Tag Archives: Diagnosis Of Abdominal Aortic Aneurysm

What Is An Abdominal Aortic Aneurysm (AAA)

When aneurysms occur in the abdominal aorta which runs through the abdominal region, they are called abdominal aortic Aneurysms.

  • Pulsations can be felt at the site of an aneurysm.
  • When aneurysms rupture, terrible pain may result.
  • Aneurysms are accidentally detected when a person undergoes physical examination or diagnostic tests for some other reason.
  • Antihypertensive drugs are given to reduce the pressure on the arterial wall and to prevent the aneurysm from worsening.
  • Large aneurysms have to be surgically repaired.

Men in the age group of 50 to 80 and those with high blood pressure are more prone to abdominal aortic aneurysms. People with a family history of the disease and those who smoke are also at greater risk. Abdominal aneurysms rupture in one fifths of cases, resulting in a potentially fatal situation.

Symptoms Of Abdominal Aortic Aneurysm

Abdominal aortic aneurysms are usually asymptomatic in most people, but some may feel pulsations in the abdomen. Pain due to a worsening aneurysm is felt as a piercing pain deep down in the back, and leakage results in excruciating and continuous pain.

 Severe, unrelenting pain in the back and lower abdomen may be an indication of a ruptured aortic aneurysm. Pain and tenderness may be felt externally, over the location of the aneurysm. The rupture of an abdominal aortic aneurysm results in significant blood loss that leads to shock and eventually death, in most cases.

Diagnosis Of Abdominal Aortic Aneurysm

By the time pain due to aneurysm is felt by people, it may be too late. However, accidental discovery of aneurysm from an abdominal scan or X-ray, occasionally make early intervention possible, saving lives. A whooshing sound, called bruit, resulting from blood rushing by the bulge in the artery can be picked up by the stethoscope, when the doctor listens to the sounds from the mid abdominal area. A pulsation also can be felt. Aneurysms may be the cause of pain and tenderness when doctor presses on the abdomen and further investigations may be done. It is difficult to detect abdominal aneurysm in obese people through physical examination.

When there is calcification of the walls of the bulge, it may be detected in an x-ray, but that cannot be considered a conclusive evidence of the condition. Ultrasonography can give a better diagnosis of aneurysms in the abdomen and it can track their progress over a period of time. CT scan of the abdomen, with the injection of radio opaque dye, gives a very clear picture of the aneurysm but the high levels of radiation involved is a cause of concern. On the other hand, MRI scan does not have any risk of radiation but availability may be a problem.

Treatment Of Abdominal Aortic Aneurysm

Smaller aneurysms do not pose any risk of rupture, and people are treated with blood pressure lowering drugs only. They are advised to discontinue tobacco usage, which is known to aggravate aneurysms. Aneurysms less than 2 inches wide are tracked at regular intervals to watch their progress.

To prevent the rupture of aneurysms larger than 2 inches wide, surgical repair is attempted, unless the patient is not in a condition to withstand the surgery which may take 3 to 6 hours. There are two methods; both involve grafts. In the traditional method, a large vertical incision, extending from below the sternum to a point beyond the navel, is made. The graft is first stitched on to the aorta with the walls of the aneurysm wrapped around the graft. It is a long surgery extending up to 6 hours and is done under general anesthesia. More than a week of hospitalization also may be required. Endovascular stent grafting is a newer, less invasive surgery, usually performed under epidural anesthesia which numbs the person from waist down. A guide wire is inserted through small cut in the groin and threaded up the femoral artery and into the aorta, to reach the location of the aneurysm. It is followed by a catheter with a stent graft which is guided to the location of the aneurysm and fixed inside it. The stent is a small collapsible tube made of a mesh and on reaching the site; it is opened up to fit the inside of the aorta very snugly, providing strength and support to the wall of the aorta. Usually, 2 to 5 hours are taken to complete the surgery and hospital stay is reduced to less than a week. The fatality from surgery is about 2 to 5%, but considering the almost cent percent risk of death from ruptured aneurysm; this may be a risk worth taking.

Immediate surgical intervention, either through open surgery or by endovascular stent graft, is necessary to handle an abdominal aortic aneurysm that has already ruptured or is on the verge of rupture. There is a risk of death of 50% during the surgical repair of a ruptured aneurysm; endovascular stent graft placement reduces it by almost half. There is a high probability of shock developing due to excessive blood loss; it can cause kidney failure, in which case, the prognosis becomes extremely poor. Fatality is 100%, if ruptured aneurysm is left untreated.

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