ABDOMINAL AORTIC ANEURYSM
Introduction
The term "abdominal aortic aneurysm" refers to the enlargement of the diameter of the abdominal aorta at a weakened point of the aorta in the abdominal area. The aorta is the largest artery of the body and the diameter of the abdominal aorta is considered normal when it ranges from 14 – 30 mm. Among the factors that may contribute to the formation of an abdominal aortic aneurysm are advanced age, smoking, hypertension, as well as a family history of aneurysm.
Abdominal aortic aneurysm is a common condition in the general population. As a general rule, abdominal aortic aneurysm does not give symptoms and grows silently with the risk of rupturing. This is why in the general public this particular aneurysm is called a "silent bomb". In the case of an aneurysm, prevention is of vital importance as if it is not treated immediately it can lead to rupture. Rupture is a medical emergency characterized by intense pain, internal bleeding and can lead to the death of the patient.
The timely early diagnosis of the disease
is very important
for the good outcome of the condition in both stages of the disease.
What is an abdominal aortic aneurysm;
An aneurysm is considered to be the increase of the diameter of the aorta by 50% of its normal size or > 3 centimeters in diameter. The normal size varies depending on the patient's gender, body type and genetic predisposition. Usually, the normal diameter is estimated between 12 and 20 millimeters.
There are two types of aneurysms: the saccular (like bubbles) and the fusiform (like balloons). Saccular aneurysms are considered dangerous for rupture regardless of diameter, therefore the indication for their treatment is immediate. Fusiform aneurysms have an indication to be treated either when they reach 5-5.5 centimeters or if their diameter increases by more than 1 centimeter within a period of one year. However, the exact prediction of how fast an abdominal aortic aneurysm can grow is not feasible. For this reason systematic monitoring of the patient is recommended.
How is the diagnosis made and which patients should be examined;
Diagnosis and monitoring are carried out through ultrasound (triplex of the abdominal aorta). In the event that the ultrasound examination reveals the presence of an aneurysm with an indication for treatment, a CT angiography should be performed. The patients who should be screened preventively for the presence of an aneurysm in the abdominal aorta are:
- Men or women > 65 years of age with a history of smoking (active or non-smokers)
- Men or women with a family history of aneurysm
- Men or women with connective tissue disorders (Marfan, Ehlers Danlos)
Ποιες είναι οι χειρουργικές μέθοδοι του ανευρίσματος κοιλιακής αορτής;
Treatment options for abdominal aortic aneurysm
Abdominal aortic aneurysms are treated as a general rule minimally invasively using endografts (stents). These are metallic bifurcated grafts made of polyester or PTFE which are inserted through a thin tube inside the aorta and under fluoroscopic guidance are placed in such a way as to exclude the aneurysm from circulation.
In very specific cases (young age, connective tissue disorders, e.g. Marfan, Ehlers Danlos, graft infection, failure of an endovascular graft, etc.) open surgical repair is recommended. In this case the patient undergoes opening of the abdomen and direct replacement of the aorta with a tubular or bifurcated polyester graft.
