Abdominal aortic aneurysm and its treatment in Turkey

Abdominal aortic aneurysm

Abdominal aortic aneurysm is an expansion of a weak part of the artery wall, and it carries serious consequences if neglected. In Turkey, the condition can be diagnosed, followed up and treated by the most skilled doctors.

The abdominal aortic aneurysm is located in the ventral part of the aorta
An image showing the shape and position of the abdominal aortic aneurysm

Overview of abdominal aortic aneurysm

Older, long-term smokers are at particular risk of developing aneurysms.

Many people don't have symptoms and don't know they have an abdominal aortic aneurysm until it ruptures, which is often rapidly fatal.

Symptoms include pain in the back or abdomen. Severe and severe pain may indicate a tear that requires emergency medical treatment.

Small, slow-growing aneurysms may be treated with careful monitoring, lifestyle changes, and medications. Large or rapidly growing abdominal aortic aneurysms may require surgery.

The blood flow is disturbed when an abdominal aortic aneurysm occurs due to the sudden expansion of the artery wall
Image showing the difference between a normal aorta and a dilated abdominal aortic aneurysm

What is an abdominal aortic aneurysm?

The aorta is the largest blood vessel in the body that transports oxygenated blood from the heart to the rest of the body. The abdominal aorta is a swollen and weak area in the wall of the aorta. Over time, due to pressure within the artery, the blood vessels are at risk of bursting (rupturing) or detaching (dissection). This can cause life-threatening bleeding and possibly death.

has indicated Studies That the abdominal aortic aneurysm was associated with a mortality rate estimated at 10.9% in females and 6.8% in males during the past eleven years.

Aortic aneurysms occur most often in the part of the aorta that runs through the abdomen (abdominal aortic aneurysm) often below the level of the renal arteries. Abdominal aortic aneurysms are also called AAA or triple A.

Once formed, the aneurysm will gradually increase in size and become progressively weaker. Treatment of abdominal aneurysms may include surgical repair or removal of the aneurysm, or the insertion of a metal mesh coil (stent) to support the blood vessel and prevent rupture.

Abdominal aortic aneurysm shapes

The most common form is the spindle-shaped, which bulges out on all sides of the aorta. A distended artery is not classified as a true aneurysm until the width of the artery is increased by 50%.

The cystic form is a bulge on only one side of the aorta. Sometimes this is called a pseudo aneurysm. It usually means that the inner layer of the artery wall is torn, which can be caused by an injury or ulceration of the artery.

Abdominal aortic aneurysms are divided according to their shape into spindle-shaped and cyst-shaped aneurysms
An image showing the shapes of the abdominal aortic aneurysm

What causes abdominal aneurysm?

Several things can cause the tissue of the aortic wall to collapse and lead to an aneurysm of the abdominal aorta and the formation of an abdominal aortic aneurysm. The exact cause is not fully known, but atherosclerosis is believed to play an important role.

Atherosclerosis is the buildup of fatty deposits, cholesterol, cellular waste products, calcium and fibrin in the inner lining of an artery. Risk factors for atherosclerosis include:

  • Age (over 60 years old)
  • Males (the incidence in males is four to five times greater than in females)
  • Family history (first-degree relatives such as a father or brother)
  • DNA
  • diabetes
  • obesity
  • high blood lipids
  • high blood pressure
  • Tobacco Consumption

Other diseases that may cause abdominal aneurysms include:

  • Connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, Turner syndrome and polycystic kidney disease
  • Congenital (present at birth) defects such as the bicuspid aortic valve or aortic stenosis
  • Temporal arteritis and other arteries of the head and neck
  • bruising
  • Sepsis such as syphilis, salmonella, or staphylococcus (rarely)

What are the symptoms of abdominal aorta aneurysm?

About three out of four cases of abdominal aortic aneurysm do not cause symptoms. The aneurysm can be detected by X-ray, computed tomography (CT or CAT) or magnetic resonance imaging (MRI) done for other reasons, because the abdominal aneurysm may Asymptomatic, it is called the "silent killer" because it may rupture before diagnosis.

Pain is the most common symptom of an abdominal aortic aneurysm. Pain associated with an aneurysm may be located in the abdomen, chest, lower back, or groin area. The pain may be severe or dull. Sudden and severe pain in the back or abdomen may mean that the aneurysm is about to rupture. This is a life-threatening medical emergency.

Abdominal aortic aneurysm may also cause a pulsating sensation like a heartbeat in the abdomen, and symptoms of abdominal aortic aneurysm may look like other medical conditions or problems.

How is aneurysm diagnosed?

Because abdominal aortic aneurysm usually does not cause distinct symptoms and is often diagnosed during routine imaging and examination of the body, the doctor may feel a heartbeat in the abdomen that causes him to suspect an abdominal aortic aneurysm.

Abdominal aortic aneurysm can be detected using several imaging techniques such as arteriography (angiography), CT and MRI, but echocardiography is the gold standard for diagnosing the condition.

What is the treatment for abdominal aortic aneurysm in Turkey?

Treatment may include:

  • Monitoring with magnetic resonance imaging or computed tomography; These tests are done to check the size and rate of growth of the aneurysm.
  • controlling risk factors; Some steps (such as stopping smoking, controlling your blood sugar if you have diabetes, losing weight if you are overweight, and eating a healthy diet) may help control the functioning of the aneurysm.
  • drug therapy; It is used to control risk factors such as high cholesterol or high blood pressure.
  • surgery; It includes the following:
  1. Abdominal aortic aneurysm open repair: A large incision is made in the abdomen to allow the surgeon to view and repair the abdominal aortic aneurysm. A mesh tube similar to a metal coil called a stent or bypass may be used. The bypass is sewn into the aorta and connects one end of the aorta at the site of the aneurysm to the other. Open repair is the surgical standard for aneurysm Abdominal aortic blood.
  2. Endovascular aneurysm repair (EVAR): This requires only small incisions in the groin. Using X-ray guidance and special tools, the surgeon can repair the aneurysm by inserting a stent or bypass into the aorta. The material of the bypass may cover the stent. The stent helps hold the bypass open in place.

A small or asymptomatic aneurysm may not require surgery until it reaches a certain size or grows rapidly over a short period of time. The doctor may recommend careful monitoring. This may include an ultrasound, duplex scan, or CT scan every 6 months. To closely monitor the aneurysm, blood pressure medication may be used to control high blood pressure. If the aortic aneurysm is causing symptoms or is large, the doctor may recommend surgery.

Surgical treatment of abdominal aortic aneurysm

Surgery may be necessary if the aneurysm is large or rapidly growing because this increases the chances of rupture, bearing in mind that women with large aneurysms are more likely to rupture than men.

For suprarenal aneurysms only open surgery is available at present, although there are trials of endovascular therapy that may be an appropriate option. On the other hand, aneurysms at or below the kidney can be treated by open surgery or endovascular surgery (endovascular surgery). Endovascular surgery means “from within the blood vessels” and is considered minimally invasive).

Not all patients can afford the risks of open surgery, so endovascular repair is a great option. Unfortunately, not all patients have the anatomical structure that qualifies them for endovascular repair. The patient should consult a vascular surgeon about the best method of treatment.

Open aneurysm repair

A large incision is made in the abdomen to repair the aneurysm and another incision is made in the aorta along the aneurysm. A cylinder called a graft is used for the repair. The grafts are made of polyester fabric or polytetrafluoroethylene (non-elastic artificial graft), bypasses are sewn into the aorta From above the site of the aortic aneurysm to just below it, the arterial walls are then sutured over the bypass.

An open surgical stent or stent is placed in order to treat abdominal aortic aneurysm
Image showing how to repair an abdominal aortic aneurysm with open surgery

Intravascular aneurysm repair

A small incision is made in the groin and then a stent graft is inserted into the femoral artery and sent to the site of the aneurysm using X-ray guidance.

The stent is a thin metal mesh frame molded into a long tube that keeps the graft open and in place, while the bypass is a fabric covering the mesh made of a polyester fabric called polytetrafluoroethylene.

Endovascular aneurysm repair may be easily tolerated by high-risk patients, however the graft can sometimes slip out of place and may need to be repaired later.

An intra-abdominal stent is placed under the guidance of the catheter
Image showing how to repair an intravascular abdominal aortic aneurysm in Turkey

Puncture graft repair

When the aneurysm is pararenal (at the kidney) or involves the renal arteries, the previous standard treatment was open surgery, because the traditional stent graft has no openings to accommodate the branching of the aorta into the kidney.

In 2012 the FDA approved a perforated stent graft, which is now available in a few vascular surgery programs.

Bypass perforated stent to the exact size of each patient's aorta so that the openings of the renal arteries are in exactly the right place to maintain blood circulation in the kidneys.

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Frequently Asked Questions:

Small, slow-growing abdominal aortic aneurysms may be treated with careful monitoring, lifestyle changes, and medications. Large or rapidly growing abdominal aortic aneurysms may require surgery.

The usual length of stay is 5-7 days, this will depend on the general health of the patient and the speed of his recovery, the doctor may decide to keep the patient for a longer period if complications arise.

Abdominal aortic aneurysm has been associated with a mortality rate estimated at 10.9% in females and 6.8% in males during the past eleven years.

The abdominal aortic aneurysm is often located below the level of the renal arteries.

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