Patient Information - Abdominal Aortic Aneurysm
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1. What is an Aneurysm?
An aneurysm is a stretching of a weakened artery, which
balloons out rather like a worn motor car tyre. The wall
of the artery becomes thinned by loss of its elastic tissue
and the artery then inflates making it likely to burst.
The most common artery to be affected is the aorta, which is
the main artery in the tummy (abdomen). In England and
Wales, between 6,000 and 10,000 people each year suffer
from rupture of an abdominal aortic aneurysm. Most of these
patients are men over the age of 60 years. Smoking and
high blood pressure are known to increase the risk.
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2. How is Abdominal Aortic Aneurysm detected?
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Ultrasound scan of AAA |
Some patients have the aneurysm diagnosed coincidentally when
they are examined for another problem, or if they have a
scan for a different reason (kidney trouble, or gallstones, for
example). Occasionally, the patient may become aware of a
feeling of pulsation in the abdomen. As the aneurysm
stretches it can also cause pain in the back or abdomen. Many
aneurysms remain undetected until they burst. If this
happens then 9 out of 10 people with the condition die. In some
parts of the United Kingdom, all men aged 65 have an ultrasound
to see if they have an AAA. Unfortunately this facility is not
available in Nottinghamshire.
If an
aneurysm is suspected, your GP may refer you to a specialist
Vascular Surgeon for advice. In Nottingham, Mr Braithwaite is
one of the Specialist Vascular Surgeons to whom you may be
referred. If so, he will arrange to see you in his one stop
clinic at the Queens Medical Centre for a scan. If your GP or
another doctor has already arranged a scan, Mr Braithwaite will
see you in one of his clinics at either the QMC or City
Hospital. He may arrange to see you 6 months after you have had
the scan.
Ultrasound scanning of the
abdomen is a painless outpatient test that only takes a few
minutes to do. It is used to decide whether an aneurysm is
present and to measure its exact size.
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3. Who is at risk?
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| It is known that men over the age of 60, younger
men with a brother or father who has had an aneurysm, or
men with other arterial disease (angina, hardening of the
arteries or high blood pressure) are at risk. If a
woman has an AAA then her brothers and sons are at risk. If you
have high blood pressure and smoke and you are a man over 65
years of age then you may have an AAA. In some areas
of the country, people at increased risk of having an abdominal aortic
aneurysm are being offered screening by ultrasound scan. |
4. Do I need surgery?
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| Not all aneurysms need an operation.
The risk of rupture and therefore the need for repair, depends on
the size of the aneurysm. If the aneurysm is large (more than
5.0cms in diameter), it is probably safer to have an
operation to repair it than to leave it alone. This protects the
aorta from rupture. Smaller aneurysms are usually observed by
repeat scanning at 6 to 12 monthly intervals, in case they enlarge
and become dangerous. Mr Braithwaite will arrange follow up
scans for you if you wish. Average enlargement is about 0.5cm per
year, so surgery may be required at a later stage. Your
specialist Vascular Surgeon will give you a clear explanation of
the options in your case. |
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5. What does surgery involve?
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Current surgical treatment involves
the insertion of a new lining into the aorta (like the inner
tube of a tyre) made of a very strong plastic material
called Dacron. This will last up to 20 years, or more. The
operation is done through an incision in the abdomen.
There is a new method in which the new lining
is inserted through a smaller incision in the groin, passing it
up into the aortic aneurysm from the normal artery below (endovascular
aneurysm repair). This has been shown in the short term ( 4
years) to be better than open repair.
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6. Is surgery successful?
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| If aneurysms are repaired before they rupture,
there is a high overall chance of successful repair and a
return to normal life expectancy. However you should discuss the
risks of surgery in your particular case with your surgeon. |
7. How can I help myself?
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| There is nothing you can do about the aneurysm.
However, improving your general health by taking regular
exercise, losing weight and stopping smoking is helpful even if
you do not need an operation at present. It is important
that any high blood pressure is treated.
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8. Can Aneurysms cause other problems?
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| The most dangerous thing that an aneurysm can do
is burst (rupture). Some aneurysms can cause other problems:
Pain: Some aneurysms can cause
back pain if they enlarge and press on the back bone.
Atheroemboli: Some aneurysms are
filled with a porridge-like material called atherothrombus. If
some of this porridge breaks off it can get stuck in the blood
vessels of the leg. This can cause painful blue toes but in
serious cases the blood supply can be affected that the leg
needs to be amputated. These problems are checked when Mr
Braithwaite reviews patients with an aortic aneurysm.
Ureteric obstruction: A less
common type of aneurysm called an inflammatory aneurysm can
cause a blockage in the pipework from the kidney to the bladder
(ureteric obstruction). If this happens, special tubes may have
to be put in the ureter by a surgeon called a urologist. Mr
Braithwaite refers patients with this condition to his
colleagues at the City Hospital in Nottingham.
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