Disease

Introduction: Abdominal Aortic Aneurysm 

Heart diseases are quite common now and one among it is abdominal aortic aneurysm. Read and get to know more about its causes, risks, prevention, treatment and so on.

Overview:

Aorta runs from the center of our heart to our abdomen. It being the largest blood vessel in the whole human body is responsible for carrying oxygenated blood from heart to other parts of the body. And the abdominal aortic aneurysm is the enlargement in the lower part of this blood vessel, which can lead to a severe bleeding and needs repair. Treatment depends on the size and growth frequency of the aneurysm bruit and differs from vigilant waiting to emergency surgery.

An area of a blood vessel with localized dilation (widening) is an aneurysm. “Aneurysm” is derived from the Greek word “aneurysma” which means “a widening.” Aneurysms can develop at any location along the aorta but majorly occurs in the abdominal aorta and can extend into the iliac arteries. Majority of the abdominal aneurysms are diagnosed at a lower level than renal arteries that are responsible to provide blood to the kidneys. Blood clots are formed in the inner walls of the aneurysms because of the stagnant blood and it is layered resembling a piece of plywood.

 

Symptoms:

  1. Most abdominal aortic aneurysms are asymptomatic and are identified when casual ultrasound or CT scan is performed. It is also discovered when a physician feels the abdomen while undergoing physical examination and listens the sound made by stormy blood flow because of abdominal aortic aneurysm bruit.
  2. The most common symptom is pain when the aneurysm ruptures.
  3. An abdominal aneurysm that expands rapidly can cause constant, deep pain in the abdomen or on the sides of abdomen.
  4. A worse back pain and middle abdominal pain
  5. A pulsating abdominal mass(pulse near the belly button)
  6. Other symptoms appear based upon the location of aneurysm along the length of aorta and its affect to the nearby organs.
 

Causes:

  1. Arteriosclerosis: It is the hardening of arteries and the most common cause for aortic aneurysms. Arteriosclerosis weakens the walls of aorta and the pressure of the blood flow that is pumped through aorta leads to weakness of the aortic inner walls.
  2. High blood pressure: Since the aortic wall has 3 layers tunica intima, tunica media, tunica adventitia which provide strength and tolerance to change of blood pressure. But increased blood pressure can weaken and damage the aortic inner walls.
  3. Smoking: Studies show that the rates of aortic aneurysm cases are in accordance with the population smoking rate. Hence, it’s the major cause of aortic aneurysm.
  4. Infected aorta: A fungal or bacterial infection in the aorta can rarely cause the abdominal aortic aneurysm.
  5. Accidents: Accidents and traumas might lead to unexpected injuries which result aortic aneurysm.

Risk factors: 

The following are the risk factors

  1. Hereditary: Risk of becoming a victim of aortic aneurysms is high when you have family history of the condition.
  2. Gender: Being male has the highest risk factor of developing abdominal aortic aneurysms than females
  3. Race: Whites and Native Americans are at higher risk of abdominal aortic aneurysms than Blacks, Africans and Hispanics.
  4. Age factor: People around the age of 65 and above are mostly prone to aneurysms.
  5. Use of tobacco: Smoking is the strongest risk factor. It can weaken the aortic walls, increasing the risk not only of developing an aortic aneurysm, but also of rupture. The chances of developing are greater as a person smokes more and often.
  6. Aneurysms in other locations: Aneurysm in another large blood vessel like aorta in the chest and artery behind the knee are at higher risk of abdominal aortic.
 

Why is it genetic?

It is genetic because of the component that inclines an individual to develop aortic aneurysm, the prevalence of the condition is high as 25% in someone that has a 1st degree affected relative. Collagen vascular diseases weaken the aortic walls associating to the condition. Such diseases involve Ehlers-Danlos syndrome and Marfan syndrome.

 

Screening and management of abdominal aortic aneurysm:

  1. Physical examination: It is the initial way of screening abdominal aortic aneurysm. A pulsatile mass of abdominal aortic aneurysm bruit is felt by the health care professional in the center of the abdomen during physical examination, but it is less obvious in obese patients because of their large girth. The aorta is often felt to pulsate under the skin in very thin patients which is normal. Listening with a stethoscope might help to observe the sound from turbulence of blood flow.
  2. X-rays: Calcium deposits are shown by the X-rays of abdomen. But the extent and size of the aneurysm cannot be determined by plain X-rays.
  3. Ultrasonoscopy: It gives 98.1% accurate measurement of the size of the aneurysm. Ultrasound gives clear picture of abdominal aortic aneurysm with safety and without harm.
  4. Ct scan: Gives highest accuracy to determine the location, extent and size of the aortic aneurysm bruit. It gives us the important information whether it extends down into iliac arteries or towards the chest and whether the aneurysm is present above or below the branching of renal arteries which helps to decide the clinical measures for abdominal aortic aneurysm repair. Since dye is required to be injected in CT scanning in order to evaluate the blood vessels, hypersensitive people to dyes and with kidney diseases can have MRI/MRA (magnetic resonance imaging) as an alternative.
  5. An aortogram: A type of X-ray study where aorta is directly injected with dye and is a test of choice as MRI and CT have taken its place.
 

Complications of abdominal aortic aneurysm:

  1. This can cause a leak resulting in increased pain.
  2. Pain felt in flank/back is often misdiagnosed as a kidney stone which can lead to bursting/rupturing, can result in death
  3. Fluoroquinolone class of antibiotics (drugs) may scarcely lead to the bursting of aortic aneurysms.
  4. Aneurysms which contain a clot and are related to plaque & atherosclerosis along the aortic wall; Symptoms may show up because the debris travels into small blood vessels reducing blood flow.
  5. Aneurysms are rarely infective.
 

Abdominal aortic aneurysm surgery:

Every case of abdominal aortic aneurysm is unique and to repair it the decision is taken based on size of aneurysm, age, Patient’s underlying medical condition, Life longevity.

Two methods to repair abdominal aortic aneurysm are as follows:

1.Surgery:

In the abdomen a huge cut is made and aortic aneurysm is identified and cut out. A synthetic graft is kept on the missing piece of aorta.
2.Endovascular graft:
A tube is passed through the femoral artery (in groin )and the graft is placed so that it spans and sits inside the aneurysm and safeguards it from expanding. The method should be chosen based on the location, size, and shape of the aneurysm.

 

When to see a physician?

If you have pain and particularly if the pain is sudden and severe, seek immediate medical attention.

Prevention of aortic aneurysm:

This condition can be prevented by following the following:
1.Stop smoking /chewing tobacco and avoid secondhand smoke.
2.Have a healthy diet. Eat a variety of fruits & vegetables, whole grains, poultry, fish and low-fat dairy products. Avoid saturated fat, trans fats and limit salt.
3.Blood pressure & cholesterol should be kept under control. If you have prescribed medicines have it without fail.
4.Regular exercise. A minimum of 150 minutes a week of moderate aerobic activity or any other exercise is needed. Talk to your physician for the exercises which you can undergo. Medicines to lower blood pressure will be given by the physician, if an individual is at the risk of aortic aneurysm.
 

Treatment for repair of abdominal aortic aneurysms:

Abdominal aortic aneurysms slowly expand over time. Guidelines for following an aneurysm are as follows:

1.In male and female the normal aorta is 1.7 cm and 1.5 cm respectively. If aneurysms are found by accident that is less than 3.0 cm there’s no need to follow that. If aneurysms measure 3.0 – 4.0 cm it should be monitored once again by ultrasound every year.
2.Aneurysms which measure 4.5 cm & greater should be checked by a surgeon to know if it can be repaired.

 

Conclusion:

Getting checked up regularly if you experience any of the symptoms is recommended. Since the out patients are not given preference in the present situation take an initiative to eat healthy, exercise regularly and to follow other mentioned preventive measures to avoid this severe condition. Stay home, stay healthy!

Subin Joshua
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Author: Hi there, my name is Subin Joshua, and I am a Medical student. I grew up in a family of teachers and know that being a social worker is my calling. My passion for helping others has been evident in my involvement in helping the poor and needy for the last three years. Through those experiences, I have learned to interact with a diverse group of people, which has increased my ability to relate to others.