The aorta, the largest artery in the body, emanates directly from the heart and carries oxygen-rich arterial blood to all parts of the body. The aorta located in the thoracic cavity is called the thoracic aorta and extends down the left side of the spine to the diaphragm into the abdomen, which is called the abdominal aorta. The abdominal aorta mainly supplies blood to the lower half of the body and divides into the bilateral iliac arteries at the level of the navel, which supply blood to both lower limbs and the pelvis, respectively. The normal diameter of the abdominal aorta is about 1.5-1.8 cm. When the arterial blood flow in the aorta is under continuous pressure impact causing the local weak part of the arterial wall to swell or protrude beyond 50% of the normal value, it is called abdominal aortic aneurysm, which is the most common of all aortic dilatation diseases. The principle of aneurysm is like blowing up a balloon, and once the diameter of the artery widens beyond the safe range, it may rupture and directly threaten people’s lives. Every year, about 200,000 cases of abdominal aortic aneurysm are diagnosed in the United States, of which about 15,000 are at risk of rupture; in recent years, the incidence of abdominal aortic aneurysm in China has shown an increasing trend, and statistics show that the incidence of abdominal aortic aneurysm is about 8.8% among people over 65 years of age, and there are many patients who will suddenly have a ruptured aneurysm without any symptoms, and The mortality rate of such ruptured aneurysms can be more than 80-90%, so the medical community also calls abdominal aortic aneurysm a “time bomb” in the human body. Fortunately, there are now efficient and safe means to diagnose, treat and even cure abdominal aortic aneurysms early, before they become symptomatic. How abdominal aortic aneurysms are formed There is no definitive answer to the cause of aneurysms, but there is no doubt that atherosclerosis is the most common and primary cause of abdominal aortic aneurysm formation. It is generally believed that atherosclerosis of the arterial vessels can cause local wall thickening of the arteries, resulting in impaired nutrient supply to the vessels, which induces an inflammatory response in the middle layer of the arteries, leading to the rupture of elastic fibers and weakening of the vessel walls, resulting in the formation of swelling or protrusion at the weakest part of the arterial walls under the impact of strong blood flow, also known as aneurysm. In addition to atherosclerosis, other factors associated with aneurysms include: 1) being over 60 years of age; 2) being more frequent in men, with a male to female ratio of about 4:1; 3) having a family history of an immediate family member with a similar onset; 4) hypertension; 5) smoking; and 6) there are also some abdominal aortic aneurysms that are caused by trauma, infection, immune disorders, etc. What are the symptoms of abdominal aortic aneurysm? Abdominal aortic aneurysms are unlikely to heal on their own, and if they are not treated promptly, they can easily rupture and bleed leading to an incurable disease. Therefore, if patients can grasp the awareness related to the clinical manifestations of abdominal aortic aneurysm, it is often the key to early diagnosis of the disease. 1) Pulsating abdominal masses Early on, painless pulsating masses around the umbilicus or in the left mid-upper abdomen are most often found on physical examination or unintentionally. These pulsating abdominal masses are consistent with the rhythm of one’s heartbeat and may be accompanied by tremors and vascular murmurs. 2) Compression symptoms Further enlargement of the aneurysm may cause gastrointestinal symptoms such as abdominal distension, nausea and vomiting when it compresses the adjacent organs, such as the duodenum and proximal jejunum; it may cause urinary obstruction when it compresses the ureter; it may cause obstructive jaundice when it compresses the common bile duct; it may cause intractable lumbago when it compresses the spinal cord root. 3) Arterial embolism The thrombus or debris attached to the wall of the aneurysm dislodges down the blood flow to the branch vessels of the lower limbs, causing extreme pain and serious complications, such as amputation, once the blood flow is interrupted. 4) Pain Most patients have only mild discomfort or distension in the abdomen. If sudden and severe low back pain occurs, one must be alert to the precursor of rupture or the possibility of rupture. This is the most dangerous symptom for patients with abdominal aortic aneurysm. Aneurysm rupture can be felt as intense weakness, pain or fainting, and eventually loss of consciousness, and such life-threatening moments must be urgently sought. Do abdominal aortic aneurysms require surgery? Whether an abdominal aortic aneurysm can rupture is directly related to the size of the diameter of the aneurysm. Studies have shown that the incidence of rupture is 10% when the diameter of the aneurysm is less than 4 cm; the incidence of rupture is 30% to 50% when the diameter of the aneurysm is 5-10 cm; and the incidence of rupture is more than 80% once the diameter of the aneurysm exceeds 1O cm. If the tumor is less than 5 cm in diameter and there are no clinical symptoms, the doctor will advise you to observe the tumor closely and have an imaging examination at least once every six months, and once the tumor tends to increase in size, surgery should be actively performed to prevent serious consequences. If the risk of rupture exceeds the risk of surgery, surgery or stenting is a reasonable option. How to treat abdominal aortic aneurysms (a) Non-surgical treatment Once a patient is diagnosed with an abdominal aortic aneurysm, he or she should be treated aggressively. Abdominal aortic aneurysms do not heal on their own or shrink with medication, and the only effective way is to perform surgery. However, for patients with aneurysms less than 5 cm in diameter, growing less than 1 cm per year, without clinical manifestations, or those who do not tolerate surgery well, they need to temporarily improve their general health condition and can first create conditions for surgery through a combination of treatments mainly medication. Nothing is more important than strict control of blood pressure, which can reduce the continuous pressure of arterial blood flow on the weak aneurysm; at the same time, factors that increase abdominal pressure, such as chronic cough and constipation, need to be avoided; if you have a smoking habit, you need to strictly quit smoking. (ii) Surgical treatment If the aneurysm is more than 5 cm in diameter or growing by 1 cm per year, or if it is causing symptoms, it means that you need surgical treatment. The traditional open abdominal aortic aneurysm resection and artificial vessel replacement surgery is a classic procedure with proven efficacy. Through a median abdominal incision, the weak, dilated diseased vessel segment is replaced with a caliber and length-matched artificial vessel under direct vision, thereby restoring normal vessel morphology. The artificial vessel is made of a strong, long-lasting woven material, such as the commonly used polyester vessel. Post-operative hospitalization is usually required for 7-10 days in order to observe the healing of the incision, the recovery of intestinal function, and any other complications. After discharge from the hospital, it usually takes 6 weeks to 3 months to fully recover, depending on the individual’s physical condition. Satisfactory long-term results are achieved in more than 90% of patients. (iii) Endoluminal treatment In addition to traditional surgery, the rapid development of endoluminal treatment techniques in recent years has not only enriched the treatment of aneurysms, but also brought benefits to patients. It only requires a small incision in the groin, and a metal stent covered with artificial blood vessels is precisely implanted into the normal vessels above and below the aneurysm cavity through a minimally invasive interventional method under the monitoring of X-ray surveillance screen, thus isolating the blood flow from the weak aneurysm wall and achieving the same treatment effect as open surgery, but avoiding the trauma and related complications caused by open surgery, and the postoperative recovery time is also much shorter than that of surgery, usually 2-3 days The postoperative recovery time is much shorter than that of surgery, usually 2-3 days. Intracavitary treatment requires closer follow-up and regular CT examinations to avoid complications such as endovascular fistula. In addition, not every patient is suitable for endoluminal treatment, depending on the shape of the tumor, the length of the neck, and the angle of the neck. For patients with clear indications for endoluminal therapy, or for patients in poor general condition who have difficulty tolerating surgery, endoluminal therapy is certainly a good option, but for patients without indications for interventional therapy, surgery remains the best treatment. Your physician will provide the best treatment plan for your specific case.