On rare occasions, your feet or toes may develop pain, discoloration, or sores.

If your aneurysm bursts, you may suddenly feel severe abdominal pain, intense weakness or dizziness and you may eventually lose consciousness due to internal bleeding. An ambulance should be called  immediately.  The faster you make it to hospital the more likely you are to survive.

Screening for early detection

Surgical treatment for aneurysms is very successful before rupture occurs and they can be easily detected by a simple ultrasound scan.

All men over the age of 65 should have an abdominal ultrasound scan to check for an aortic aneurysm and anyone over the age of 50 with a family history of abdominal aortic aneurysm should be screened.

Aneurysms only require treatment if they are larger than 50mm in diameter but smaller aneurysms require surveillance with an abdominal ultrasound scan every 6 months to assess the size. It is impossible to predict how quickly they grow and they can suddenly increase in size for no obvious reason.

Treatments for Aortic Aneurysms

There are no cures for aortic aneurysms apart from surgery.

The operation is more successful if the aneurysm has not ruptured but even ruptured aneurysms can be treated. In either case there is a choice between Open Surgery or an Endovascular Repair.

 Open Surgery  is a very serious operation which involves a very large incision in the abdomen and replacement of the diseased aneurysmal portion of the aorta with a synthetic graft. This is a a very effective operation with good results but is often associated with a large amount of blood loss and the risk of many other complications including death, heart attack, kidney failure, bowel infarction, paraplegia and limb loss. Treatment in an Intensive Care Unit is always required post operatively and there is a lengthy recovery period of usually 6 to 12 weeks before normal activity can be resumed. The repair is very durable and there is hardly ever a need for any other surgery for the condition.
 Endovascular Repair  is a much less invasive operation and involves far less blood loss. Stents are inserted through the arteries in the groin and these stents are deployed inside the aorta to form a new lining that exclude the aneurysm. Only two small incisions in each groin are required and therefore the post-operative recovery is usually very fast with many patients going home after 2 or 3 days and getting back to normal activity within 2 to 6 weeks. There are still however potential risks of death, heart attack, kidney failure, paraplegia and limb loss. There is also a 20% chance that further interventions will be required to fix leaks that occur in and around the stents. These interventions are usually a day procedure.
Following both procedures regular follow-ups are required with ultrasound screening but this is far more important following an endovascular repair in order to detect the leaks that may occur.

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