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Abdominal aortic aneurysm

How serious is an aneurysm in your stomach?

How.serious is an aneurysm in your stomach?

The aorta is the largest blood vessel in the body, so a ruptured abdominal aortic aneurysm can cause life-threatening bleeding.

Abdominal aortic aneurysm

Aneurysm is the dilation of an artery at least 50% above its normal diameter. In the abdominal aorta, the dilatation may reach more than 3 cm.

About 5% of people who have reached the age of fifty years and over have an abdominal aortic aneurysm , and it is more common among men than women, and the incidence of men versus women is 1:9.

Abdominal aortic aneurysm symptoms

Most cases of abdominal aortic aneurysm are asymptomatic and are diagnosed by chance by imaging tests performed for other reasons.

When the aneurysm wall ruptures, the patient begins to feel abdominal pain that radiates to the back, and feels hemodynamic changes (low blood pressure and rapid heart rate). Also, during an abdominal exam, a sensitive, pulsating mass may be encountered and touched.

Symptoms such as fever, high white blood cell count (leukocyte), weight loss and increased erythrocyte sedimentation rate (Esr) could be signs of an inflammatory or inflammatory dilatation of the abdominal aorta.

Abdominal aortic aneurysm causes and risk factors

In the past, it was believed that atherosclerosis was the main cause of this disease. But today, it is believed that there are many causes that lead to the weakening of the walls of blood vessels, including, of course, infections, genetic factors,  high blood pressure , and in some rare cases, the cause may be an infection of the arterial wall.

As for the weakness and degeneration of the wall, they are caused by a decrease in the amount of elastin and collagen in the wall due to the enzymatic activity that leads to the disintegration of these proteins. (Elastin and collagen are two important proteins that strengthen arterial walls and give them elasticity.)

The problem that could endanger the patient’s life is the rupture of the wall and the occurrence of hemorrhage.

Abdominal aortic aneurysm complications

Follow-up of the patient’s condition without resorting to surgery: Patients who have been decided not to need surgery or who are not able to survive under surgery need follow-up in order to know if they have an increase in the diameter of the aneurysm, by performing an ultrasound examination every six months . They also need to reduce risk factors such as abstaining from smoking, or reducing the concentration of fats in the blood. It is preferable to use blood pressure lowering therapies in order to reduce the risk of heart disease, and to reduce the frequency of aneurysm expansion.

The known risk of death is between 1% and 5% during pre-planned surgeries, and up to 40% during emergency operations (after an artery rupture).

Because of the complications of surgery, and due to the advanced age of patients and their infection with other diseases, complications such as bleeding, heart attack , or shortness of breath are common .

But the most common complications are embolism and blockage of blood vessels.

Abdominal aortic aneurysm diagnosis

There is no, to date, a special screening and examination program to detect this disease, but if such a program existed, it would be very useful for people with a family history and record that include injuries, as well as for the elderly and smokers.

An artery dilatation with a diameter of 4-5 cm can be diagnosed by physical examination, in only 50% of cases, and when the diameter is greater than 5 cm, the dilatation is diagnosed in only 75% of cases.

  • Ultrasound examination (ultrasound – Ultrasound): little examination costs, reliable results and noninvasive (Noninvasive). This examination helps in diagnosing abdominal aneurysms, and its main effectiveness is to identify patients at risk of contracting this disease and to monitor and follow up the diameter of the aneurysm in patients with abdominal aortic aneurysm.
  • Computerized tomography (CT): the most expensive, as it exposes the patient to radiation and contrast agents that are inserted into the vein, which may lead to some disturbance in the performance of the kidneys. However, the accurate data that we obtain regarding the prevalence of abdominal aortic aneurysm and the injury of the iliac arteries, and the injury of the rest of the abdominal organs, make this examination the best and most useful for patients who may need treatment for aneurysms.
  • Magnetic resonance imaging (MRI): Equal to efficacy with computed tomography scan, but much more expensive than it in terms of cost, and it is used in patients with renal failure.

Assessment of the patient’s condition

The decision to treat an abdominal aortic aneurysm depends on three components: the odds of the aneurysm rupturing, the patient’s life expectancy, and the severity of the surgery.

  1. Rupture in the wall of the aneurysm : The risk of rupture increases as the diameter of the aneurysm increases. When the diameter of the expansion is less than 4 cm, the chances of a rupture are minimal. When the diameter is more than 6 cm, the risk of rupture rises sharply, reaching 10% of patients per year. Hence, as is followed, the expansion that has reached this diameter must be treated. When the aneurysm is between 4-6 cm in diameter, it is important to consider other risk factors that may cause a rupture. The diameter of the expansion increases at a rate of 10% per year. However, rapid expansion, which may reach 1 cm per year, increases the risk of rupture, in addition to family background, heterogeneous form of aneurysm and chronic obstructive pulmonary disease.
  2. Average life expectancy of the patient : The treatment of aneurysms is considered a preventive treatment that aims to prolong the life of the patient, and from here the general condition of the patient must be taken into account. For patients with a particularly short average life, the aneurysm may not be treated, due to the high risks inherent in this treatment, which justify not performing it.
  3. Surgery risks : The risks are determined based on factors related to the surgical staff or those related to the patient’s general condition in terms  of heart disease ,  kidney failure , and pulmonary disease. In young patients, with low risk levels, it is possible to perform surgery for relatively small aneurysms with a diameter of 4-5.5 cm, due to the high possibility of aneurysm enlargement and the need to undergo surgery in the future.

Abdominal aortic aneurysm treatment

Abdominal aortic aneurysm can be treated in the following ways:

Endo-vascular treatment

When using this modern method, the treatment is done by catheterization by inserting an artificial tube into the patient’s blood vessel. This operation does not require surgery, but can be performed under a minimally invasive procedure and under local anesthesia. The catheter is inserted through the femoral artery. Because of the anatomical problems, this method is suitable for a section of patients only, and for the rest, surgery is performed on them according to the traditional method.

The main disadvantages of this method

Internal leakage as a result of insufficient fixation, movement of the graft.

Also, the longevity of this tube has not been proven, until now.

Follow-up of the patient’s condition after surgery

Five years after surgery, a computed tomography (CT) scan is done in order to rule out an artery aneurysm, above and below the treated area.

As for endovascular treatment, it needs to be monitored at a higher rate (every 6 months), and this is done through an ultrasound examination in addition to a Doppler examination in order to ensure that the aneurysm is not enlarged, and to deny the movement of the tube or internal leakage.

Surgical methods

During the surgery, the abdominal aorta is exposed and blocked above and below the aneurysm, and the diseased part is changed by implanting an artificial graft that is attached to the healthy part of the artery.

There are 3 ways to perform the surgery:

1. A large incision is made in the front of the abdomen, and the abdominal organs are removed, thus reaching the anterior aorta.

2. The lateral method, which is called retroperitoneal. In order to avoid incision in the abdomen, the patient lies on his side and then an incision is made under the rib cage from the left. Each of these methods has its advantages and disadvantages in technical terms.

3. Laparoscopy, which is used in several medical centers around the world, with good results The basic principle of this surgery is the same as that of normal surgery, as well as patients can enjoy early recovery and moderate pain. Another advantage of this method is to reduce the possibility of a delayed hernia in surgical scars, a phenomenon very common in these patients. The main disadvantage of this method is its technical complications.

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