Abdominal aortic aneurysm – a silent killer

About four in hundred men and one in hundred women over the age of 65 have an abdominal aortic aneurysm. It becomes more common with increasing age. However, most people with an abdominal aortic aneurysm are not even aware they have one!

The aorta in the human body is a major blood vessel which runs from heart, through chest and to abdomen where it divides to supply blood to legs. An abdominal aortic aneurysm is a blood-filled bulge or ballooning in a part of aorta that runs through abdomen. The area affected by aneurysm becomes weak and the force of normal blood pressure can cause it to rupture. A ruptured aneurysm situation can be extremely dangerous. It can lead to severe pain and massive internal bleeding, or haemorrhage that can be life threatening. The risk of rupture increases with increasing size.

Causes and risk factors
Abdominal aortic aneurysm usually affects people over 50 years of age and is more common in men than in women.

• Hardening of the arteries (atherosclerosis)
• Infection in the aorta (vasculitis)
• High blood pressure
• Family history of aortic aneurysms in first-degree relatives (parent, brother, or sister).
• Chronic obstructive pulmonary disease - lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.

Around 8 out of 10 people with a rupture either die before they reach hospital or do not survive surgery.

Not everyone experiences symptoms of an abdominal aortic aneurysm, and it may rupture before being diagnosed that is why this condition is often referred to as the 'silent killer'. However, for those patients with symptoms, the most common one is pain in the abdomen, back or chest. The pain may range from mild to severe and the diagnosis may get delayed as there are many causes of pain in the back or abdomen. Abdominal aortic aneurysm is usually discovered during an examination being done for other unrelated health reasons where the doctor may feel a bulge or pulsation near the navel, deep, constant pain in the abdomen or on the side of the abdomen.

Sometimes small blood clots called emboli and form on the inside lining of an abdominal aortic aneurysm. These may break off and be carried down the aorta which can be dangerous as these could lead to blockage of a smaller artery. For example, an artery supplying blood to the foot, if complete blockage occurs then it may lead to loss of blood to part of the foot, which can cause pain in the foot and gangrene if it left untreated.

Tests & Diagnosis

• Abdominal Ultrasound
• CT Scan
• Magnetic Resonance Imaging (MRI)
• Angiogram
• Doppler Ultrasound- uses reflected sound waves to see how blood flows through a blood vessel. 
• How can Aortic Aneurysms be treated?

Non-surgical treatment options for abdominal aortic aneurysm
Not all abdominal aortic aneurysms need surgery. If the aneurysm is small,  doctor may decide to wait and watch carefully to see if there are any changes. Regular check-ups and scans can help doctor monitor its size and growth closely. Some of the precautionary measures to be taken are:

• Control high blood pressure - eat low sodium diet and get regular exercise
• Control high cholesterol - eat low fat and low cholesterol diet and keep  healthy through regular exercise
• Manage weight - this lowers the risk of complications when there is need for a surgery
• Be active - consult the appropriate doctor to learn about the right exercise. Dedicating thirty minutes every day can be beneficial.
• Consume a heart healthy diet - this includes fruits, vegetables, high-fibre foods and foods low in saturated fat, trans-fat and cholesterol.
• Quit smoking and tobacco chewing.

Surgical treatment options for abdominal aortic aneurysm
Open surgical repair: It is called an open surgery because the abdomen is open while the doctor is working on the aorta for him to see. It is a traditional method of repair. The surgeon makes a large cut, or incision, into abdomen where the aneurysm exists. The area damaged by the aneurysm is then separated surgically from the main part of the aorta and replaced with a synthetic tube (known as an aortic graft), that is sewn into place.

Open surgical repair of an abdominal aortic aneurysm is performed under general anaesthesia and takes about 3 to 4 hours, and can expect to spend 3 days in an intensive care unit and will remain in the hospital for 7 to 10 days.

Endovascular aneurysm repair (EVAR)
Endovascular aneurysm repair is a minimally invasive alternative to major open surgery for the repair of abdominal aortic aneurysms (AAAs) that results in reduced recovery times and potentially improved survival rates. Can expect the hospital stay to be typically as short as 2 to 4 days. It is performed using a special device called an endovascular stent graft, like the Endurant abdominal aortic aneurysms stent graft system which is designed to conform to a broad range of aortic anatomies, empowering physicians to offer endovascular aortic repair to more abdominal aortic aneurysm patients than ever before.

It is a flexible wire frame (stent) sewn onto a specially woven fabric tube (graft) that physicians use to create a new path for blood flow in the patient's aorta, reducing pressure on the aneurysm and the risk of rupture. It is placed inside the abdominal aorta through catheters inserted into blood vessels in the groin.

Patient should go for follow-up and ultrasound check-up on half yearly basis to ensure the graft is patent.

Post-surgery restrictions

• Driving is not allowed until doctor sees an improvement in condition and says so.
• Bathing is not allowed until the incisions heal. Showers and sponge baths around the incision can be taken two days after the procedure.
• Heavy work and lifting heavy weight for about 4 to 6 weeks after the procedure is not allowed.
• Doctor may give additional or alternate instructions after the procedure, depending on the particular situation.