An Overview of Aortic Aneurysms

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An aortic aneurysm is a bulging of the aorta, the main artery that travels from the heart to supply blood to the rest of the body. The most common location of an aortic aneurysm is the abdomen. Aortic aneurysms can rupture, leading to catastrophic blood loss and death.

If you get prompt medical attention, emergency surgical repair may save your life. An aortic aneurysm that is diagnosed prior to rupture can be surgically repaired, too, with a good prognosis. 

Symptoms

An aortic aneurysm can produce symptoms that wax and wane before it ruptures. Often, when an aortic aneurysm becomes larger, symptoms either begin for the first time or worsen.

Symptoms may be an indication that a rupture is more likely to happen. The symptoms of a ruptured aortic aneurysm are relatively dramatic and progress rapidly over the course of minutes. Most of the time, an aortic aneurysm will rupture without any prior symptoms.

The aorta, itself, is a large blood vessel that exits from the heart to carry oxygenated blood to the body. Many small arteries branch off of it. The two regions where an aortic aneurysm is most likely to develop, though, are in the abdominal section of the aorta, which is located behind the belly, and the thoracic section of the aorta, which is located behind the ribs. 

Abdominal Aortic Aneurysm 

The abdominal section of the aorta is the most common region of an aortic aneurysm, and this type of an aneurysm is often referred to as AAA (abdominal aortic aneurysm). The symptoms can be subtle (or there may be no symptoms at all prior to a rupture) and may include: 

  • Back pain in the mid to lower part of the back
  • Abdominal pain and discomfort
  • Pulsating sensation in the abdomen

Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is the section of the aorta that has recently exited the heart and is located in the chest. As with an AAA, symptoms may be subtle (or there may not be symptoms prior to rupture) and involve: 

  • Chest pain
  • Back pain
  • Shortness of breath

Ruptured Aortic Aneurysm

When an aortic aneurysm ruptures, symptoms can progress rapidly. The most common symptoms of an aortic aneurysm rupture are not necessarily similar to those of an un-ruptured aortic aneurysm, although the pain in the area of an aneurysm can occur. Symptoms include:

  • Lightheadedness, dizziness, and blurred vision
  • Severe weakness
  • Severe chest, abdominal or back pain
  • Loss of consciousness

Aortic Aneurysm Affecting Other Organs 

Blood clots may form within an aortic aneurysm. If these blood clots break off and travel to other areas of the body, they can cause organ damage, such as stroke, kidney failure, or a heart attack. The symptoms vary and may include chest pain, vision loss, and blood in the urine. 

Causes

An aortic aneurysm can develop when the walls of the aorta become weak. This can happen over time as a result of diseases and conditions that tend to affect all blood vessels of the body, not just the aorta.

The weakness of the aorta causes bulging which results in a predisposition of rupturing or blood clotting. The physical pressure of an aneurysm on the nearby organs can produce some detectable symptoms, while the blood loss of an aneurysm rupture causes the more severe and life-threatening consequences.  

Leading Risk Factors

  • Smoking, by far, is the main risk factor for aortic aneurysms. Smokers have a fivefold increase in the incidence of aortic aneurysms compared to non-smokers.
  • Aging (Aortic aneurysms are rare in people under 60 years of age.)
  • Male gender (Aortic aneurysms occur much more commonly in men than in women.)
  • Long-term high blood pressure (or hypertension), particularly if untreated, can increase the risk of aneurysm formation. 
  • Hardening of the arteries, or atherosclerosis, which occurs as a result of high cholesterol and hypertension, predisposes you to an aortic aneurysm by making the walls of the artery irregular and prone to weakening.
  • A family history of aortic aneurysm is an important risk factor.
  • Several genetic diseases can increase the risk of an aortic aneurysm, due to the weakness of the blood vessels caused by these conditions. Marfan syndrome, Ehlers-Danlos syndrome, Takayasu's arteritis, bicuspid aortic valve, Loeys-Dietz syndrome, familial thoracic aortic aneurysms, and polycystic kidney disease all increase the risk of aortic aneurysms. 
  • Trauma to the abdomen or chest may cause an aortic aneurysm to develop or rupture.

Risk Factors for Rupture

It is not easy to predict whether an aortic aneurysm will rupture. Worsening symptoms, large size or enlarging size of an aneurysm, as well as evidence of slow bleeding on an imaging exam all, suggest an increased likelihood of rupture. Extreme changes in blood pressure or severe infections can increase the chances of an aortic aneurysm rupture as well. 

Diagnosis 

The initial symptoms of an aortic aneurysm are often due to rupture—and rupture can be fatal. If you have an aortic aneurysm, your outcome will be much better if the aneurysm is diagnosed before it produces any symptoms. Here are the diagnostic methods:

  • Screening: Most pre-rupture aortic aneurysms are diagnosed when people who are assumed to be at increased risk are specifically screened for it, even if there are no symptoms or signs on physical examination. The U.S Preventative Services Task Force has established recommendations for aortic aneurysm screening based on age, gender, and smoking history. 
  • Physical examination: A pulsatile mass, which is a large pulsing area deep in the abdomen, can be detected by physical exam in about 33 percent of people who have AAA. Because the blood vessel is even harder to feel if you have a thoracic aneurysm, identification during a physical examination is much lower for thoracic aneurysms.
  • Chest X-ray: A chest X-ray is not usually the test that your doctor would order if you are at risk of an aortic aneurysm. However, many aneurysms are first detected with a routine chest X-ray that may have been ordered for another reason besides screening for an aortic aneurysm. 
  • Ultrasound study: An ultrasound is a type of study that can detect abnormalities in fluid movement and anatomical structure of the body. Ultrasound studies are considered particularly sensitive in the diagnosis of aortic aneurysms. It is a safe and relatively fast diagnostic test, making it useful in urgent situations as well.  
  • CT scan: Another imaging study, a CT scan, can detect changes in the structure of the aorta and can be useful in surgical planning. 
  • MRI scan: An MRI, like a CT, is an imaging study that can identify anatomical abnormalities. Depending on the specifics of your aneurysm, an MRI or a CT may be selected to evaluate your aorta. 

Treatment

If you have been told that you have an aortic aneurysm, you and your doctor will have to decide on the best path of treatment. The two approaches to aneurysm management include surgical repair to prevent rupture or carefully monitoring over time. To a large extent, this decision will depend on the estimated likelihood that your aneurysm will rupture and on your estimated risk from surgery.

The likelihood that an aortic aneurysm will rupture depends largely on two factors:

  1. Size of an aneurysm
  2. Rate of growth

The size of an aortic aneurysm is considered the best indicator of the risk of rupture and it can be measured by ultrasound testing, CT scan, or MRI. Aneurysms greater than 5.5 cm in diameter in men, or greater than 5.0 cm in women, are more likely to rupture than smaller aneurysms.

If these threshold diameter values have been reached, the risk of rupture is greater than 40 percent over five years and surgery is often recommended. Below these threshold values, the risk of rupture may be closer to the risk of complications from surgery, so surgery might not be recommended.

Surgery

Repair of an aneurysm requires a surgical procedure. There are several methods of surgical repair, including what is referred to as an open repair and another approach which is an endovascular repair. Your surgeon will plan out your procedure to give you the best chance of effective repair and safe recovery with as few complications as possible. 

Many people with aortic aneurysms have other cardiovascular disorders due to age and other risk factors, so the risk associated with surgical repair is often not trivial. In general, the risk of dying from the surgical procedure is usually about 5 percent or less, but the risk of surgery has to be carefully assessed for each individual. 

If surgery is not recommended, then regular reassessments of the size of an aneurysm should be made. If an aneurysm grows in size by more than 0.5 cm in a year, the risk of rupture is much higher. Surgery is usually recommended even if the overall size of an aneurysm is still less than 5.0 or 5.5 cm.

Aortic Aneurysm Rupture

An aortic aneurysm rupture is a surgical emergency. If this happens to you or a loved one, immediate medical stabilization and surgical repair are necessary. In addition to repair of the aneurysm, excessive blood loss and impact on other organs must be managed as well. 

Prevention

An aortic aneurysm is more likely if you have certain risk factors. Some of the risk factors, such as age and genetic predisposition, are not controllable. Other risk factors, however, can be modified or controlled, which greatly reduces your chances of developing an aortic aneurysm.

Some of the steps you can take to reduce your risk include:

  • Don't smoke: Smoking is a major risk factor for all vascular disease, including aortic aneurysms. The only effective way to decrease the damage that results from smoking is to discontinue smoking. 
  • Control blood pressure: High blood pressure is a significant contributor to vascular disease, and maintaining normal blood pressure by the use of diet, stress control, or medications reduces your chances of developing an aortic aneurysm. 
  • Control your cholesterol level: High cholesterol leads to atherosclerosis, which is the hardening of the arteries. Atherosclerosis is among the leading causes of an aortic aneurysm. There are a number of ways of reducing high cholesterol levels. Several medications can reduce cholesterol and a healthy diet that is high in fiber and low in unhealthy fats can also reduce cholesterol, for some people. 
  • Get regular medical care: Routine medical visits are important. Your doctor may discover that you could be at risk of having an aortic aneurysm and you may need a screening test. Additionally, when you maintain your regular medical visits, issues that can increase your risk of aortic aneurysms, such as hypertension and high cholesterol, can be detected and treated early. 

    A Word From Verywell

    Aortic aneurysm rupture is a major life event that can result in death. Aortic aneurysms often do not cause symptoms, which makes screening an important aspect of health maintenance, especially if you have risk factors like smoking, advanced age, hypertension, and atherosclerosis. 

    If you have an aortic aneurysm, the decision about whether you need a repair, and the details of the procedure itself, require a high-level consultation with a vascular surgeon. The surgery is considered a major procedure. After repair, however, most people have a good outcome and do not experience a ruptured aortic aneurysm.

    If you or your loved one is recovering from a ruptured aortic aneurysm, this recovery will take time and there may be a long-term impact of your aortic aneurysm rupture. 

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