Abdominal Aortic Aneurysm

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Abdominal aortic aneurysm definition and facts

  • An aneurysm is an abnormal area of localized widening of a blood vessel.
  • The aorta bulges at the site of an aneurysm like a weak spot on a worn tire.
  • Aortic aneurysms are typically spindle-shaped and involve the aorta below the arteries to the kidneys.
  • The most common cause of an aneurysm is arteriosclerosis. Smoking is a major risk factor.
  • Abdominal aortic aneurysms often do not cause symptoms. If they do, they may cause deep boring pain in the lower back or flank. Prominent abdominal pulsations may be present.
  • X-rays of the abdomen and other radiologic tests including ultrasound, CT, and MRI may be used in diagnosing and monitoring the aneurysm.
  • Rupture of an aortic aneurysm is a catastrophe.
  • Repair of the aneurysm can be done by surgery or endovascular stenting.

What is an abdominal aortic aneurysm?

The aneurysm is an area of ​​localized expansion (expansion) of blood vessels. The word “vasodilatation” was taken from the Greek “vasodilation” meaning “amplitude”. Aortic aneurysms include an aorta, the main artery that leaves the heart to supply blood to the body. The aortic aneurysm is the expansion or swelling of the aorta.

Aortic aneurysms can develop anywhere in the aorta, but most are located in the ventral aorta. Most of these abdominal blood vessels are below the level of the renal arteries, which provide blood vessels to the kidneys. Aortic aneurysms of the abdomen can spread to the iliac arteries.

The inner walls often align to dilate the blood vessels with a blood clot formed because there is stagnant blood. The wall of the blood vessel is stretched, like a piece of plywood.


What is a thoracic and abdominal aorta?


The aorta is the large artery that leaves the heart and sends blood to the body. It starts at the aortic valve that separates the left ventricle from the heart from the aorta and prevents the blood from returning to the heart after contraction, when the heart pumps blood. The different sections of the aorta are labeled according to the relationship with the heart and the location of the body. Therefore, the beginning of the aorta is known as the ascending aorta, followed by the arch of the aorta, then the descending aorta. The part of the aorta found in the thorax (thorax) is called the thoracic aorta, while the abdominal aorta is located in the abdomen. The abdominal aorta extends from the diaphragm to the middle of the abdomen, where it divides into the iliac arteries that supply the legs.


What are the symptoms of aneurysms in the aorta?


Most aortic aneurysms in the abdomen do not produce any symptoms (they are asymptomatic) and are detected along the way when the abdomen image test (CT or ultrasound) is performed. It can also be detected by a physical examination when the abdominal health professional feels and hears the lid, the sound produced by the problematic blood flow.

Acute pain is the most common symptom when blood vessels dilate or rupture. It often begins in the central abdomen and radiates to the back or wing. Other symptoms may occur depending on where the blood vessels are in the aorta and if nearby structures are affected.

Aortic aneurysms in the abdomen can remain without symptoms or produce minimal symptoms for years. However, the rapid expansion of the abdominal blood vessels can cause the sudden onset of severe pain in the abdomen, back or back. The rupture of the aneurysm of the abdominal aorta can be catastrophic, even fatal, and is associated with abdominal distension, pulsatile abdominal mass and shock due to massive blood loss.


What is the rupture of the blood vessels in the aorta?


The rupture of the abdomen by aneurysm is a surgical emergency. Once the aneurysm ruptures, 50% of patients with vasodilation die before reaching the hospital. The longer it takes to get to the operating room, the higher the mortality rate.

What are the causes of abdominal aortic aneurysms?

The most common cause of aortic aneurysms is “atherosclerosis” called atherosclerosis. The majority of the aortic aorta is caused by atherosclerosis. Atherosclerosis can weaken the aortic wall and increase blood pressure that is pumped through the aorta, causing weakness of the inner layer of the aortic wall.

The aortic wall has three layers, the parathyroid gland, the middle tunic and the endothelium. The layers add strength to the aorta and elasticity to tolerate changes in blood pressure. The increase in blood pressure often causes the media layer to collapse and lead to a slow and continuous expansion of the aorta.

Smoking is an important cause of aortic aneurysms. Studies have shown that the rate of aortic aneurysm has decreased in the same proportion as population smoking.


Other causes of aortic aneurysms

  • Genetics: genetics can play a role in the development of aortic aneurysms. The risk of vasodilation increases if one of the first-degree relatives also has one. The blood vessels can dilate at an earlier age and also with a higher risk of rupture.
  • Genetic disease: Ehlers-Danlos syndrome and Marfan syndrome are connective tissue diseases associated with the development of aortic aneurysms. Conductive abnormalities of the connective tissue in the layers of the aortic wall may contribute to the weakness of the aortic sections.
  •  Post trauma: trauma can damage the aortic wall and cause immediate damage or can cause an area of ​​weakness that forms an aneurysm over time.
  •  Arteries: vasculitis As in Takayasu’s disease, giant cell arteries, cartilage inflammation can contribute to the expansion of blood vessels.
  •  Fungal infection: fungal or fungal infection may be associated with immunodeficiency, drug abuse, syphilis and cardiac valve surgery.


What is the most enlarged abdominal aortic aneurysm?

Most aortic aneurysms are spherical. It has the shape of a spindle (“Phosos” means the spindle in Latin) with the width around the anterior aorta. (Blood vessels with blood only affect part of the aortic wall with your pocket located).
Who has an aneurysm in the abdominal aorta? Is it hereditary?

Abdominal aneurysms in the abdomen tend to occur in white men older than 60 years. In the United States, vasodilation occurs in up to 3.0% of the population. The aneurysms begin around the 50 years and reach their maximum point at the age of 80 years. Women are less likely to have aneurysms than men and African Americans are less likely to dilate blood vessels than Caucasians.

There is a genetic component that prepares it for the development of a blood disease. It can be spread in person who has a first-class relative with a condition of up to 25%.

Collagen diseases Blood vessels that can weaken the tissues of the aortic walls are also associated with aortic aneurysms. These include Marfan syndrome and Ehlers Danlos syndrome.

What are risk factors for abdominal aortic aneurysms?

The risk factors for aortic aneurysm are the same as those for atherosclerotic heart disease, stroke, and peripheral artery disease and include:

  • Cigarette smoking: This not only increases the risk of developing an abdominal aortic aneurysm, but also increases the risk of aneurysm rupture. Aortic rupture is a life-threatening event where blood escapes the aorta and the patient can quickly bleed to death.
  • High blood pressure .
  • Elevated blood cholesterol levels.
  • Diabetes mellitus.

How are abdominal aortic aneurysms diagnosed?

The physical examination may be the main method of diagnosis of aneurysms in the ventricular aorta. A health professional may feel a pulsating mass in the middle of the abdomen and make a clinical diagnosis. In large-scale obese patients, the physical examination is less useful. In very thin patients, the aorta can often be seen as a subcutaneous pulse and this may be a natural result. Listening with a stethoscope can also reveal a cavity or an abnormal sound of a blood disorder within the blood vessels.

In most cases, X-rays show abdominal calcium deposits in the wall of anemia. But minor radiography in the abdomen can not determine the size and extent of vasodilation.

Ultrasound usually gives a clear picture of the size of the blood vessels. Ultrasound has approximately 98% accuracy in measuring the size of blood vessels and is safe and not dilated.

Computed tomography is very accurate to determine the size and extent of vasodilation and its location in the aorta. To help in the reform plan, if necessary, it is important to know if the aneurysm is above or below where the renal arteries branch to go to the kidneys and if the dilation of the blood vessels around the chest or down to the arteries in the iliac legs. CT scans require the contrast medium to be injected to evaluate blood vessels (including the aorta). People with kidney disease or dye allergies may not be candidates for the cat. MRI / MRI (magnetic resonance and arterial images) can be an alternative.

An X-ray study was performed, where a dye was injected directly into the aorta, a screening test, but a CT and an MRI were performed.

What is abdominal aortic aneurysm surgery?

Each patient is different, and the decision to repair ventricular aortic aneurysm depends on the size of the aneurysm, the patient’s age, underlying medical conditions and life expectancy.

There are two approaches to reform:

  •  The first is the traditional surgical approach. A large incision is made in the abdomen, the aortic aneurysm is determined and cut or cut. The missing piece of the aorta is replaced by an artificial compass.
  • The second approach is to develop vascularization of the graft. A catheter or tube is placed in the femoral artery of the thigh and the graft is placed so that it extends and sits within the blood vessels and protects against dilation (rewinding: ENDO = vascular + vascular = vascular).

    The treatment approach must be adapted to the patient and depends largely on the location, size and shape of the aneurysms.

 

What is the nonsurgical management of abdominal aortic aneurysm?

Once an aneurysm is detected, the goal is to try to prevent it from enlarging. Life-long control of risk factors is a must and includes the following:

  • Stopping cigarette smoking.
  • Controlling high blood pressure: Beta blocker medications may be used to control both blood pressure and to decrease the pressure within the aneurysm.
  • Controlling blood cholesterol.
  • Keeping diabetes under control.
  • Routine monitoring of the size of the aneurysm:
    • A normal aorta measures up to 1.7 cm in a male and 1.5 cm in a female.
    • Aneurysms that are found incidentally or by accident that are less than 3.0 cm do not need to be re-evaluated or followed.
    • Aneurysms measuring 3.0 to 4.0 cm should be rechecked by ultrasound every year to monitor for potential enlargement and dilation.
    • Aneurysms measuring 4.0 to 4.5 cm should be monitored every 6 months by ultrasound.
    • Aneurysms measuring greater than 4.5 cm should be evaluated by a surgeon for potential repair.

 

What are the complications of the aorta in the abdomen?


Aortic aneurysms can spread, causing an increase in abdominal pain in the abdomen. When the pain is felt in the back or the wing, the symptoms can be mistakenly diagnosed as kidney stones. If the diagnosis is not made or if the patient does not provide care, the aneurysm may explode or rupture and cause possible disaster and death.

Since vasodilation is associated with atherosclerosis and plaque along the anterior wall and because blood vessels often contain clots, debris can travel or embolize into small blood vessels and cause symptoms due to low blood flow. .

Rarely has vascular disease.

 

REFERENCE:

Rahimi, SA, MD. Abominal Aortic Aneurysm.” Medscape. Updated: Aug 16, 2017.
<https://emedicine.medscape.com/article/1979501-overview>

Svensjö, S., et al. “Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease.” Circulation 124.10 (2011): 1118-1123.

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