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This month, GP Alice Fitzgibbon looks at Abdominal Aortic Aneurysms (AAA for short). A what? Let’s break it down and discover exactly what an AAA is.
Let’s start with the first A: abdominal. This refers to the abdomen – your tummy area. The second A is for aorta – the main artery that supplies blood around the body. The aorta carries blood away from the heart; it lies within the chest and the abdomen. The aorta is a big blood vessel –in adults it is normally 1.5-2cm wide.
The final A stands for aneurysm. An aneurysm is when the muscular wall of a blood vessel is stretched so the vessel gets wider and wider. Abdominal aortic aneurysms usually get bigger over a long period of time – typically 1-2mm per year. When the aorta reaches a diameter of 5.5cm it becomes high risk – this is because the blood vessel’s muscular wall has been stretched thinly and due to high pressures in the blood vessel, the wall may start to leak or burst completely. If this happens it is a life-threatening medical emergency. Sadly, 80% of people who have a ruptured AAA will not survive as too much blood is lost too quickly before an operation can be done to help. Around 5,000 people in the UK will die of AAA every year according to the British Heart Foundation.
Many people with an AAA will have no symptoms. They are often found only at screening or when people have tests for other reasons. Some people may have a strong pulsing sensation they can feel in their tummy, or abdominal and back pain that does not go away. If the aneurysm ruptures, it can cause the following symptoms:
- sudden onset severe abdominal or lower back pains
- becoming pale, sweaty and clammy
- feeling dizzy
- feeling short of breath
- collapsing
- having a racing heartbeat
These symptoms relate to signs of shock and a 999 ambulance must be called immediately.
Although many people will die of a ruptured AAA each year, many more will have the condition and it will never cause any problems. We are lucky in the UK to have a screening programme to check men for AAAs when they turn aged 65. This test is an ultrasound scan to look at the aorta in the abdominal region and measure it to see if there is any widening. It is done at this age as it is unlikely to happen in younger people. If there is an aneurysm seen on the ultrasound, what happens next will depend on the size of it. If it is small (3 – 4.4cm wide) then yearly ultrasounds are offered to keep an eye on how much it grows, if it is medium sized (4.5 – 5.5cm) then ultrasounds are offered every three months to check its size, and people with large AAAs over 5.5cm may be offered surgery to try and prevent it getting bigger or bursting. Surgery to fix an AAA is a major operation that carries risks. It is not always successful, and if done as an emergency, due to the aorta bursting, it is less likely to succeed.
Men are screened for AAAs as they are six times more likely to be affected than women. Woman with AAAs tend to be slightly older than men (over 70 years), but it does happen to them too. There are several things that increase the risk of an AAA developing:
- having high blood pressure
- having chronic obstructive pulmonary disease (smoking related lung disease)
- having high cholesterol
- family history of AAA
- having cardiovascular disease – heart disease or stroke
- being a smoker or an ex-smoker
You will notice that this list of risk factors contains all the common culprits for raising the risks of many diseases. Addressing these risk factors by having a healthy diet, losing weight, exercising regularly, controlling your blood pressure, reducing alcohol intake and stopping smoking can have a tremendous health benefit. They may also help stop an aneurysm increasing in size. If you have a family history of AAA, and are a woman, it may be worth discussing the possibility of having a screening USS with your GP as you will not be offered one routinely when you reach 65 years old.
If you have any concerns about having a AAA, or think you might have missed your screening appointment, then you should check in with your GP practice. The administrative team should be able to direct you to the screening service to contact to arrange an appointment if required. More information about screening for AAAs can be found at: Abdominal aortic aneurysm screening – NHS (www.nhs.uk).
