The abdominal aorta is the largest artery in the human body. The abdominal aortic aneurysm is completely asymptomatic except when the aneurysm ruptures. It is an emergency because the risk of death is high.
abdominal aortic aneurysm often evolves silently until breaking. There ruptured abdominal aneurysm is an emergency vital. Explanations with Dr. Adrien Boutin, vascular surgeon at Rouen University Hospital.
What is an abdominal aortic aneurysm?
I’abdominal aortic aneurysm is defined by a pocket or dilation of the wall of the abdominal aorta, the largest artery in the human body which is located at level of the abdomen. The diameter of the aorta then increases more than 5 cm And weakens due to high blood pressure. If theartery breaksWe are talking about aneurysm rupture of the abdominal aorta. A fatal pathology without urgent care. “The aneurysm can be located in different places. Not to be confused with brain aneurysms, aneurysms in the thoracic aorta and those in the arteries of the legs and visceral arteries. Abdominal aortic aneurysm often occurs in the infrarenal portion, between the renal arteries and the aortic bifurcation.“, notes Dr. Adrien Boutin, vascular surgeon at the University Hospital of Rouen. This type of aneurysm affects men more. It occurs most often in people over 60 years of age.
What causes an abdominal aortic aneurysm?
Abdominal aortic aneurysm is favored by atherosclerosis, i.e. lipid deposits in the arteries (atherosclerotic plaque) which contribute to their obstructions. “This is done over several years, over time, therefore to prevent the aneurysm, it is necessary to limit its risk factors“says the vascular surgeon. The risk factors for atherosclerosis are:
What are the symptoms of abdominal aortic aneurysm?
Abdominal aortic aneurysm is completely asymptomatic. The only time it causes symptoms is when there is a ruptured aneurysm. There pain is then brutal and very sharp at the abdominal level. She can also project yourself in the back and the risk of death is major.
“Very often, the abdominal aortic aneurysm is discovered fortuitously in people with cardiovascular risk factors. We will therefore follow them with regular ultrasounds to ensure that the aneurysm does not increase in size, and treat them preventively when the aorta exceeds 50 mm in diameter.“, explains the specialist.
What are the treatments for an abdominal aortic aneurysm?
There are two types of treatment:
→ The surgical technique which consists of opening the belly wide and replacing the aorta by interrupting the circulation and doing a bypass.
→ The endovascular technique which is based on the placement of an aortic endoprosthesis.
After the operation, regular monitoring is set up with ultrasounds and scanners.
“A ruptured abdominal aortic aneurysm leads to 70 to 75% of deaths”
What does the operation for an abdominal aortic aneurysm involve?
“We operate when the aneurysm exceeds 50 mm because we know that at this stage, the risk of rupture becomes considerable. What must be understood is that an abdominal aortic aneurysm that is ruptured causes 70 to 75% of deaths in patients, whereas on an aneurysm intervention, it is around 5 %. Overall, 50% of them die before arriving at the hospital and 50% once they arrive at the hospital“, warns Dr. Adrien Boutin. Hence the importance of carrying out preventive treatment with patients who present cardiovascular risk factors. “The big problem with this disease is really the fact that it does not cause any symptoms. Sometimes we miss it, patients come in with a ruptured aneurysm and we don’t know they had one.”regrets the vascular surgeon.
What are the risks of complications?
If the aneurysm of more than 50mm is not operated on and it ruptures, the person dies. By operating preventively through a laparotomy, that is, by opening the belly and replacing the aorta with a bypass, the risks are the same as those inherent in surgery. In other words, bleeding and infection. “This intervention is still quite heavy, it requires a little resuscitation and rehabilitation behind. As for the placement of endoprostheses in the arteries, the gesture is carried out from the inside, which makes it possible toisolate the aneurysm. This technique is less heavy and patients recover much faster but it is not accessible to everyone since the anatomy and the aneurysm must be suitable for it“, says the specialist.
Prevention and recommendations
Prevention is based on controlling cardiovascular risks: smoking cessation, treatment of hypertension, treatment of cholesterol and diabetes, even if it is not very favorable for aneurysms. It is especially people who have coronary heart disease, artery problems or other who must systematically be screened for abdominal aortic aneurysm.
Thanks to Dr Adrien Boutin, vascular surgeon at the University Hospital of Rouen.