Abdominal Aortic Aneurysm

 

Have you ever heard about Abdominal aortic aneurysm? Do you know that your arteries if not healthy can swell up like a balloon and can even burst? Do you want to know what you can do to prevent this? If yes then let's go ahead and learn about Abdominal aortic aneurysm, it's impact in our lives and how we can stop this from occuring.

Let’s talk aneurysm!

 

Ever wondered what all those vampires in TVD Vampire diaries are doing when they give an “aneurysm” to their enemies by using their telepathic powers?

A simple death stare at the enemy and suddenly his or her blood vessel start ballooning and as it reaches its capacity, *pop* *splash* and *swoosh* and the enemy is dead!

In this article we won’t be talking about any of this supernatural violence, or how a mere stare can cause other person’s blood vessels to burst insanely, but we are going to attempt to understand this ballooning of arteries, referred to as aneurysm that actually exists in real life and is to blame for around 2% of “preventable” deaths worldwide.

 

What is aneurysm and how is it affecting the world?

A review of the anatomy of our wonderful body

How AAA presents itself?

Complications

Should I worry about AAA?

Risk factors of AAA

How do doctors know if someone’s abdominal aorta is dilated?

Treatment

Screening

What can I do to reduce the dangers of an abdominal aortic aneurysm (AAA)?

 

 

What is aneurysm and how is it affecting the world?

 

“Aneurysm” means dilatation or ballooning of blood vessels due to reduced strength of its wall, that is a product of several factors like high blood pressure, high blood cholesterol, genetic diseases like Marfan syndrome and others.

The most common site of an arterial aneurysm is “Aorta” and here too the “abdominal aortic aneurysm” leads all other forms.

Abdominal aortic aneurysms (AAAs) are seen in up to 8 percent of men aged above 65 years.

 Rupture of an AAA and its associated fatal physiological insult carries an overall death rate of 60 to 80 percent. A large percentage of patients (60 to 75 percent) die before they arrive at the hospital and around 90 percent die before they can even reach the operating room. At least 13,000 die annually in U.S. following an AAA rupture.

Why I used the word “preventable deaths” before is because this extremely fatal condition can be prevented if detected and treated on time, saving a large population from a precocious death.

A review of the anatomy of our wonderful body

Aorta is the major and largest blood vessel in our body that is responsible for carrying oxygen rich blood from heart to various other organs. This major vessel comes out from the heart in the form an arch, named as arch of aorta, and sooner, based on its route, is classed into three types:

•      Ascending aorta, which carries blood to the upper regions of body including head, neck and arms.

•      Descending thoracic aorta, this travels down through the chest, and provides blood to the ribs and other structures in the chest

•      Abdominal aorta that begins at diaphragm (a dome shaped muscle that divides the inner body cavity into upper thorax and lower abdomen). Most of the major organs such stomach, liver, intestines, kidney etc., receive blood from branches of abdominal aorta.

The layers of aortic wall provide this major artery with the property to stretch to a certain extent and then return to its normal shape, which is usually 2 cm in diameter, with variation in some people. However, if the wall of aorta becomes weak, it loses its distensibility i.e., stretched aorta can no longer return to its original shape and size, resulting in a condition known as aneurysm, or simply enlargement or ballooning of aorta. It is the abdominal aorta that is mostly found to be involved in this condition.

Abdominal aortic aneurysm, or AAA or Triple A, as the name suggests is the aneurysm of abdominal aorta. It is a relatively common condition in men above 65 years old.

This bulging itself is not fatal but it has the potential to keep growing with time, and at a certain point when it no longer can grow further, it results in a split within the wall of aorta, which is a serious medical condition and emergency as it leads to severe internal bleeding, that can cause death if not dealt with on time.

How AAA presents itself?

AAAs doesn't usually cause any obvious symptoms, which makes this condition more serious or we can say, a “silent killer”. It’s often only picked up during screening or tests administered for some other reason.

Some people with an AAA may present with symptoms such as:

  • a pulsing sensation within the tummy (like a heartbeat)
  • or a pulsatile mass felt in the abdomen
  • persistent abdominal pain that doesn't go away
  • lower back pain that's constant and doesn't go away
  • flank pain which may be confused with kidney stones
  • groin pain that may be due to pressure over femoral nerve because of a large or expanding AAA.

 

A ruptured AAA however, results into a sudden drop in blood pressure because of massive internal bleeding and might present as:

•      an abrupt and severe pain in the stomach or lower back

•      fast heartbeat

•      pale, sweaty and cold skin

•      dizziness

•      difficulty in breathing

•      fainting or passing out

Call for an ambulance immediately if you or some other person develops symptoms of a ruptured abdominal aortic aneurysm.

Complications

Neglected and rapidly expanding abdominal aortic aneurysm, whether ruptured or not, can lead to certain complications by either eroding or compressing the adjacent organs which can be fatal.

These include:

  • Abdominal Aortic wall dissection, is the most common complication of AAA. Its symptoms include sudden sharp pain in the abdomen, hypotension, pale and sweaty skin, even loss of consciousness.
  • Aortoduodenal syndrome ,that is a rare cause of intestinal obstruction due to a large AAA, compressing the duodenum, causing nausea, vomiting , abdominal distension, constipation and if severe enough, inability to pass even gas (known as obstipation). Vomiting in this case if severe and projectile can increase the risk of abdominal aortic rupture.
  • Blood clot formation in the dilated region of abdominal aorta. These clots if detached from the source can block a smaller vessel especially in the legs that may present as sudden pain in the leg and limping or may travel to any organ, obstruct its circulation and produce severe outcomes. If not treated on time, damage due to an obstructed vessel may result in amputation of a limb.
  • Arterio-venous fistula or connection between abdominal aorta and inferior vena cava that manifests as symptoms of heart failure including fatigue, difficulty in breathing , swollen and edematous legs.
  • Aorto-enteric fistula or channel between abdominal aorta and duodenum with clinical symptoms of GI bleeding such as abdominal pain, tarry stool, hypotension, tachycardia etc.

Manifestation of these complications, depend on the size of the AAA and also on how long it has been present in someone’s body. Longer the delay in detection and treatment, more is the risk of fatal complications.

Should I worry about AAA?

If you smoke, live a sedentary and unhealthy lifestyle, then you may want to know more about abdominal aortic aneurysm.

It is not known with certainty, what weakens the aortic wall but medical researchers have found various risk factors that make an individual vulnerable to AAA. Some of these factors are unavoidable but few others can be avoided and this avoidance has proven to cut back the possibilities of AAA.

Thus, it's important for us to educate ourselves about all the avoidable risk factors, so we can be our own superheroes and be vigilant enough to not let AAA become the villain of our life.

Risk factors of AAA

There are certain diseases like atherosclerosis, hypertension, Ehler Danlos and Marfan syndrome etc., and unhealthy behaviors that damage this major vessel, making one vulnerable to aneurysm. Smoking is one among the most important behavioral factors responsible for aneurysm. Studies have shown that smoking cessation correlates with a significant decrease in AAA prevalence.

Other major risk factors include:

•      male sex

•      age above 65

•      family history of AAA

•      Heart diseases like history of stroke

•      White race or Caucasian

•      over weight and high blood cholesterol

 

As one cannot change one’s family, ethnicity, sex or genetics, what we are left with are the behavioral factors, which incorporates smoking, low HDL fatty diet, leading a sedentary lifestyle with no exercise and others. Changing these unhealthy behaviors does prevent weakening of arterial walls or if they're weak already, prevents further bulging and thus rupturing of abdominal aorta.

Knowledge of these risk factors is vital for an early detection and timely medical intervention and treatment of abdominal aortic aneurysm.

 

How do doctors know if someone’s aorta is dilated?

Revolutionary scientific researches, inventions and development of high tech devices and machines, have made it relatively easier to diagnose diseases, compared to previous times, before they lead to catastrophic events within the body.

Hence, a prompt analysis of all the risk factors, proper physical examination and a large number of paraclinical tools like an ultrasound scan, CT scan, are useful in AAA detection.

CT scan has proven to be an especially great tool for diagnosing AAA with a 100% sensitivity and is additionally helpful for preoperative planning

Other less commonly used techniques include MRI and angiography.

Also, medical software compute aortic rupture risk by assessment of mechanical stress over the aortic wall, from standard CT data and provides a patient-specific AAA rupture risk diagnosis.

So, if your physician suspects an aneurysm, he/she will do your physical examination, during which a palpable and pulsatile or beating abdominal mass can be noted.

Your physician then may ask you for an ultrasound or CT scan to verify the diagnosis and then plan the treatment accordingly.

Treatment

The treatment for an AAA is surgical repair, which is opted for only after considering possible risks and benefits of the surgery and risk of AAA dissection or other complications. Surgical repair will be performed as an emergency procedure if AAA ruptures.

For asymptomatic people and those with very low risk of AAA complications, non invasive methods are considered for management, which includes:

•      a change in lifestyle and treatment of underlying conditions such high blood cholesterol and high blood pressure, and hence, lowering the risk factors.

•      Surveillance using ultrasound to investigate the expansion rate of aneurysm and need for intervention.  An intervention is commonly recommended if the aneurysm grows more than 1 cm annually or it is bigger than 5.5 cm.

Treatment isn't always needed immediately if the chance of an AAA bursting is low. Based on size of aneurysm, physicians usually follow the below mentioned treatment patterns;

•      small AAA (3cm to 4.4cm across) – ultrasound scans are recommended each year to test if it's getting bigger; you will be advised about healthy lifestyle changes to prevent it from growing.

•      medium AAA (4.5cm to 5.4cm) – ultrasound scans are recommended every 3 months to test if it's getting bigger; in this situation again, you will be advised about healthy lifestyle changes

•      large AAA (5.5cm or more) – surgery to prevent it from growing bigger or rupturing is typically recommended.

The surgical techniques used to repair an AAA include:

1.    Open repair or Open aortic surgery

Open repair is indicated in

•      young patients as an elective procedure

•      growing or large, symptomatic or ruptured aneurysms

Recovery after open AAA surgery takes significant time; the minimums are, a few days in intensive care, a week in total within the hospital and a few months before full recovery.

2.    Endovascular aneurysm repair or EVAR

Preferably done in,

•      older, high-risk patients or patients  who are unfit for open repair.

Feasibility of this method, however, depends on the shape of the aneurysm. Although EVAR may have certain advantages over open repair like less time in intensive care, less time in hospital and earlier return to normal activity, latest studies reveal that EVAR procedure provides no benefit in overall survival or health-related quality of life in comparison to open surgery.

Screening

Taking the importance of early detection of AAA in preventing untimely death of an individual into consideration, various countries have started screening programmes to diagnose and treat this condition as soon as possible.

Many such countries include:

•      United States of America

According to the U.S. Preventive Services Task Force (USPSTF), males above the age of 65 to 75 years with a history of smoking need a single abdominal ultrasound for AAA screening.

 •     United Kingdom

The NHS AAA Screening Programme, encourages men to get screened as they turn 65.  For men over 65, screening can be arranged by contacting the programme.

•      Sweden

All males over 65 years of age are recommended to do a one time screening. In those with a family history of AAA, especially in a close relative, an ultrasound at around 60 years of age is recommended.

 

What can I do to reduce the dangers of an abdominal aortic aneurysm (AAA)?

As we've already mentioned above that changing one’s unhealthy behaviors can significantly reduce the danger.

 There are several steps that one may take to reduce the chances of getting an AAA or stop one from getting bigger.

These include:

•      stopping smoking

•      intake of healthy food – eat a balanced diet and cut down on fatty food

•      regular exercise – aim to do a minimum of 150 minutes of exercise every week

•      maintaining a healthy weight 

•      cutting down on alcohol

If you have got a condition that increases your risk of an AAA, like high blood pressure, your GP might also recommend taking tablets to treat this.

 

Abdominal aortic aneurysm is a serious condition with complications ranging from pain, nausea, vomiting, and difficulty in breathing to loss of a limb and even sudden death. But, if we stay vigilant and take proper care of ourselves and our loved ones by living a healthy life, this condition can easily be prevented or managed and treated, if already present.

I hope I was able to provide a general perception of this serious condition to the audience, so now they may be able to recognize this rogue condition, consult a doctor on time and get this disease treated, before it becomes a baddy in their lives!

 

Stay safe, stay healthy!

Thank you

 

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