What is an abdominal aortic aneurysm? The abdominal aorta is the continuation of the aorta in the abdomen and is primarily responsible for the blood supply to the abdominal viscera, abdominal wall and lower extremities. An abdominal aortic aneurysm is formed when a segment of the abdominal aorta becomes dilated to a diameter more than 1.5 times the normal abdominal aortic diameter. An abdominal aortic aneurysm is actually a dilated arterial disease caused by degeneration of the arterial vessel wall, not a “tumor” in the usual sense, yet it is no less dangerous to human health than any other malignant tumor. What are the risks of abdominal aortic aneurysm? Abdominal aortic aneurysm is like an unscheduled bomb in the human body, which is very dangerous. Once an abdominal aortic aneurysm ruptures, high velocity, high pressure arterial blood is immediately ejected into the abdominal cavity, causing the patient to lose thousands of milliliters of blood in just a few minutes, followed by shock, hemorrhage and death. As long as the rupture occurs in the abdominal cavity, any resuscitation and blood transfusion is futile, so clinicians call this dangerous disease “untimely bomb”, which means that as soon as an abdominal aortic aneurysm is found, it is equivalent to bringing an untimely bomb that may rupture anytime and anywhere. What is the incidence of abdominal aortic aneurysms? In recent years, the incidence of abdominal aortic aneurysms has been on the rise worldwide. In the United States, the incidence of abdominal aortic aneurysms has increased sevenfold compared to 30 years ago, resulting in about 15,000 deaths per year, which is the 13th leading cause of death. In China, the incidence of abdominal aortic aneurysm is increasing year by year as the standard of living continues to improve and the population ages. What are the causes of abdominal aortic aneurysm? The causative factors of abdominal aortic aneurysm are complex and are currently considered to be most closely related to atherosclerosis, as well as congenital factors, genetic factors and metabolic factors. Degradation, dissection and calcification of elastic fibers in the aortic wall in the elderly, excessive fat intake, and atherosclerotic plaque formation in the arterial wall can all contribute to the occurrence and development of abdominal aortic aneurysms. Many common diseases are also high-risk factors for abdominal aortic aneurysm: hypertension promotes the hardening of the arterial wall and makes it more prone to dilatation; diabetes reduces the ability of the arterial wall tissue to repair and rebuild, making it difficult to resist the attack of various pathogenic factors. In addition, many tissue lesions that are under tension in the human body have been found to be closely related to abdominal aortic aneurysm after investigation and statistics, such as emphysema, chronic bronchitis, and abdominal hernia. In conclusion, the causes of abdominal aortic aneurysm can be summarized as “eight highs and one low”: high blood lipids, high blood sugar, high uric acid, high body weight, high blood pressure, high (blood) viscosity, high age, high (mental) stress, and reduced exercise. What are the clinical manifestations of abdominal aortic aneurysm? Most patients are asymptomatic. Occasionally, a pulsating mass is found around the umbilicus or in the middle and upper abdomen, either by the patient himself or by the physician. Some patients only feel a throbbing sensation and mild discomfort in the abdomen. A small number of patients complain of abdominal pain or distending discomfort. When abdominal pain is significant and involves the low back, it suggests that the aneurysm has compressed or eroded adjacent tissues (e.g., lumbar vertebral body) or that the posterior wall of the aneurysm has ruptured and formed a hematoma. If abdominal pain suddenly increases, it is often a precursor to aneurysm rupture. Most aneurysms rupture into the abdominal cavity, resulting in intra-abdominal hemorrhage with shock. Very rarely, aneurysms penetrate into the duodenum or jejunum and cause upper gastrointestinal bleeding. Partial intestinal obstruction may occur as the aneurysm enlarges forward, compressing or displacing the duodenum and upper jejunum located anterior to it. Sclerotic plaque debris or attached thrombus dislodged from the aneurysm can cause arterial embolism of the lower extremity, resulting in acute or chronic ischemic symptoms. What are the characteristic findings on physical examination of abdominal aortic aneurysm? Most patients with abdominal aortic aneurysm have almost no symptoms until the vessel ruptures, except for a portion of wasting patients who can palpate a pulsating mass in the abdomen with a frequency consistent with the heart rate and a few other patients who have vague pain in the abdomen and low back, in which case early diagnosis and early treatment are particularly important. There are many clinical methods used to examine blood vessels, such as ultrasound, CT, MRI, and arteriography. Among these examinations, vascular ultrasound has become an important tool for screening abdominal aortic aneurysm by virtue of its non-invasive, inexpensive and easy operation. It can not only detect aortic aneurysms quickly, but also provide many important information about the aneurysm, such as the diameter and length of the aneurysm, the size of the sclerotic plaque and the thrombus condition. How to prevent abdominal aortic aneurysm in early stage? 1.Strengthen health education, raise people’s health awareness and develop good health and hygiene habits. Strictly control fat intake and avoid overeating for the elderly over 55 years old. Frequent consumption of low-fat, low-sugar, high-fiber, high-protein foods and fresh vegetables and fruits can help reduce the incidence of atherosclerosis. 2, pay attention to behavior regulation, quit smoking and alcohol, for long-term smoking in more than 20 cigarettes per day should be strictly controlled, and those who have difficulty quitting smoking should be patiently persuaded, explain the advantages and disadvantages, and gradually reduce, in order to reduce the damage of harmful gases to the blood vessel wall. 3, to maintain adequate sleep, emotional stability, mood, avoid excessive tension, emotional excitement. Participate actively in social activities within your ability and appropriate physical activities to improve the body’s ability to resist disease. Avoid forceful bowel movements and violent coughing. 4.Strictly control obesity, hyperlipidemia, and actively treat diabetes and hypertension. 5.Once diagnosed with abdominal aortic aneurysm, blood pressure should be strictly controlled and trauma, forceful defecation and violent coughing should be avoided. All activities that increase abdominal pressure should be avoided, and abdominal pain should be closely observed. Prevent rupture of abdominal aortic aneurysm. What are the treatment options for abdominal aortic aneurysm? In recent years, the surgical treatment of abdominal aortic aneurysm has been improved with the development of vascular surgery technology, from the initial ligation, embolization and wrapping to the classic transabdominal surgical aneurysm removal and artificial vessel replacement, as well as the recently emerging endovascular repair and laparoscopic aneurysm removal and artificial vessel replacement. How is endoluminal treatment of abdominal aortic aneurysms performed? After anesthesia, the patient is placed in a lying position, an incision is made in the inguinal ligament on one side, the femoral artery is dissected, the femoral artery is punctured, a sheath of approximately 2 mm in diameter is inserted, a guide wire of approximately 1 mm in diameter is fed through the sheath, the geometric parameters of the aneurysm are measured through the monitoring screen of the DSA, a graft of appropriate caliber and length is selected, and a pre-stored graft is fed along the guide wire. When the graft reaches the appropriate position, the graft is released from the introducer system and the stent with memory alloy automatically opens and adheres to the normal inner wall of the artery, completely repairing the aneurysm. The repaired aneurysm lumen is thrombosed and blood flows through the graft. This minimally invasive procedure is a boon to every patient with abdominal aortic aneurysm because of its rapid recovery and its adaptation to many patients who cannot tolerate traditional open surgery. What are the advantages of the endoluminal approach to abdominal aortic aneurysms? Endoluminal repair is a minimally invasive procedure with the advantages of less trauma and faster recovery. Numerous clinical reports and evidence-based studies have confirmed that endoluminal repair has a higher perioperative safety profile than open surgery. Randomized controlled trials in recent years, such as the EVAR1 trial in the United Kingdom and the multicenter DREAM trial in the Netherlands, have also shown lower rates of death and serious complications at 30 days after endoluminal repair than open surgery, and better survival rates at 5 years of follow-up for patients undergoing endoluminal repair than for those undergoing traditional open surgery. Patients are concerned that the risks of surgery or endoluminal treatment are high, is this true? If traditional open surgery for abdominal aortic aneurysms is a heavy-handed and massively invasive procedure that many patients cannot tolerate, resulting in high mortality during the operative period; then endoluminal repair for abdominal aortic aneurysms can be considered light and minimally invasive, and can be tolerated by almost all high-risk patients, which, together with the recent use of various organ-protective drugs and contrast agents that have less impact on renal function, has further reduced the riskiness of endoluminal repair. Most patients can be out of bed by day 2 after endoluminal repair and can be discharged from the hospital in 3-5 days. What should I expect after abdominal aortic aneurysm surgery? Patients should have regular follow-up after endoluminal repair. It is essential to assess the degree and location of graft patency. In addition, the presence or absence of endoleaks is an important indicator to assess whether the aneurysm has been completely repaired after surgery, usually at 3 months, 6 months, 12 months and annually after surgery. A CTA is usually done to know the intermediate and long-term outcome of endoluminal repair. After endoluminal repair, patients can continue to exercise as before, including walking, riding in a car, swimming and cycling.