Abdominal Aortic AneurysmIn abdominal aneurysm, an abnormal dilation in the arterial wall generally occurs in the aorta between the renal arteries and iliac branches. Such aneurysms are four times more common in men than in women and are most prevalent in whites ages 50 to 80. Over 50% of all people with untreated abdominal aneurysms die within 2 years of diagnosis, primarily from aneurysmal rupture; over 85%, within 5 years.
About 95% of abdominal aortic aneurysms result from arteriosclerosis; the rest, from cystic medial necrosis, trauma, syphilis, and other infections. These aneurysms develop slowly.
First, a focal weakness in the muscular layer of the aorta (tunica media), due to degenerative changes, allows the inner layer (tunica intima) and outer layer (tunica adventitia) to stretch outward. Blood pressure within the aorta progressively weakens the vessel walls and enlarges the aneurysm.
Signs and symptoms
Although abdominal aneurysms usually don't produce symptoms. If an aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along the wall of the vessel (aortic dissection), symptoms may develop suddenly.
The symptoms of rupture include:
Because an abdominal aneurysm rarely produces symptoms, its often detected accidentally as the result of an X -ray or a routine physical examination. Several tests can confirm suspected abdominal aneurysm;
TreatmentUsually, an abdominal aneurysm requires resection of the aneurysm and replacement of the damaged aortic section with a Dacron graft. If the aneurysm is small and produces no symptoms, surgery may be delayed; however, small aneurysms may also rupture. Beta blockers may be administered to decrease the rate of growth of the aneurysm. Regular physical examinations and ultrasound checks are necessary to detect enlargement, which may presage a rupture. In asymptomatic patients, surgery is advised when the aneurysm is 2" to 2.3"(5 to 6 cm) in diameter. In symptomatic patients, repair is indicated regardless of size. In patients with poor distal runoff, external grafting may be done.
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