Aortic Aneurysm

Aortic Aneurysm - What it is

An aortic aneurysm is an abnormal, balloon-like swelling in the aorta, which is the body’s largest artery. The aorta originates from the heart, makes a U-turn in the upper chest and ends around the umbilical area, with branches of artery supplying the whole body with oxygenated blood.

A large, fast-growing aortic aneurysm may rupture or dissect, which will cause massive bleeding into the chest or the abdomen. This bleeding can send the body into a severe, fatal shock.

What are the types of aortic aneurysm?

Aortic aneurysms can occur anywhere in the aorta. There are mainly two types of aortic aneurysm:

Abdominal aortic aneurysm: Occurs in the abdomen along the part of the aorta, which passes through the abdomen.
Thoracic aortic aneurysm: Occurs in the chest along the part of the aorta, which passes through the chest cavity.

Other types of aneurysms

Aneurysms can also happen in other parts of the body, such as a brain aneurysm. Read more on aneurysm.

Aortic Aneurysm - Symptoms

What are the symptoms of an aortic aneurysm?

An aneurysm may grow gradually over the years and may appear asymptomatic (without symptoms).

Therefore, detecting an aortic aneurysm early may be difficult, due to the initial lack of symptoms. At a later stage, symptoms usually depend on the location of the aneurysm.

1) Abdominal aortic aneurysm

Deep, constant abdominal pain
Pulsations in the abdomen
Throbbing lump in the groin or legs
Lower back pain

2) Thoracic aortic aneurysm (chest)

Deep, throbbing chest pain
Difficulty swallowing
Shortness of breath
Cough and hoarseness

Aortic Aneurysm - How to prevent?

The best way to prevent or to slow the growth of aortic aneurysms is by leading a healthy lifestyle, such as engaging in the following healthy activities:

Keep your blood pressure and cholesterol levels under control
Eat a healthy diet
Exercise regularly. Complete at least 150 minutes of moderate intensity exercise a week.
Stop or do not start smoking

Aortic Aneurysm - Causes and Risk Factors

Causes of aortic aneurysms

While the exact cause of aortic aneurysms is unknown, ageing and chronic health conditions can lead to a weakening of the aortic wall, which can then bulge under the pressure of blood flowing through the aorta.

These chronic conditions include:

Hypertension or high blood pressure
Infection or inflammation in the aorta
Coronary atherosclerosis (hardening of the arteries) due to diabetes, chronic smoking, high blood cholesterol or lipids
Genetic or congenital conditions, such as Marfan’s syndrome (a connective tissue disorder)

Risk factors of aortic aneurysm

An aortic aneurysm usually occurs in:

The middle-aged and elderly, of around aged 50 and above
Smokers bear a significantly higher risk

Screening for abdominal aortic aneurysms is recommended for current or past male smokers over the age of 65.

Congenital conditions, such as Marfan’s syndrome and bicuspid aortic valves, may also weaken aortic walls, diminishing their ability to withstand the sheer forces of blood flowing through them.

Aortic Aneurysm - Diagnosis

Doctors will conduct a thorough physical examination, such as checking for high blood pressure, heart murmurs, or any pulsating lumps in the abdomen, groin or legs. An aortic aneurysm can show no symptoms until it has grown so large that it bursts, or tears within its wall. Early detection and treatment enhances survival. If large enough, an aortic aneurysm in the abdomen can be detected by a clinical examination.

Investigative tests to help confirm the diagnosis of an aortic aneurysm may also be administered, including:

• Ultrasound

• Computed tomography (CT) scan

• Magnetic resonance imaging (MRI) scan of the chest or abdomen

• Angiogram

• Chest X-ray

These investigative tests may also be used to monitor the size of the aneurysm over time, to assess the risk of rupture and the timing of surgery.

Aortic Aneurysm - Treatments

Surgery/Procedure

Traditionally, patients with aortic aneurysms are usually offered higher risk conventional open-heart surgeries. Generally, intervention is recommended for aortic aneurysms that are larger than 5.5cm or growing at a fast rate.

Doctors may surgically remove the aneurysm and replace the weakened portion of the aorta with a synthetic graft if the aneurysm is at risk of rupturing, usually when the aneurysm grows beyond a threshold size. This threshold varies depending on the location of the aneurysm.

However, an open surgery is not suitable for everyone. The conventional open surgery to treat the aortic aneurysm before it ruptures may be associated with risks of morbidity and death. It is also not suitable for high-risk patients with diabetes and heart conditions.

With the emergence of minimally invasive procedures, such as the thoracic endovascular aortic repair (TEVAR) procedure, there is other alternative to conventional open-heart surgery for selected groups of patients, such as those with aortovascular conditions and are elderly or frail and have a number of medical conditions, as well as those who were previously not recommended for any intervention due to health conditions.

Medications

The larger an aneurysm becomes, the more likely it will burst. Doctors will prescribe oral medications, such as beta blockers to reduce the force of blood pressure against the weakened artery wall. In general, high blood pressures will be aggressively treated.