Time bomb in the belly of disease – abdominal aortic aneurysm

       Abdominal aortic aneurysm is an aneurysmal dilatation of the abdominal aorta and is generally considered to be defined as an aneurysm of the abdominal aorta when the diameter of the aorta is greater than 1.5 times the normal diameter. It is the most common type of aneurysm, and most patients are asymptomatic in the early stages and are often found incidentally for other reasons on physical examination. Abdominal aortic aneurysms are more common in older men, with a male to female ratio of 10:3, especially in smokers, and smoking also significantly increases the risk of aneurysm rupture.  The most common cause of abdominal aortic aneurysm is atherosclerosis. Other rare causes include cystic degeneration of the middle layer of the artery, syphilis, congenital dysplasia, trauma, infection, and connective tissue disease. Common causative risk factors for abdominal aortic aneurysms include: smoking, hypertension, advanced age, and male gender.  Pain is the most common clinical symptom, and can be distending, dull, sharp, or knife-like. If the pain is significantly worse, it is often a precursor to acute aneurysm expansion, or rupture. Once an abdominal aortic aneurysm ruptures, it is very dangerous, with a mortality rate of 80-90%. Sometimes thrombosis within the aneurysm cavity and dislodgement of the thrombus can cause occlusion of other vessels, resulting in arterial embolism, such as lower extremity arterial embolism. Compression of surrounding tissues by the aneurysm may also cause symptoms, such as intestinal obstruction due to duodenal compression and peripheral edema due to compression and obstruction of the inferior vena cava.  The diagnosis of abdominal aortic aneurysm is not complicated, based on the medical history and the presence of a swollen pulsating mass in the peri-umbilical or mid-upper abdomen, sometimes with light pressure pain, which may be accompanied by acute or chronic ischemic symptoms in the lower extremities, and in some patients, abdominal vascular murmurs and tremors can be heard. Further color ultrasonography, CT or MRI examination can establish the diagnosis.  The treatment of abdominal aortic aneurysm is mainly surgical, which is divided into traditional developmental surgery and endoluminal treatment. Endoluminal abdominal aortic aneurysm repair (EVAR) is a minimally invasive surgical approach for the treatment of abdominal aortic aneurysms, which is characterized by minimal trauma, avoiding the tremendous trauma and pain associated with traditional surgery, reducing the incidence of complications and mortality of important organs such as the heart and lungs of patients, and allowing some high-risk cases of advanced age with severe comorbidities, expected to be unable to tolerate traditional open surgery or the possibility of serious complications after surgery The treatment opportunity is provided.