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1. What is an Aneurysm?
An aneurysm is a stretching of a weakened artery. The wall of the artery becomes thinned by loss of its elastic tissue and the artery then inflates making it likely to burst. The most common artery to be affected is the aorta, which is the main artery at the back of the tummy (abdomen). If an aortic aneurysm ruptures it causes massive internal bleeding which can be life threatening. In England and Wales, between 6,000 and 10,000 people each year suffer from rupture of an abdominal aortic aneurysm. Most of these patients are men over the age of 60 years. Smoking and high blood pressure are known to increase the risk.
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2. How is an Abdominal Aortic Aneurysm detected?
Some patients have the aneurysm diagnosed coincidentally when they are examined for another problem, or if they have a scan for a different reason (e.g. kidney trouble, or gallstones, for example). Occasionally, the patient may become aware of a feeling of pulsation in the abdomen. As the aneurysm stretches it can also cause pain in the back or abdomen.
If an aneurysm is suspected, your GP will refer you to a specialist Vascular Surgeon for advice; either your GP or specialist will order an ultrasound scan. Ultrasound scanning of the abdomen is a painless outpatient test that only takes a few minutes to do. It is used to decide whether an aneurysm is present and to measure its exact size.
3. Who is at risk?
It is known that men over the age of 60, younger men with a brother or father who has had an aneurysm, or men with other arterial disease (angina, hardening of the arteries or high blood pressure) are at risk. In some areas of the country, people at increased risk of having an abdominal aortic aneurysm are being offered screening by ultrasound scan.
4. Do I need surgery?
Not all aneurysms need an operation. The risk of rupture and therefore the need for repair, depends on the size of the aneurysm. If the aneurysm is large (more than 5.5 cm in diameter), it is probably safer to have an operation to repair it than to leave it alone. This protects the aorta from rupture.
Smaller aneurysms are usually observed by repeat scanning at 6 to 12 monthly intervals, in case they enlarge and become dangerous. Average enlargement is about 0.5 cm per year, so surgery may be required at a later stage. Your specialist Vascular Surgeon will give you a clear explanation of the options in your case.
5. What does surgery involve?
Current surgical treatment involves replacing the swollen aorta with an artificial blood vessel made of a very strong material called Dacron. The operation is done through an incision in the abdomen. Research is now going on into a new method in which a new lining is inserted through a smaller incision in the groin, passing it up into the aortic aneurysm from the normal artery below. This is still experimental and more work needs to be done before it becomes routinely available.
6. Is surgery successful?
If aneurysms are repaired before they rupture, there is a high overall chance of successful repair and a return to normal life expectancy. However you should discuss the risks of surgery in your particular case with your surgeon.
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