Abdominal Aortic Aneurysm (AAA)

An Abdominal Aortic Aneurysm (AAA) is a localized enlargement of the abdominal aorta, the largest artery in the abdomen. This condition occurs when the aortic wall weakens and bulges out, posing a risk of rupture, which can lead to life-threatening internal bleeding. AAAs are typically asymptomatic until they reach a critical size or rupture. Screening and monitoring are crucial for early detection and management. Treatment options include surgical repair or endovascular stent placement.

Causes and Risk Factors

Atherosclerosis

Atherosclerosis, the buildup of plaque in the arteries, is a common cause of AAA. Plaque weakens the arterial wall, making it more susceptible to bulging and aneurysm formation. Risk factors for atherosclerosis include smoking, high blood pressure, high cholesterol, and diabetes.

Genetic Factors

Genetic factors also play a role in the development of AAA. A family history of aneurysms increases the risk of developing the condition. Certain genetic disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, are associated with an increased risk of aortic aneurysms.

Other Risk Factors

Other risk factors for AAA include age (most common in individuals over 65), male gender, and chronic inflammation or infection of the aorta. Lifestyle factors such as obesity and lack of physical activity can also contribute to the development of AAA.

Symptoms and Diagnosis

Symptoms

AAAs are often asymptomatic and may be discovered incidentally during imaging studies for other conditions. When symptoms do occur, they may include abdominal or back pain, a pulsating sensation in the abdomen, and, in severe cases, sudden and severe pain indicating a rupture.

Diagnosis

AAA is typically diagnosed through imaging studies such as ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI). These imaging techniques allow physicians to visualize the aneurysm, measure its size, and assess the risk of rupture. Regular screening is recommended for individuals at high risk, such as those with a family history of AAA or risk factors for atherosclerosis.

Treatment Options

Monitoring and Surveillance

Small AAAs that are not at immediate risk of rupture are often managed through regular monitoring and surveillance. Patients undergo periodic imaging studies to track the aneurysm’s size and growth rate. Lifestyle modifications, such as smoking cessation and blood pressure control, are recommended to reduce the risk of aneurysm expansion.

Surgical Repair

Surgical repair is indicated for larger AAAs or those at high risk of rupture. The traditional approach involves open surgery, where the damaged section of the aorta is replaced with a synthetic graft. This procedure is highly effective but carries risks associated with major surgery, such as infection and complications.

Endovascular Stent Grafting

Endovascular stent grafting is a minimally invasive alternative to open surgery. In this procedure, a stent graft is inserted through a small incision in the groin and guided to the site of the aneurysm. The stent graft reinforces the weakened aortic wall and reduces the risk of rupture. This approach has a shorter recovery time and lower complication rates compared to open surgery.

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