Abdominal Aortic Aneurysm

Ruptured Abdominal Aortic Aneurysm

admin — Sun, 08 Jan 2012 16:58:38 +0000

Ruptured abdominal aortic aneurysm is potentially life threatening. Ruptured aortic aneurysm causes internal bleeding that could lead to serious complications like heart attack, stroke and deprivation of blood to the colon or spinal cord and eventually death. The mortality rate is extremely high in this condition.
The symptoms of ‘AAA’ are asymptomatic. They become known only through ultrasound or computed tomography scan (CT scan) ordered for examination of other aliment, through sudden onset of severe symptoms, rupture or through initial screening of abdominal aortic aneurysm done under Medicare program. Men particularly between 65 to 75 years age are vulnerable to ‘AAA’. Hence, it is imperative to take a referral for ‘AAA’ screening under Medicare part B from a physician. ‘AAA’ is an emergency and requires immediate medical attention.
A ruptured abdominal aortic aneurysm sign is sudden excruciating pain in the abdomen and back, pulsating abdominal mass and hypotension. The patient might faint; vomit and the skin will feel cold and clammy. Such patient should be rushed to the hospital immediately. Once the patient reaches the hospital it is important to perform an urgent ultrasound or computed tomography scan. However, in most cases only X-ray or ultra sonography is possible due to paucity of time.
The initial X-ray results usually reveal an aneurysm that is grown over 50% its normal size due to calcification, hemorrhage and clearly visible stretched base of the aorta. The doctor will be able to decipher a pulsatile mass to the left side of the abdomen, just little away from the umbilicus, reduced inferior extremity pulses and abdominal systolic bruit. The internal bleeding that happens due to rupture can cause severe irritation in the peritoneal area. The peritoneal area is a thin serous membrane that lines the walls of the abdominal cavity and envelops the entire viscera.
Types of ruptured abdominal aortic aneurysm:
Retroperitoneal – Accumulation of blood is found in the retroperitoneal hematoma (an anatomical gap in the abdominal cavity that is situated behind the peritoneum (gut cavity). About 80% of abdominal aortic aneurysm cases reported have been caused due to retroperitoneal rupture.
Intraperitoneal- The rupture occurs within the peritoneum. About 20% reported abdominal aortic aneurysm cases are caused due to intraperitoneal rupture. In this situation, there are no tissues present to restrain the break out of blood from the aorta unlike in retroperitoneal rupture. Hence, the mortality rate is higher in intraperitoneal rupture cases.
Chronic- Chronic rupture is rare and occurs in a confined anatomical area and the surrounding tissues contain the blood leak. Chances of survival are higher in this case.
Rupture into vena cava inferior-Vena caval is the vein that carries oxygenated blood from lower part of the body to the right atrium of the heart. Sometimes the ‘AAA’ wears down the adjoining vena cava inferior that leads to formation of aortacaval fistula that grows in size and eventually ruptures. Compression of inferior vena cava can result in high output heart failure or peripheral edema.
Rupture into duodenum- Duodenum is a portion of small intestine that stretches from stomach to jejunum. An aortoduodenal fistula formation in the duodenum bursts open causing gastrointestinal bleeding.
Ruptured abdominal aortic aneurysm is treated through open surgery or endovascular surgery. The aneurysm is cleaned and the void space is replaced with a graft that is sewn from one end of the aorta to the other covering the void space. Endovascular surgery is less invasive compared to open surgery. There is risk of blood clots, hypotension, shock and other complications during the surgery. Considering severity of the condition, existing medical issues and other risks involved which type of surgery is to be undertaken is decided. It is important to remember a ruptured abdominal aortic aneurysm is an acute condition. Thus requires prompt medical attention as it may occur suddenly owing to the symptoms being asymptomatic.

Infrarenal Abdominal Aortic Aneurysm

admin — Mon, 02 Jan 2012 15:33:56 +0000

Infrarenal abdominal aortic aneurysm occurs just below the kidney.Abdominal Aortic Aneurysm is an illness that occurs when the walls (lining) of the aorta (the largest blood vessel that extents until the abdomen and is located in the left ventricle of the heart) begins to balloon. The ballooning (swelling or expansion) process is called dilatation. When the blood vessel grows out of proportion, it ruptures and leads to internal bleeding. Aneurysm occurring above the kidney is called suprarenal ‘AAA’. If it is located at the same level or on top of the kidney, it is called pararenal ‘AAA’ and if it occurs just below the kidney it is called infrarenal ‘AAA’.
Here we will look at infrarenal abdominal aortic aneurysm in detail.
Shape of infrarenal ‘AAA’
‘AAA’ has asymptomatic symptoms hence common symptoms like pain in abdomen and swelling in the blood vessel could be mistaken as symptoms of some other aliment. The correct way to decipher if the dilatation is related to ‘AAA’ is through its shape. The outer area of the blood vessel is called adventitia; it is a thin connective tissue on the surface of the blood vessel. If an aneurysm is present only in the outer layer of the blood vessel (walls) it is not an abdominal aortic aneurysm.
A correct ‘AAA’ is made of three layer called the adventitia that is an outer connecting tissue, the media that is muscular elastic fibers and intima that is made up of endothelial cells. Actual infrarenal abdominal aortic aneurysm is located inside the endothelium. The shape of the aneurysm is saccular (bag like formation that contains liquid) or fusiform (spindle or rounded shape that tapers from center to each end). The saccular aneurysm balloons only on one side of the aorta whereas fusiform shaped aneurysm covers entire area that is all sides of the aorta.
Fusiform infrarenal ‘AAA’
Most common form of infrarenal abdominal aortic aneurysm is fusiform aneurysm. In fusiform infrarenal ‘AAA’, all three layers of the blood vessel are involved. Fusiform aneurysm can expand up to 20 cm in diameter and spread to the iliac arteries as well. This condition exerts pressure on the adjoining tissues that causes pain in the chest, abdomen and legs. Fusiform infrarenal ‘AAA’ affects the ascending aorta and in some cases the root and the arch of the aorta as well. It occurs just below the kidney situated slightly away towards the left subclavian artery. As the time passes by calcification takes place.
If a patient is detected with, infrarenal ‘AAA’, treatment can be done by regularly monitoring the growth of the aneurysm and by controlling smoking, blood sugar levels, exercising and keeping a check on diet. Medication can be given to avoid high blood pressure and hyperlipidemia. In severe cases, the aneurysm needs to be repaired through surgery.
Repairing infrarenal abdominal aortic aneurysm
There are two ways to repair infrarenal aneurysm. An open surgery or endovascular surgery.
Open surgery: A large opening is created in the abdomen so that the aneurysm is clearly visible. A graft that looks like a cylindrical tube is sewn from one end of the aorta to the other end covering the aneurysm.
Endovascular surgery: Endovascular surgery is less invasive compared to open surgery. An incision in the groin is made to insert a stent graft that is made of metal mesh and is cylindrical in shape. A femoral artery is slightly pulled out; the stent graft is inserted into the artery and made to travel up to the place of the aneurysm with help of appropriate medical equipment. The stent is used to keep the graft open and hold it tightly in place.
Infrarenal abdominal aortic aneurysm could be fatal condition as symptoms are asymptomatic and sudden onset of symptoms results in rupture of the blood vessel. Hence, if the aneurysm has grown over 5cm it is imperative to get a surgery done.

Abdominal Aortic Aneurysm Surgery

admin — Mon, 02 Jan 2012 15:28:56 +0000

Abdominal Aortic Aneurysm Surgery is the only Way to Repair an Aneurysm.
Abdominal aortic aneurysm is dilatation of the largest artery in the body that may rupture and cause internal bleeding. The only treatment for a ruptured aneurysm is abdominal aortic aneurysm surgery. If the swelling is less than 3 cm, no surgery is required. Two types of surgeries are used to treat ‘AAA’, conventional type of open surgery or less invasive endovascular abdominal aortic aneurysm surgery. Depending on the present severity of the condition and future predictions, the doctor and patients should discuss the risks involved in a surgery compared to rupture of the aneurysm.
Risks involved in abdominal aortic aneurysm surgery
Patients suffering from prior medical issues are at higher risk. Example,
High blood pressure
Diabetes
Kidney failure
Stroke
Gastrointestinal problems
Lung disease
Patients suffering from cardiovascular disease are vulnerable to surgical complications especially in open surgery. Elderly people are at higher risk of complications due to age related issues.
If the aneurysm has increased, more than 5.4 cm in diameter following risks may develop during the abdominal aortic aneurysm surgery.
Excessive bleeding prior to and post surgery
Injury to adjacent tissues
Injury to intestine and adjoining organs
Blood clots in the legs (this might carry the blood clot to the lungs through artery track)
Numbness in legs (caused because of damage to certain nerves)
Vascular issues (difficulty in breathing)
Infection in the urinary track and lungs
Damage to the ureter
Improper blood supply to colon
Impotency (rare)
Injury to the spinal cord caused due to improper blood supply to the spinal cord
Prosthetic graft infection
Heart attack or stroke
Reaction to medicines
Most of these risks are associated with open surgery. Endovascular surgeries being less invasive poses lower risk. However, acceptance of the stent graft by the body in endovascular abdominal aortic aneurysm surgery is a major risk. Hence, patients undergone endovascular surgery requires regular ultrasounds and CT scan for 6 months to 1 years post surgery to monitor progress.
Open surgery: As the name suggests, a large cut is made in the abdomen area or on the left side of the abdomen. An anticoagulant is administered to avoid thickening of the blood and avoid formation of blood clots. Then the blood flow is redirected by clamping the arteries. The aneurysm is then physically pulled out slightly; cleaned and drained if contains any liquid. Then cylindrical shape graft is inserted and sewn in place from where the portion of the aneurysm attached to the aorta was removed. The graft is then rinsed out to remove any existing debris or air. Once the graft is in place the clamps on the arteries is removed for proper blood flow. Intravenous lines are inserted for providing fluids and monitoring progress.
Endovascular abdominal aortic aneurysm surgery: Endovascular surgery is less invasive and less risky compared to open surgery. An endovascular surgery starts by administering anesthesia and intravenous sedation. Then the doctor makes an incision in the groin area and pulls out a femoral artery. A thin tube called a catheter is inserted into the artery. Then with the aid of fluoroscopy, that is an x-ray and contrast dye the floating of the graft is monitored. Once stent graft is drifted to the place of the aneurysm either it opens up automatically or it is stretched out with help of an angioplasty inflate. Finally, the incision is sewn up. Endovascular surgery requires regular computed tomography (CT scan) monitoring for 6 months to a year post surgery.
Abdominal aortic aneurysm surgery is the only way to repair the aneurysm. Which type of surgery suits the patient best depends on the severity of the condition and complications involved. Hence, a thorough medical checkup and discussion with the doctor is advisable prior to surgery.

Abdominal Aortic Aneurysm Screening

admin — Sun, 01 Jan 2012 17:47:29 +0000

Abdominal aortic aneurysm screening is an important procedure that aids in identifying number of people who are at increased risk of the disease. ‘AAA’ has asymptomatic signs. Early diagnosis might help in curbing the high mortality rate, avert any other medical complications and reduce the risk that is associated with abdominal aortic aneurysm. Patients detected with abdominal aortic aneurysm symptoms can be provided detailed information on the illness, further tests that need to be undertaken and appropriate treatment to be availed.
There is an internationally set criterion for the abdominal aortic aneurysm screening. Organizations as US Preventive Task Force or UK National Screening Committee recommends one time screening of abdominal aortic aneurysm under clinical practice guidelines.
Who is eligible for abdominal aortic aneurysm screening?
It has been observed that men are at higher risk of getting ‘AAA’ than women are. Eligibility criteria for ‘AAA’ screening is
Men between the ages of 65 to 75 years
Men who have smoked at least 100 cigarettes until time of screening
Genetics- people who have had a family history of abdominal aortic aneurysm
Patients who have never had an ultrasound done for ‘AAA’ under Medicare cover.
If screening results detect abdominal aortic aneurysm , depending on the severity of the disease, prompt medical action needs to be taken. If the symptoms are mild to moderate, the doctor may advice abdominal aortic aneurysm screening as part of regular healthcare program. This could include annual screening of ‘AAA’ to check if the aneurysm is increasing in size, development of any other symptoms and inflammation of the aorta. In such cases, the patient should discuss with the doctor if the risk of surgery is higher than risk of internal bleeding and vice-versa. If the illness is in its last stages and risk of rupture of blood vessel is higher, doctors may advice for an open surgery or an endovascular surgery.
Types of abdominal aortic aneurysm screening
Various types of techniques are used to screen abdominal aortic aneurysm . It is called anuerysmorrhaphy. The most common one is ultrasound or ultra sonography. Ultrasound is a reliable, low cost and speedy technique. The abdomen and aorta is scanned by applying a gel and scanned through a scanner.
Apart from ultra sonography, Arteriogram, CT scan (computed tomography), MRI (magnetic resonance imaging) and radiography techniques are used to ascertain the presence of ‘AAA’. Ultrasound is the preferred choice for initial examination for ‘AAA’. If infrarenal aorta is found to be involved in reports, MRI or CT scan is then ordered for detailed analysis.
Interpretation of the abdominal aortic aneurysm screening results
If the aneurysm is found to be below 3cm, no further screening is required for at least two years.
If the ‘AAA’ is 3 to 3.9 cm in diameter, patient may be advised to get an examination done within next one to two years
Four to 5.4 cm abdominal aortic aneurysm is at higher risk of growing at a faster rate and eventually rupturing. Therefore, six monthly screening is advisable. Doctors might ask the patient to opt for an immediate surgery.
Aneurysms that are bigger than 5.4 cm necessitate immediate open or endovascular surgery as they may burst anytime.
‘AAA’ screening is often covered under the Medicare part B program. It offers one time ultrasound screening under the “welcome to Medicare” preventive appointment. Abdominal aortic aneurysm screening referral is required from a general physician or a non-physician practitioner. Abdominal aortic aneurysm screening does involve certain risk factors that should be discussed with the doctor prior to taking an appointment for the examination. On basis of several studies conducted on abdominal aortic aneurysm, it can be concluded that abdominal aortic aneurysm screening aids in timely diagnosis of the illness in men between 65 to 75 years of age and helps reduce mortality rate.

Abdominal Aortic Aneurysm Symptoms

admin — Thu, 29 Dec 2011 18:52:52 +0000

Abdominal aortic aneurysm can be a life threatening medical condition if it is not detected in time. However, as ‘AAA’ has asymptomatic symptoms it may be difficult to identify the illness in time. In most cases, abdominal aortic aneurysm symptoms become apparent very late. Sometimes, the illness is deciphered only when the aneurysm ruptures or if the patient is admitted to the hospital for another medical emergency.
What is ‘Abdominal aortic aneurysm’?
‘AAA’ occurs when the walls of the largest aorta (blood vessel) located in the left ventricle of the heart becomes weak and begin to swell. The blood vessel slowly begins to take a balloon shape. If this swelling (aneurysm) expands or grows rapidly it will burst and cause internal bleeding. Growing of the aneurysm is a slow procedure hence during initially stages it may not show any major symptoms or symptom like pain in the abdomen may be incorrectly perceived as part of other sickness. Usually aortic aneurysm that grows above 3cms or up to 50% greater in size requires urgent medical attention.
Most of the ‘AAA’ cases are a result of atherosclerosis that is hardening of the arteries, aging, excessive smoking or genetics. Apart from this, infection and inflammation of the aorta are other two reasons of ‘AAA’ development.
General Abdominal Aortic Aneurysm Symptoms:
Pain or tenderness in abdomen
Pulsating sensation in the abdomen
Pain in lower back, hips, groins, buttocks or chest
Pain in the flank (above the kidney)
Numbness in legs
{Pain is one of the major abdominal aortic aneurysm symptoms. A characteristic of ‘AAA’ pain is that it is felt as if it is piercing into a person. ‘In ‘AAA’ pain is usually felt in the middle section of the abdomen and in severe cases can extend to the back. Changing positions may aid in easing the pain a bit but is typically unwavering}.
If the ‘AAA’ develops at a faster rate sudden onset of abdominal aortic aneurysm symptoms develop. Example,
Nausea
Palpitation in the heart
Vomiting
Clammy skin (In this condition, skin is usually moist, cool to touch and appears pale.)
Shock
Different types of shock that can occur are hypovolemic shock that is caused due to insufficient volume of the blood. Cardiogenic shock is related to the heart and neurogenic shock is caused when the nervous system is affected.
If a blood clot starts to form, it may show symptoms like a blue or black color toe that is extremely painful. This condition is also called “cold foot”. If there is extreme inflammation, it might lead to sudden weight loss and fever.
Hoarse voice is a symptom that might arise if the aneurysm is related to or develops in the arch of the aorta. This happens when branch of the vagus nerve that is the recurrent laryngeal nerve begins to enlarge. The reason of laryngeal nerve to be affected is that it is situated around the arch of the aorta. It sticks around the aorta in a winding arrangement.
Development of abdominal aortic aneurysm symptoms
Development of ‘AAA’ is a slow process and hence do not show any major symptoms. In some patients, the symptoms might occur in mild to moderate form for years together and suddenly result in rupture of the blood vessel. However, a severe ‘AAA’ patient may experience sudden onset of symptoms. Many a times the blood vessel ruptures and internal bleeding takes place only then the existing symptoms are understood to be linked to ‘AAA’.
As abdominal aortic aneurysm symptoms are asymptomatic and can easily go undiagnosed, the mortality is rate is very high. It is a potentially life threatening illness. Hence, a medical checkup after 50 years of age is imperative.

Abdominal Aortic Aneurysm

admin — Thu, 29 Dec 2011 18:48:50 +0000

Abdominal Aortic Aneurysm – A Potential Life Threatening Medical Condition
The largest aorta of the body originates from the left ventricle of the heart and descends until the abdominal aorta that is the biggest artery in the abdominal cavity. The major blood vessel that carries oxygenated blood to various parts of the body. Abdominal aortic aneurysm (swelling) takes place when the aortic walls begin to weaken. Weakening of the walls leads to ballooning of the blood vessel which is called dilatation. If the aneurysm expands rapidly or out of proportion, it ruptures causing internal bleeding. This is a very serious condition and mortality rate is about 60% to 90%.
Abdominal aortic aneurysm occurs mostly in males and people who smoke a lot. People between 65 to 75 years of age are more prone to this illness. Aortic aneurysms are of various sizes. They may grow up to 50% more than its normal size. Aneurysm more than 3cm in diameter is risky and requires open surgery or endovascular abdominal aortic aneurysm surgery to restore it.
Abdominal aortic aneurysm symptoms
Usually ‘AAA’ symptoms are asymptomatic that is it does not show subjective evidence of the presence of the disease. However, due to abnormal expansion of the blood vessel it may cause
• Pain in the abdomen
• Pulsating feeling in the abdomen
• Pain in scrotum, lower back, scrotum, chest and hips
• Rapid heart rate
Most ‘AAA’ cases are detected during ‘X-ray’ or ‘CT scan’ ordered for examination of other diseases. However, if ‘AAA’ develops rapidly, symptoms appear like
• Vomiting
• Nausea
• Sweaty skin
• Shock
• Pain in lower back and groins occurs
It also poses risk of rupture that can create major complications like acute aortic occlusion, peripheral embolization, and aortoduodenal or aortocaval issues. Such situations require urgent medical attention and surgery.
What happens in abdominal aortic aneurysm?
The bloating of the artery leads to rupture that causes internal bleeding. Rapid bleeding from the blood vessel can lead to development of tachycardia, hypotension (low blood pressure), hypovolemic shock, disturbed mental condition or cyanosis. The ruptured abdominal aortic aneurysm is usually situated below the point of renal arteries. If ‘AAA’ develops below the kidney, it is called infrarenal abdominal aortic aneurysm. Nonetheless, it can also occur above the kidney (suprarenal AAA) or at the same level or place of the kidney (pararenal AAA).
Once the blood vessel burst open, it creates a fistula either between the aorta (aortacaval) or between the intestine (aortaintestinal). Bleeding occurs either in retroperitoneal area that is behind the peritoneum (serous membrane inside layer of the cavity of the abdomen) or in intraperitoneal area that is inside the cavity of peritoneum.
Causes of Abdominal Aortic Aneurysm – The actual development process is yet to be known however, following factors may influence the development:
Smoking
Chewing tobacco
High blood pressure
Obesity
Genetic aspects
High cholesterol
Emphysema
Infection in vasculitis (aorta)
Cystic medial necrosis
Trauma
Arteritis
Atherosclerosis (coagulation or solidification of the arteries)
The above factors cause breakdown of collagen and elastin proteins located in the wall of the aorta. They weaken the walls leading to development of ‘AAA’.
An abdominal aortic aneurysm screening can be done with help of ultrasound or CT scans and confirms presence of the disease. If the aneurysm is above three cms in diameter, it can be treated through open (invasive) or endovascular (non-invasive) surgery. The type of surgery is based on severity of the aneurysm and risk of the aneurysm rupturing. Although smaller ‘AAA’ may not require surgery but surely proper medical attention is needed as they can rupture. Hence, special medical advice or test done for abdominal aortic aneurysm post 50 years of age can help avert this potentially life-threatening illness.

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