Simplified Explanation of Abdominal Aortic Aneurysm
I am sure you must have heard of Tripple A, I do not mean the famous company in your neighborhood or the Coppertop AAA Batteries that you know, I am referring to Abdominal Aortic Aneurysm. And Abdominal Aortic Aneurysm or Tripple A as I will call it is the excessive enlargement of a localized region of the abdominal aorta as a result of the weakening of its arterial walls. When the Aorta leaves the heart, it forms an Arch referred to as the arch of the aorta which then loops downwards to become the Thoracic Descending Aorta since it is still above the diaphragm. The Aorta goes further downwards through the abdominal cavity to become the Descending Abdominal aorta/Abdominal Aorta after which it has a bifurcation where it divides to give the Iliac artery. While there is a true and false aneurysms, when it comes to an Abdominal Aortic Aneurysm, it is a true Aneurysm.
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The abdominal aorta is a large vessel that supplies the abdominal extremities and larger vessels with bifurcation are at a higher risk of getting their arterial walls weakened and enlarged, having atherosclerosis, or having any other cardiovascular problem. For Abdominal Aortic Aneurysm, it has to do with the weakening of the arterial wall of the aorta which would lead to the enlargement or ballooning of the vessel (fusiform) which could lead to the rupturing of the vessels. The Intima, the media, and the Adventitia are involved in the aneurysm. So Abdominal Aortic Aneurysm is the dilation of the abdominal aorta, but most times patients are not aware they have an aneurysm until it ruptures which can be very life-threatening as blood flows into the abdominal cavity. Abdominal Aortic Aneurysm is found in about 8% of men above the age of 65 and ruptures have a mortality rate of 80%, telling that Abdominal Aortic Aneurysms can be very life-threatening. Let's also bear in mind that for a dilation to be regarded as an aneurysm, it has to be permanent and must have dilated about or over 1.5 times its normal diameter.
There are certain risk factors that can lead to a person having an Abdominal Aortic Aneurysm, and these risk factors include old age, as a person gets older their vessels to become weaker. Males have been studied to have Abdominal Aortic Aneurysms more compared to females, people who have a family history of Abdominal Aortic Aneurysms are also going to have it, People who have other cardiovascular diseases such as history of Coronary Artery Disease, Smoking history, COPD, hyperlipidemia, hypertension, hypercholesterolemia are likely going to have Abdominal Aortic Aneurysm.
When it comes to presentation, most patients with Abdominal Aortic Aneurysms are Asymptomatic as they do not know that they have the condition. Normal Aorta has a diameter lesser than 3cm, small aneurysms are enlargements of about 3cm to 4cm, and enlarged aneurysms are about 4.5cm and above 5.5cm. It can be identified during routine screening, or when it ruptures. An Abdominal Aortic Aneurysm can present with non-specific abdominal pain, pulsatile and expansile mass when palpated as a result of a ballooning mass which also presents with a turbulent sound, pain in the lumbar side of the body, Pain can also be experienced in the hip, buttocks, and groin, patients can also experience weight loss, nausea.
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Screening for an Abdominal Aortic Aneurysm can help identify it early and prevent it from rupturing. When detected early, rupture can be easily prevented. So in some countries, there are routine ultrasound scans done on the aged and elderly. When the Blood vessel is above 3cm in diameter, they are immediately attended to prevent a case of rupture. In some cases, incidental findings with X-ray, ultrasound, and CT Scan can be a life safer. To diagnose patients with Abdominal Aortic Aneurysms clinicians can use Ultrasound, X-Ray, and CT-Angiogram.
When it is diagnosed, it is basically managed and prevented from expanding so it doesn't rupture. The patient is asked to treat reversible risk factors such as stopping smoking, healthy diet, exercising, and treating other cardiovascular conditions. Follow-up scans can be done on patients to identify the size of the aneurysm and monitor the progress of the aneurysm. There can be elective surgical repair done on symptomatic aneurysms, aneurysms of above 5.5cm, and when the aneurysm grows above 1cm yearly. This repair has to do with an artificial graft which can be done through Laporotomy in an open repair, or via endovascular aneurysm repair which is inserted through the femoral arteries.
An Abdominal Aortic Aneurysm can advance to become an Abdominal Aortic Dissection which has to do with rupturing of the wall, preventing blood from getting to the lower extremities. The signs and symptoms of dissection are sudden and severe pain which can be like 9/10 or 10/10 pain, the pain is intense and persistent with hotness and searing, where the patient feel a ripping or tearing sensation, patients with a ruptured aneurysm can have other hemodynamic instability such as hypotension (low blood pressure), tachycardia (increased heart rate), the patient can collapse and lose consciousness. The Aneurysm can also develop thrombi (clot) causing thrombosis which can also embolize and float around the bloodstream and can be stuck in smaller blood vessels leading to ischemic damage (damages caused by deprivation of blood to those regions). Patients with Abdominal Aortic Aneurysms may also have Saccular Berry Aneurysms. Also, Abdominal Aortic Aneurysms can block and obstruct other neighbors such as arteries and organs.
https://pubmed.ncbi.nlm.nih.gov/21079638/
https://www.nhs.uk/conditions/abdominal-aortic-aneurysm/
https://www.ncbi.nlm.nih.gov/books/NBK557480/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/abdominal-aortic-aneurysm
https://www.ncbi.nlm.nih.gov/books/NBK470237/
https://www.uptodate.com/contents/endovascular-repair-of-abdominal-aortic-aneurysm
This is really educating.
Thanks a lot for reading, I am glad you did
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