Abdominal Aortic Aneurysm
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What is Aneurysm?
An aneurysm is a ballooned artery, a type of arterial disease. An artery is an elastic blood vessel that transports blood away from the heart. The aorta is the largest artery in the body, running from your heart through the centre of your chest and abdomen, distributing blood to all parts of the body. Aneurysms can occur anywhere along the aorta, but when they develop in the upper part of the aorta, they are called thoracic aortic aneurysms. Rarely, an aneurysm develops in between the upper and lower parts of your aorta called a thoracic abdominal aneurysm. The most common aneurysm occurs at the lower part of the aorta. An abdominal aortic aneurysm is a weakened and protruding found in the lower part of the aorta. As the aorta is the body’s primary provider of blood, an abdominal aortic aneurysm bursting and bleeding can be life threatening.
Most small and slow-growing abdominal aortic aneurysms do not rupture. However large, fast-growing abdominal aortic aneurysms may enlarge to more than 1.5 times of its normal diameter and rupture. Depending on the size and speed at which the aortic aneurysm is growing, medical procedures may differ from careful monitoring to emergency surgical procedure. When an abdominal aortic aneurysm is diagnosed, the doctor will closely examine it so that surgical treatment can be done if it is required.
What causes Aneurysm?
Patients with a family history, hypertension and high cholesterol and those beyond the age of 65 have a higher risk of developing this condition. Although the exact cause of abdominal aortic aneurysms is unknown, a number of factors may increase your risk, including:
- Tobacco use. Smoking cigarettes and other tobacco use may increase your risk of aortic aneurysms. In addition to the harmful effects that smoking causes directly to your arteries, smoking contributes to the buildup of fatty plaques in your arteries (atherosclerosis) and high blood pressure.
- Infection in the aorta (vasculitis). In rare cases, aortic aneurysm may be caused by an infection or inflammation that weakens a section of the aortic wall.
Symptoms of Aneurysm
Aneurysms develop slowly over many years and often have no symptoms. If an aneurysm grows quickly, ruptures, or blood leaks along the wall of the artery (aortic dissection), symptoms may develop suddenly.
The symptoms of rupture include:
- Severe, sudden, persistent, or constant pain in the abdomen
- Dizziness
- Nausea and Vommitting
- Clammy Skin
Diagnosis of Aneurysm
The doctor will examine your abdomen. The examination also will include an evaluation of pulses in your legs. The doctor may find:
- A lump (mass) in the abdomen
- Pulsating sensation in the abdomen
- Stiff or rigid abdomen
If it is suspected that you have an aortic aneurysm, specialized tests such as Angiogram or Sonography (vascular ultrasound) can confirm it
Should I seek treatment for Aneurysm?
Treatment for aneurysm depends on individual cases.
Small aneurysm of less than 4cm.
- If you have a small aortic abdominal aneurysm and you have no symptoms, our doctor may suggest a watch-and-wait (observation) approach, instead of surgery as the risks of surgery outweighs that of rupturing.
- If you choose this approach, our doctor will monitor your aneurysm with regular ultrasounds every six months and encourage you to report immediately if you start having abdominal tenderness or back pain – potential signs of a dissection or rupture.
Medium aneurysm measuring between 4 and 5.5 cm.
- You’ll need to discuss the benefits and risks of waiting versus surgery and make a decision with our doctor
Aneurysms bigger than 5.5 cm and aneurysms that are growing quickly. The doctor may recommend you to perform surgery before complications or symptoms develop.
There are two approaches to surgery:
- Traditionally, a large cut is made in your abdomen. This open-abdominal surgery involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place, through an open-abdominal approach. With this type of surgery, it will likely take you several months to fully recover.
- The other approach is using Stenting for Endovascular Aneurysm Repair. EVAR involves small cuts in the patient’s groins and through these cuts the stent device is deployed in the patient’s Aneurysm to seal it off and to prevent it from rupturing, so you may get well faster. If you have certain other medical problems, this may be a safer approach.
Diagnosis of Varicose Veins
During the diagnosis of varicose veins, our vascular specialist will do a physical exam to check for swelling, sores, skin colour changes or tender areas in your legs while you are standing or sitting with your legs dangling. Our doctor may also ask you to describe any cases of pain and discomfort in your legs over the years to diagnose varicose veins.
If you have signs of deep vein thrombosis or abnormal blood flows, our doctor may do a Sonography (vascular ultrasound test) to examine if your blood is flowing normally or if there is any evidence of a blood clot within the varicose veins. Our doctor is among the few vascular surgeons in Singapore trained to do this non-invasive test. With his ability to do an ultrasound and understand the information in the same consultation, our doctor can quickly diagnose and recommend customised procedures to prevent the worsening of varicose veins.
Should I seek treatment for Varicose Veins?
This condition is not just a cosmetic issue, without treatment, it can lead to other medical complications. There are several reasons why you should make an appointment and seek treatment for your varicose veins from medical centres.
Discomfort and Aches: There may be no symptoms associated with this condition in the initial stages. As varicose veins become more severe, you will start to experience major discomforts such as aches, cramps and swelling and affect your quality of life.
Progressive Disease: Varicose veins will NOT recede with self-care remedies. While compression stockings, medication, cream and leg elevation will alleviate the symptoms and prevent the condition from getting worse, these treatments will not cure the disease or remove the unsightly veins.
Leg Ulceration: If you see any skin colour changes around the ankle, it can be a sign that your varicose veins are rather serious and there is a substantial risk that it may become leg ulceration. When this happens, if patients get cuts and/or wounds, these wounds do not heal up, progressing to become leg ulcers or gangrene and may end up getting infected resulting in surgical amputations.
The latest Treatment, Clarivein, is minimally invasive: In the past, the treatment of varicose veins involved major invasive surgery to strip your affected veins that take weeks to recover. Technology has advanced to effective treatments for varicose veins where you could come into the vein clinic, have the procedure performed under local anaesthesia and leave 1 hour later to go about your normal activities. The advantages of this treatment are no bruises, no scars, no general anaesthesia and no hospitalization needed.
Covered by medical insurance: If you have medical insurance, varicose veins should be a medical condition covered by your insurance.
Why choose EVAR treatments by our doctor?
The aorta is the largest artery in the body and it can involve many parts of the human body, as your arteries bring nutrients to important organs. It is important for an experienced surgeon to do the procedure as it involves the functioning of your organs. Our vascular surgeon in Singapore, is currently a regional proctor for simple and complex stenting EVAR procedures. He has been involved in teaching and training doctors in the region in this life-saving procedure and has helped doctors in Vietnam kick-start this procedure in their own hospitals. This minimally invasive method does not require General Anaesthesia and shortens the patient’s ICU stay.
