Good morning everyone! Thank you for coming back for another day of #AorticDiseaseAwarenessMonth! Just briefly to introduce myself, my name is Duc and I am a fourth-year medical student at Harvard Medical School and together with Adham will be helping with some of the educational posts for this month.
Yesterday Adham went over thoracic aortic aneurysms. Today we will be continuing the discussion and go further along the aorta to go over abdominal aortic aneurysms or AAA.
To review, an aneurysm is a bulge or ballooned area within the wall of a blood vessel that causes that area of the vessel to stretch to a size larger than its normal width. The vessel then loses much of its natural strength and ability to accommodate different blood volumes and thus is higher risk of rupture due to instability.
AAA
An abdominal aorta aneurysm is a bulge of the aorta that extends through the level of the abdomen. The aorta is the largest blood vessel in the body and is usually about 2 centimeters wide at the level of the abdomen, which is roughly the width of a garden hose. When an aneurysm forms it can be a risk for a dissection or rupture, which is very serious and can be fatal. Here is a representative diagram below of an AAA.
Symptoms of an AAA
In most cases, an AAA causes no symptoms. However, if it becomes large, it may cause some people to feel a deep, constant pain in the belly area, a pulsation near the bellybutton, or persistent back pain. The larger the aneurysm grows, the more dangerous they become. The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen. A ruptured aneurysm can cause massive internal bleeding, which is usually fatal.
Causes and risk factors of an AAA
Some causes of AAA include atherosclerosis due to hardening of the arteries from cholesterol and fat build-up, high blood pressure, blood vessel diseases, or trauma. The biggest known risk factors for AAA are increasing age (>65 years old), and being male. Other risk factors include long-term smoking and high cholesterol level. Having a family history of aortic aneurysms also leads to an increased risk of having an aneurysm.
Diagnosis, Management and Treatment
Because AAAs usually cause no symptoms, they tend to be detected or diagnosed from screening or during routine examination. The screening test is often done through an abdominal ultrasound, which allows the doctor to measure the size of the abdominal aorta. If the patient is known to have an abdominal aneurysm, a CT scan can also be used to follow the size. Surveillance with medical management is typically appropriate when the AAA has a diameter < 5.5 centimeters (in males) or < 5.0 centimeters (in female). This involves medications to lower cholesterol and blood pressure, and quitting smoking, which helps to slow down the growth of the aneurysm.
If an abdominal aneurysm is large (close to 5.5 cm) and detected before it ruptures, most people will be advised to have surgery to replace the aneurysm with a piece of synthetic material. A ruptured AAA requires immediate surgery. If you are at high-risk for TAAs or have a family history for one, please be sure to reach out and discuss your concerns and potential screening options.
And this wraps up this today's session! Join us back here tomorrow where we will be covering aortic dissection.
Thanks for tuning in!
Duc
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