Aesthetic Medicine Today
Abdominal Aortic Aneurysm

What is an abdominal aortic aneurysm?
An abdominal aortic aneurysm is an enlargement of the lower part of the aorta that
extends through the abdominal area (at times, the upper portion of the aorta in the
chest can be enlarged). The aorta is the main blood vessel that carries blood from the
heart to the rest of the body. Since arteries are elastic and are filled with blood under
high pressure, the wall of the artery may become weakened and distended like a
balloon. The analogy of a bubble in a garden hose would be appropriate in describing
an aneurysm. Aneurysms are usually discovered before they produce symptoms, such
as back pain, but like the weakened hose, they may rupture if they become too large.
Since a ruptured aneurysm is extremely dangerous, causing life-threatening bleeding,
aneurysms are best corrected by an operation before this happens.

What are some predisposing factors for abdominal aneurysms?
•        Arteriosclerosis (also called atherosclerosis). This occurs when the normal lining
of the arteries deteriorates, the walls of the arteries thicken, and deposits of fat and
plaque block the flow of blood through the arteries.
•        High blood pressure (hypertension). This speeds up damage to blood vessel
walls.
•        Disease, such as diabetes, high cholesterol.
•        Injury.
•        Infection.
•        Congenital defects, such as an inherited weakness in the blood vessel wall,
example Marfan's syndrome.
•        Heredity.
•        Smoking.

What are some different types of aneurysms?
•        Abdominal aneurysm -- in an artery in the abdomen (mid-section)
•        Thoracic aneurysm -- in an artery in the chest area
•        Cerebral aneurysm-- in an artery in the brain (usually treated by
neurosurgeons)
•        Peripheral aneurysm-- in the large arteries that run down the legs and behind
the knees, and occasionally arms

Most aneurysms occur in the abdomen. Abdominal aortic aneurysms occur most
frequently in people over age 60 and most commonly at a point in the aorta just
below the level of the kidneys. Men are more commonly affected by aneurysms than
women.

What are the symptoms of abdominal aneurysms?
Most people are unaware that they have an aneurysm because in most cases, there
are no symptoms. However, as aneurysms grow, symptoms may include:
•        Pulsating enlargement or tender mass felt by a physician when performing a
physical examination
•        Pain in the back, abdomen, or groin that may be prolonged and not relieved
with position change or pain medication

A ruptured aneurysm usually produces sudden, severe pain and other symptoms
such as loss of consciousness or shock, depending on the location of the aneurysm
and the amount of bleeding. A ruptured aneurysm requires emergency treatment.

How is an abdominal aneurysm detected?
Most abdominal aneurysms are diagnosed during a routine physical examination or
on X-rays when being tested for other health concerns.

Once an aneurysm is suspected, the following imaging tests may be used to
determine size, location of the aneurysm, and treatment options. Your primary care
physician can provide a referral to the Acute Response Testing Center for a testing:
•        Ultrasound -- high-frequency sound waves, inaudible to the human ear, are
transmitted through body tissues. The echoes from the sound waves are recorded
and transformed into video or photographic images.
•        CT scans -- computed tomography, commonly known as a CT scan, uses X-rays
and computers to produce images of a cross-section of the body.
•        Magnetic resonance imaging (MRI) -- a large magnet, radio waves, and a
computer are used to produce clear pictures of the body. This procedure does not
involve the use of X-rays.
•        Angiogram -- test in which a thin tube (catheter) is inserted into a blood vessel
and a contrast dye is injected to make the blood vessels visible on the X-ray.

How are abdominal aneurysms treated?
Very large or symtomatic aneurysms require immediate treatment.

Surgical repair
There are two types of surgical treatments for large aneurysms.

Open surgical repair: This involves the surgeon making an incision to access the
abdominal aortic aneurysm. The diseased portion of the aorta is replaced with a graft
that acts as a replacement blood vessel. Open surgical repair is a proven procedure
that has a good track record and acceptable risks. But it also involves a long recovery
period. Average hospital stay ranges from 5 to 8 days. The time until return to normal
activity ranges from 6 weeks to 3 months. As with any operation, open surgical repair
has a risk of complications. You will want to discuss them thoroughly with your doctor.

Endovascular repair: "Endovascular " means "inside or within a blood vessel" -- and
that is exactly how a small fabric tube that has metal stents attached to the fabric,
called a stent-graft, is introduced into your body and moved into place. First, small
incisions are made in each groin to get to arteries that carry blood from the aorta.
The surgeon then moves the stent-graft up through these arteries until it is opened
inside the diseased portion of aorta. The stent-graft reinforces the weakened part of
the vessel from the inside and creates a new channel through which the blood flows,
eliminating the risk of rupture. This procedure usually takes 1 to 3 hours and patients
typically leave the hospital in 1 to 2 days. Return to normal activity ranges from 2 to 6
weeks. Like any medical procedure, endovascular repair has a risk of complications. It
also involves regular routine follow-up visits with your doctor to evaluate the stent-
graft. These regular follow-ups are extremely important and will require CT.

Observation
If you have a small aneurysm, your doctor will ask you to come back every 6 to 12
months for an ultrasound to measure the size of your aneurysm and to review any
other symptoms you may have.