DEFINITION
Abdominal aortic aneurysm or aneurysm Abdominal aorta
(abdominal aortic aneurysms) occur on the part of the aorta that passes through
the stomach. Also known as AAA.
Aneurysm is a protrusion (dilation, dilatation) on the wall
of an artery / vein. Aortic aneurysms can develop anywhere along the aorta.
Most, located along the abdominal aorta (abdominal aorta). Most (approximately
90%)
CAUSE
An abdominal aortic aneurysm can be caused by several
factors that cause decomposition component of a well-organized structural
(proteins) of the aortic wall that provide support and stabilize the wall. The
exact cause is not fully known.
Atherosclerosis (plaque formation, which is a deposit of
fatty substances, cholesterol, cellular waste products, calcium, and fibrin in
the inner lining of the arteries) is thought to play an important role in
aneurysmal disease, including the risk factors associated with atherosclerosis,
such as:
·
Age (older than age 60)
·
Male (occurrence in males is four to five times
greater than women)
·
Family history (first-degree relatives such as
father or brother)
·
Genetic factors
·
Hyperlipidemia (elevated fats in the blood)
·
Hypertension (high blood pressure)
·
Smoke
·
Diabetes
·
Obesity
Other diseases that can cause abdominal aneurysm include:
·
A genetic disorder of the connective tissue
(abnormalities that can affect tissues such as bone, cartilage, heart, and
blood vessels), such as Marfan syndrome, Ehlers-Danlos syndrome, Turner's
syndrome, and polycystic kidney disease
·
Congenital (present at birth) syndromes, such as
bicuspid aortic valve or coarctation of the aorta
·
Giant cell arteritis (a disease that causes
inflammation of the temporal arteries and other arteries in the head and neck,
causing the arteries to narrow, reducing blood flow in the affected area; can
cause persistent headaches and vision loss)
·
Trauma
·
Aortitis infection (infection of the aorta) due
to infections such as syphilis, salmonella, or staphylococcus. Infectious
conditions are rare
SYMPTOMS
Most are asymptomatic aneurysms. However, abdominal aortic
aneurysm can cause pain and cause a throbbing sensation in the stomach or pain
in the chest, lower back, or scrotum.
If AAA rupture usually involves excruciating pain, such as:
·
Acute onset, sudden back pain
·
Severe pain. Some patients explained that
doubled during illness.
·
Abdominal pain, ranging from the lower back side
of the abdomen, and groin.
·
Pain that is continuous and does not feel better
with rest
·
Pain may radiate to the groin or leg.
·
Bleeding usually leads to hypovolemic shock with
hypotension, tachycardia, cyanosis, and altered mental status.
·
Pain may be accompanied by internal bleeding
symptoms, such as nausea, vomiting, rapid heartbeat, cold or wet skin,
sweating, and / or shortness of breath.
AAA rupture mortality rate of up to 90%
DIAGNOSIS
·
An abdominal aortic aneurysm is usually
diagnosed by:
·
Physical examination, physical examination, a
palpable mass / lump in the stomach / abdomen, noisy sounds using the
stethoscope in the abdominal area.
·
USG. Ultrasound is used to see clearly and to
determine the size of the aneurysm caused. In addition, free peritoneal fluid
can be detected. This action is noninvasive and highly sensitive, but the
presence of intestinal gas or obese may limit its usefulness.
·
CT Scan. CT scans have a sensitivity of almost
100% for the aneurysm and is also useful in preoperative planning, and
detailing the anatomy.
·
Plain abdominal radiography may show the outline
when the aneurysm.
·
Alternative methods are more frequently used for
visualization of the aneurysm including MRI and angiogram. Arteriogram
(angiogram) is an X-ray image of the blood vessels used to evaluate various
conditions, such as aneurysm, stenosis (narrowing of a blood vessel), or
blockages. A dye (contrast) will be injected through a thin flexible tube
placed in an artery. This dye makes the blood vessels visible on X-ray.
TREATMENT
Treatment of an aneurysm depends on its size. If the width
is less than 4 cm, rarely broken; but if more than 5 cm wide, often broken.
Because the aneurysm was wider than 5 cm, surgery. At surgically inserted a
synthetic graft to repair the aneurysm. The mortality rate for this surgery is
2%.
Aneurysm rupture or threatened rupture, need to be addressed
through emergency surgery. The risk of death during surgery aneurysm rupture is
50%. If an aneurysm rupture, kidneys have increased risk for injury due to
disruption of blood flow to the kidneys or from shock due to blood loss. If
kidney failure after surgery, survival is very slim. Aneurysms that rupture and
untreated, is always fatal.
Surgery:
·
Open abdominal aortic aneurysm repair. A large
incision is made in the abdomen to directly visualize the abdominal aorta and
repair the aneurysm. A cylindrical tube can be used as so-called graft to
repair the aneurysm. Open repair is considered the standard surgery for
abdominal aortic aneurysm repair.
·
Endovascular aneurysm repair (EVAR). EVAR is a
procedure which requires only small incisions in the groin along with the use
of X-ray guidance and specially designed instruments to repair the aneurysm.
With the use of special endovascular instruments and X-ray images for guidance,
the stent-graft is inserted through the femoral artery and advanced up into the
aorta to the site of the aneurysm.
CONTROL OF OPERATIONS NON aneurysm
For patients who are not candidates for surgery (for
example, for patients with aneurysms smaller than 5 cm), medical care to
prevent the expansion and tear / rupture of an aneurysm include:
·
Quit smoking.
·
Controlling high blood pressure, hypertension.
·
Lowering high blood cholesterol.
·
Strict monitoring of the size of the aneurysm
with ultrasound or CT scans every 6 to 12 months (faster in patients at high
risk)
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