The aorta is the largest artery (blood vesel) in the body. It carries blood from the heart and runs down through the chest and the abdomen (belly). An aneurysm occurs when the wall of a blood vessel weakens and balloons out. In the aorta this ballooning makes the wall weaker and more likely to burst. When this happens to the section of aorta in the belly, it is known as abdominal aortic aneurysm (AAA). When AAA bursts, it usually leads to death. Early detection saves lives.
Once AAA is found, doctors will closely monitor it so that surgery can be planned if it's necessary. Emergency surgery for a ruptured abdominal aortic aneurysm can be very risky.
Abdominal aortic aneurysms often gtowcslowoly and usually without symptoms, making them difficult to detect. some aneurysms will never rupture. many start small andststy small, althoguh many expand over time. Others expand quickly. Predicting how fast asd AAA may enlarge is difficult.
As an AAA enlarges, some people may notice:
* A pulsating feeling near the belly button
* Deep, constant pain in your abdomen or on the side of your abdomen
* Back pain
When to see a doctor
* You should see your doctor if you have any of the symptoms listed above.
* Anyone age 60 and older who has risk factors for developing an abdominal aortic aneurysm, such as smoking or a family history of abdominal aortic aneurysm, should consider regular screening for the detection. Because being male and smoking significantly increase the risk of abdominal aortic aneurysm, men ages 65 to 75 who have ever smoked cigarettes should have a one-time screening for abdominal aortic aneurysm using abdominal ultrasound.
* If you have a family history of abdominal aortic aneurysm, your doctor may recommend an ultrasound exam to screen for the condition. There are no specific screening recommendations for women. Ask your doctor if you need to have an ultrasound screening based on your risk factors.
Abdominal aortic aneurysm risk factors include:
* Age. Abdominal aortic aneurysms occur most often in people age 65 and older.
* Cigarette smoking. Tobacco use is a strong risk factor for the development of an abdominal aortic aneurysm. The longer you've smoked or chewed tobacco, the greater your risk.
* Atherosclerosis. Atherosclerosis, the buildup of fat and other substances that can damage the lining of a blood vessel, increases your risk of an aneurysm.
* Being male. Men develop abdominal aortic aneurysms much more often than women do.
* Family history. People who have a family history of abdominal aortic aneurysm are at increased risk of having the condition. People who have a family history of aneurysms tend to develop aneurysms at a younger age and are at higher risk of rupture.
Why do I need to have my aneurysm checked regularly?
The larger your aneurysm becomes the more chance there is of it to burst. Most aneurysms grow slowly at a rate of about 3 mm (1/8 inch) per year. However, larger aneurysms are more likely to grow quickly so scans are done more frequently as the AAA enlarges. If an AAA gets bigger there is an increased risk that it may leak or rupture (burst) without any warning.
Do I need an operation to treat my aneurysm?
Research has shown that for people with AAA measuring less than 5.5 cm. it is safer not to operate as the risks of having an operation are greater than the benefit.
If an aneurysm measures 5.5 cm. or over, starts to produce symptoms, or rapidly increases in size, you will need to see a a vascular surgeon to discuss treatment options, usually surgical repair.
However, there is a debate that in Asians, there may be indications to treat earlier as Asians have smaller blood vessels.
There are two types of operations that can be done to repair an aneurysm:
Open surgery: The traditional operation involves cutting open your abdomen to replace the aneurysm with an artificial piece of artery (a graft). This is a major operation and carries some risk. However, it is successful in most cases and the long term outlook is good. The graft usually works well for the rest of your life. You will usually spend 1-2 days in the Intensive Care or High Dependency Unit after your operation so that your progress can be closely monitored.
As open surgical repair for AAA is a major operation with significant risks, a less invasive alternative surgery for AAA repair has been developed.
Endovascular (EVAR) Surgery: This is a form of keyhole surgery using a stent graft. EVAR involves inserting a graft within the aneurysm through small groin incisions using X-trays to guide the graft into place. The advantage of this type of repair is that there is no abdominal surgery. This technique is therefore safer than the traditional operation, and you need to spend less time in hospital. A disadvantage is that some patients have to undergo a further operation at a later stage to refine the initial procedure. However, not every patient or every aneurysm is suitable for EVAR and will need to be assessed by the vascular surgeon first.