Q
: Can you explain what abdominal aortic aneurysm is and how common it is ?
A
: Abdominal aortic aneurysm , or “ triple A ( AAA )”, is a dilatation or bulge in the normally straight , tubular structure of the aorta , the biggest artery in the body located deep in the abdominal cavity . The most common location for a AAA to develop is below the branches of the aorta which supply each kidney and above where the aorta divides into two branches , one for each leg . Imagine an area just above the belly button .
AAA affects 4-8 percent of the population but is more common in men over 65 and in those who smoke and have a family history of AAA . Type 2 diabetes , however , seems to be protective against the development of AAA . The major health risk associated with AAA is that once it reaches a certain size , which may take years , it is prone to rupture and cause lifethreatening internal bleeding .
Q
: What are its telltale symptoms people should look out for to seek care ?
A
: Unfortunately , AAAs can have very few symptoms even when quite large in size , making prevention of rupture , the most feared and serious complication of the condition , a difficult task . As AAAs enlarge , patients may have a sense of a “ pulsation ” in their abdomen , which may be tender to touch , or feel a vague abdominal pain . AAA rupture , which is usually accompanied by extremely severe abdominal pain often radiating through to the back , is a medical and surgical emergency requiring immediate hospital treatment .
Q
: What are the risks if the condition is not treated promptly , and which procedures can fix it ?
A
: Once the AAA reaches 5.5cm in diameter , its repair is advised to avoid future risk of rupture . AAA repair is performed using either an open surgical procedure with graft placement or via an endovascular approach through a small incision in the patients groin and insertion of a stent to prevent the AAA from increasing in size .
Q
: Who should get tested for AAA ?
A
: Whilst there are no strict rules about testing for AAA ,
Caucasian men over 65 who smoke and have a family history should consider ultrasound screening for AAA . Of course , any symptoms relating to abdominal pulsations and pain , particularly in the older age group , should also be investigated to exclude AAA . Once identified , AAAs can be observed with six to 12 monthly ultrasound and physical
examinations to determine if there are any signs of possible future rupture .
Q
: Which lifestyle choices could help prevent AAA ?
A
: These include abstinence from smoking and attention to risk factors for atherosclerotic blood vessel disease , such as maintaining healthy blood pressure and cholesterol levels .
Q
: How could the drug metformin improve AAA treatment ?
A
: Unexpectedly , clinical studies suggest that patients with type 2 diabetes have a lower incidence of AAA disease compared to other patients . As most patients with type 2 diabetes are also prescribed metformin as a treatment for their elevated blood sugar levels , it is thought that metformin may play a therapeutic role in reducing AAA growth and rupture due to its anti-inflammatory properties . Clinical trials are currently underway to investigate the effect of metformin on AAA growth and rupture . If shown to be effective , it would be the first medical therapy for AAA disease and a significant advance in the management of AAA patients , with the potential to avoid major surgical procedures and lifethreatening rupture .
Dr Anthony Dear
An Associate Professor in the Department of Medicine at Monash University , Dr Anthony Dear is leading a clinical trial to test the efficacy of metformin against abdominal aortic aneurysms .
GlobalHealthAsiaPacific . com MAY 2022
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