What is Abdominal Aneurysm?
An abdominal aneurysm is an abnormal dilation in the arterial wall that generally occurs in the aorta between the renal arteries and the iliac branches. Nearly 98% of all abdominal aneurysms are located in the infrarenal aorta. These aneurysms can be fusiform (spindle-shaped) or saccular (pouchlike) and 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.Abdominal aneurysms are seven times more common in hypertensive men than in women and are most common in whites ages 50 to 80.
Causes of Abdominal Aneurysm
About 95% of abdominal aneurysms result from arteriosclerosis or atherosclerosis; the rest, from cystic medial necrosis, trauma, syphilis, and other infections.
Signs & Symptoms of Abdominal Aneurysm
Aortic aneurysms often enlarge slowly and without symptoms, making them difficult to detect. Not all aortic aneurysms reach the point of rupture. Many start small and stay small. Others slowly expand over time like a balloon that's slowly being overinflated, increasing little by little each year — typically about 1/8 inch (3 to 4 millimeters). Larger aneurysms expand at faster rates.
As an aortic aneurysm enlarges, some people may notice:
Abdominal aortic aneurysm may be diagnosed with these tests:
Usually, abdominal aneurysm requires resection of the aneurysm and Dacron graft replacement of the aortic section. If the aneurysm is small and produces no symptoms, surgery may be delayed; however, small aneurysms can rupture. Beta-adrenergic blockers may be administered to decrease the rate of growth of the aneurysm. Regular physical examination and ultrasound checks monitor progression of the aneurysm. Large aneurysms or those that produce symptoms risk rupture and require immediate repair. In symptomatic patients, surgery is advised when the aneurysm is 2" to 2'3/8" (5 to 6 cm) in diameter. In symptomatic patients, repair is indicated regardless of size. In patients with poor perfusion distal to the aneurysm, external grafting may be done.In acute dissection, emergency treatment before surgery includes resuscitation with fluid and blood replacement, I.V. propranolol to reduce myocardial contractility, I.V. nitroprusside to reduce and maintain blood pressure to 100 to 120 mm Hg systolic, and analgesics to relieve pain. An arterial line and indwelling urinary catheter are inserted to monitor the patient's condition.
Exercise, eat well, and avoid tobacco to reduce the risk of developing aneurysms.
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