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[Local Medical]Abdominal aortic aneurysm burst can be fatal if it is usually difficult to detect without symptoms

[Local Medical]Abdominal aortic aneurysm burst can be fatal if it is usually difficult to detect without symptoms

Written by ◆Chen Qiulei and compiled by ◆Liang Yingxiu

Abdominal aortic aneurysm is not a rare disease, but it is often overlooked. Although it cannot be prevented or reduced, as long as it has not worsened, its growth can be slowed down through physical examination, medication, changes in living habits, and active review.

(Kuala Lumpur News) There are two systems of blood vessels in the human body, namely arteries and veins. Arteries are responsible for carrying blood from the heart to various parts of the body, and at the same time providing oxygen and nutrients to the body; while veins are responsible for transporting all carbon dioxide and other waste materials back to the heart.

Vascular and Endovascular Surgery Consultant
Dr. Chen Kaitong
(Dr Tan Kia Lean)

Smoking accelerates aortic aging

Dr. Tan Kia Lean, consultant vascular and endovascular surgeon, pointed out that the aorta is the largest blood vessel in the human body and is responsible for transporting blood from the heart to various organs. It is like a federal highway of blood vessels.

He said that the aorta is affected by the blood pressure of the heart, and it expands and contracts every day and night throughout human life. As we age, the walls of blood vessels begin to weaken, causing localized swelling of the aorta, leading to the formation of aneurysms. Simply put, an aneurysm is a degenerative disease that may have a genetic component.

“In addition to being a disease of aging, it is also closely related to some risk factors, namely high blood pressure, high cholesterol and smoking. If it is inherited in the family and other risk factors, it may accelerate degeneration, leading to faster blood vessel wall lesions. quick.”

He said that human arteries are like skin, rich in collagen and elastin, and are very elastic. Over time, the elastic fibers in the arteries are gradually broken down; smoking is also a risk factor because the chemicals in cigarettes weaken the fibers in the blood vessel walls, accelerating the aging process. Likewise, high blood pressure and elevated cholesterol can cause arteriosclerosis and damage.

In short, the occurrence of aneurysm is related to family inheritance. If it is accompanied by the above-mentioned bad habits, it will accelerate the aging of the aorta and the chance of getting the disease will be relatively increased. Even if there is no relevant medical history in the family, the blood vessel walls will become weaker as we age, and with various risk factors, it is not impossible to develop this disease. Generally, the incidence rate is about 4 to 8%.

It is more common in Chinese males, accounting for 59%

“It must be mentioned that aneurysms can also occur in the thoracic aorta, brain, pelvis, groin, mesentery, etc. The most common one is abdominal aortic aneurysm.”

He said that abdominal aortic aneurysm (AAA) refers to the aorta that supplies blood to the human body. There is local swelling in the part below the kidneys and near the abdomen.

“Up to 25% of these patients may also face leg aneurysms. A common site is the popliteal artery behind the knee. When the artery in this area is blocked, the blood flow cannot flow downward smoothly, and the leg cannot flow smoothly. Blackening refers to gangrene (Gangrene), in which body tissue dies.”

How to identify abdominal aortic aneurysm? He pointed out that it mainly depends on the diameter of the enlargement. That is to say, when its diameter is 1.5 times that of the adjacent artery, it can be defined as an abdominal aortic aneurysm.

According to international standards, an aneurysm is defined as one with a diameter greater than 3 centimeters. This number is more applicable to Europeans. According to a study by the Kuala Lumpur General Hospital, the average aorta in British men is about 2.4 centimeters, while that in Malaysian men is about 1.8 centimeters. Therefore, the treatment of definitive aneurysms remains to be evaluated.

“According to British research, treatment is initiated when an aneurysm is larger than 5.5 cm.

Our country follows the British index, which is 5.5 centimeters for men and 5 centimeters for women.

Since the average size of the aorta in Malaysians is smaller than that in Europeans,

Those with a treatment threshold greater than 5 centimeters can receive treatment.

Studies have shown that abdominal aortic aneurysms are more likely to occur in men.

The ratio is 3:1 to 6:1.

In another study in Sarawak, it was stated that

The incidence rate of each ethnic group in my country is 59% (Chinese);

17% (Malay); 7% (Indian). “

From an incidence perspective, in Malaysia, the number of new cases of aneurysm problems each year is 6% due to vascular risk factors and 3% without risk factors; in the UK, it was 7 to 8% in the early years, but in the past 20 years Here, the proportion has dropped slightly to 5% as the country actively controls risk factors.

Thin people can easily notice throbbing lumps

Abdominal aortic aneurysms are often asymptomatic, except in very thin people, in which case they are easier to detect. Since most Malaysians are smaller than Europeans, you may be able to feel a “pulsing” lump in your abdomen.

He revealed that this is generally an asymptomatic disease. In addition, our country’s data collection and detection capabilities are incomplete, so there are many potential cases that have not yet been diagnosed. Despite this, he believes that the situation in our country is quite close to the incidence rate in European countries and even the world.

“In fact, modern people almost coexist with high-risk factors, such as high-risk factors, diabetes, lack of exercise, aging population, etc. I think the incidence rate is on the rise.”

In the UK, this disease mostly affects men. When men over 65 years old enjoy the national physical examination service, ultrasound examination for related diseases is included. If there is no difference in the examination, it means that the possibility of developing the disease is extremely low. Those diagnosed will be transferred to relevant hospitals for regular examinations and continuous observation of changes in their aneurysms. If the aneurysm exceeds 3 cm, it will be examined once a year. If it increases to 4 cm, it will be examined every 3 to 6 months. , depending on the condition of the patient and the aneurysm.

Early detection and operation survival rate is 98%

Currently, most government hospitals in my country do not yet have similar screening programs.

He said that if the aneurysm ruptures, it will pose a huge threat to life. A European study pointed out that 50% of patients are lucky enough to be sent to the hospital when an aneurysm ruptures, but only half survive after surgery, which means their survival rate is only 25%; if early detection and surgery are performed, the survival rate As high as 95 to 98%.

Other data show that more than half of the patients died due to ruptured aneurysms and were unable to be sent to the hospital in time. There are two main reasons. One is that they are aware of the problem and insist on staying with their families or refuse to be sent to the hospital; the other is that they are unable to be sent to the hospital in time. Died in hospital.

“Sadly, the other 25% of patients are unable to undergo surgery due to physical weakness and medical conditions, and even being sent to the hospital will not help. Some may suffer from medical emergencies during surgery or while in the intensive care unit, such as Kidney failure, blood clots, heart attacks, chest infections, and strokes all result in life-threatening injuries.”

Pre-rupture symptoms: abdominal pain, hypotension, syncope

If an abdominal aortic aneurysm ruptures, several symptoms will occur, including persistent abdominal pain above the belly button, back pain, low blood pressure, pale face, and then syncope.

These symptoms occur so suddenly that people are caught off guard.

Since aneurysms are asymptomatic diseases in the early stages, how do patients know they have the disease? Chen Kaidong pointed out that many times patients are “accidentally” discovered to have an abdominal aortic aneurysm when they undergo examinations for other ailments, or when they are thin and feel something strange when they touch their abdomen while lying down.

More than 5 cm requires surgery

There are two main steps in the examination. The first is to clinically observe whether there is a throbbing mass in the belly button, which is more common in thin people, and to ask about the family history of aneurysms and other related risk factors. This can be done by experienced general or vascular surgeons. This check.

The second is to use vascular ultrasound (Ultrasound), which uses a probe to scan the abdomen. Use this method to find the aorta and measure its size. Because the gas produced in the intestine after eating will blur the imaging display and affect the results, the patient must fast for 4 hours before the scan.

As mentioned above, when the diameter of the aneurysm reaches or exceeds the specified standard, which is 5.5 cm, surgery is an inevitable treatment method.

First, open surgery. The doctor will make a large incision at the location of the abdominal aneurysm and clamp the entrance and exit of the aneurysm with clamps. Next, the damaged part of the aneurysm is removed from the main part of the aorta, replaced with a dacron graft and sutured, and the operation is completed.

According to research, the mortality rate of this surgery is 7-10%, but there are also certain risks and problems, such as kidney, intestinal, wound dehiscence, chest infection, excessive blood transfusion, etc. Therefore, general recommendations are applicable to patients who are healthy and have no other diseases or risk factors. In particular, the mortality rate will increase with age and the patient’s condition background.

Second, endovascular stent implantation repair surgery (Endovascular Aneurysm Repair, EVAR). This minimally invasive surgery first inserts a fabric-covered metal stent into the aorta, then pulls the sheath away, and then inserts another connecting stent to block the diseased aneurysm from the outside. Prevent blood pressure from continuously impacting the dilated and thinned inner walls of blood vessels, causing them to rupture.

EVAR surgery has a lower mortality rate than open surgery, about 1.3%, and patients usually only need to stay in the hospital for a few days after surgery before returning home to recuperate.

Follow medical instructions to control the three highs

Generally speaking, doctors will decide which treatment plan to use based on the patient’s physical condition and the shape of the aortic aneurysm, which also depends on the patient’s own wishes.

Doctors have no other option to treat an abdominal aortic aneurysm other than surgery. However, taking prescribed medications as directed by your doctor, as well as actively changing your lifestyle habits, such as controlling high blood pressure, quitting smoking, exercising, etc., can delay the growth of aneurysms.

Some studies have shown that although taking cholesterol-lowering statins cannot shrink aneurysms, they can effectively slow down the accelerated growth of the tumors.

Despite this, Chen Kaidong still wants to emphasize that if the aneurysm has increased to 5.5 centimeters, you must go to the hospital immediately. If you delay seeking medical treatment, the consequences will be disastrous.

As mentioned above, the growth of aneurysm is asymptomatic. If it is not detected and treated in time, once it ruptures, it will be life-threatening. This is what everyone is worried about.

Another complication of an aortic aneurysm is that because the aneurysm is filled with blood clots, the condition can extend to the feet. It can suddenly cause a blockage in the artery, causing the leg to appear black or blue, and ultimately necessitating amputation.

Legs turn blue, painful and weak

Therefore, he would like to remind the public that the complications are not just a ruptured aneurysm, but the above-mentioned condition called acute limb ischemia is also one of them.

“This complication means that the patient’s abdominal aortic aneurysm has not ruptured, but due to the formation of embolism, the patient’s legs first become pale and gradually turn blue, and at the same time they feel pain, weakness and paralysis, unable to walk, or even suddenly paralyzed. .”

This means that the aneurysm has obvious symptoms, is unstable, and is at risk of rupture at any time. At this point, you need to see a vascular surgeon immediately. The doctor will not only remove the blood clot in the foot, but also perform surgery to repair the aneurysm at the same time.

He suggested that men over 50 years old who are thin and feel a throbbing mass in their abdomen; or men and women with risk factors, such as smoking, high blood pressure, etc., and members of the family with a history of aneurysms, should consider routine ultrasound examinations.

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