Abdominal Aortic Aneurysm

Aneurysm a Vascular Health Problem

Abdominal aortic aneurysm is more common among Caucasians, affecting men four times more than women and is prevalent in elderly patients. An aneurysm is a permanent focal swelling of an artery to 1.5 times its normal diameter.

The goal of treatment is to limit the progression of the disease by modifying risk factors, controlling the blood pressure to prevent strain on the aneurysm, recognize the symptoms early and prevent rupture. This guideline will familiarize you with the disease process.

An aneurysm is defined as permanent swelling of an artery or an out pouching of an arterial wall. They vary in clinical findings and treatment depending on where the aneurysm is located. All aneurysms involve a damaged media layer of the vessel. The abnormal swelling of the arterial wall is caused by localized weakness and stretching in the cellular walls of the artery. After it develops, it tends to enlarge. The causes of aneurysms include tobacco use, hypertension, trauma, atherosclerosis, hereditary, or infections. The most common cause of abdominal aortic aneurysm is atherosclerosis. Most of these out pouching occur below the renal arteries. Untreated, they eventually rupture causing severe pain, massive internal bleeding, and death.

Types of Aneurysms

  • Fusiform aneurysm is a diffused dilation that involves the entire circumference of the arterial segment.
  • Saccular aneurysm is distinct, localized out pouching of a sac on vessel.
  • Dissecting aneurysm is created when blood separates the layers of the artery wall forming a cavity between them.
  • Pseudoaneurysm aneurysm is formed after complete rupture and subsequent formation of a scar sac.

Signs and symptoms

Most abdominal aortic aneurysms do not produce symptoms. As they enlarge however pain extending to the neck, shoulders, lower back and abdomen is experienced. A prominent pulsating mass in the abdomen at or above the navel is also felt and extreme tenderness on deep palpation is experienced. As the aneurysm further enlarges additional symptoms are felt like light headedness, nausea and vomiting, clammy skin and rapid heart rate. Rupturing of the aneurysm causes even further abdominal and back pain as well as lumber pain radiating to the groin.

Diagnostics tests

Ultrasonography, CT scan or MRI, chest x-ray, and renal function studies are the most common diagnostic tests done. They are performed to confirm the presence of an aneurysm, the size and also the location.

Medical interventions

  • Pharmacologic therapy
    An association between increased blood pressure and increased aneurysm rupture has been established. Antihypertensive agents, including diuretics, beta-blockers, ACE inhibitors and calcium channel blockers are frequently prescribed to maintain the patient’s blood pressure within acceptable limits.  
  • Surgical management
    An aneurysm of 5cm may be palpable. Treatment of an abdominal aneurysm is surgery. The standard treatment has been open surgical repair of the aneurysm by resetting the vessel and sewing a bypass graft in place.
  • Prevention management
    Since blood pressure caused by atherosclerosis is the main reason for aneurysm rupture, attention to the patient's general blood pressure, tobacco use and dietary habits help reduce the risk on an individual basis.  
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