Aortic aneurysm

2021-07-31 03:50 PM

An aortic aneurysm is an area of the artery that is weak and bulging, and the aorta is a large blood vessel that supplies blood to the body. The aorta runs from the heart through between the chest and abdomen.

Define

An aortic aneurysm is an area of ​​the artery that is weak and bulging, and the aorta is a large blood vessel that supplies blood to the body. The aorta runs from the heart through between the chest and abdomen. Because the aorta supplies the body with blood, ruptured aortic aneurysms can cause life-threatening bleeding. Although you may never have symptoms, finding out you have an aortic aneurysm can be scary.

Most aortic aneurysms are small and do not rupture and grow slowly, but large aortic aneurysms can grow rapidly. Depending on the size and rate at which the aortic aneurysm is growing, treatment can vary from wait-and-see to emergency surgery. Once an aortic aneurysm is found, your doctor will closely monitor it for surgery, which can be scheduled if necessary. Emergency surgery for a ruptured aneurysm can be risky.

Symptoms

Aortic aneurysms are slow-growing and often asymptomatic, making them difficult to detect. Some aneurysms will never burst. Many people start off with a small and stable bulge, although it expands over time. Some aortic aneurysms slowly widen, growing less than 1.2 cm/year. Others expand at a faster rate, increasing the risk of dissection and rupture. The duration and extent of dilated aortic aneurysms can be difficult to predict.

As an aortic aneurysm develops, some people may notice:
 
Feeling of a pulse near the navel, if an aneurysm occurs in the abdomen.

Pain in the abdomen or chest.

Backache.

Aneurysms can develop anywhere along the aorta, but most occur in the abdomen and are called abdominal aortic aneurysms. An aneurysm that occurs in the part of the aorta higher in the chest is called a thoracic aortic aneurysm.

You should see your doctor if you have any of the symptoms listed above.

Anyone age 60 and older who has risk factors for developing an aortic aneurysm should consider getting regular screening for this condition. Men aged 65-75 years who have ever smoked should have a one-time screening for abdominal aortic aneurysms using abdominal ultrasound. Men of age 60 and older with a family history of abdominal aortic aneurysms should also consider testing.

If you have a family history of aortic aneurysms, your doctor may recommend regular ultrasounds to check.

Causes

Abdominal aortic aneurysm

About 75 percent of all aortic aneurysms occur in the part of the aorta in the abdomen. Although the exact cause of an abdominal aortic aneurysm is unknown, researchers think a number of factors may play a role, including:

Cigarette. Smoking and other forms of tobacco use constitute one of the most important factors associated with the development of aortic aneurysms. In addition to the harmful effects that tobacco has on the arteries directly, smoking contributes to atherosclerosis, high blood pressure and causes aneurysms to grow faster.
 
Hypertension. High blood pressure, especially if poorly controlled, increases the risk of developing an aortic aneurysm.

Infection in the aorta (vasculitis). In rare cases, an aortic aneurysm can be caused by an infection or inflammation (vasculitis) that weakens part of the aortic wall. There is often a pattern of aneurysms that develop among family members, which means it can be inherited.

Thoracic aortic aneurysm

About 25 percent of aortic aneurysms occur higher inside the chest. While the same risk factors associated with an abdominal aortic aneurysm can contribute to a thoracic aortic aneurysm, several additional factors can lead to a thoracic aortic aneurysm, including:

Marfan syndrome. People who are born with Marfan syndrome, an inherited disease that affects the connective tissues in the body, are particularly at risk for thoracic aortic aneurysms. People with Marfan syndrome may have weakness in the wall of the aorta that makes them more susceptible to aneurysms. Marfan syndrome often has distinct physical features, including tall stature, very long arms, deformed sternum, and eye problems.

Aortic injury. You are more likely to have a thoracic aortic aneurysm if there is a previous problem with the aorta, such as a cut in the wall of the aorta (aortic dissection).

Injury. Some people who are injured in a fall are at risk of developing a thoracic aortic aneurysm.

Aortic surgery is a potentially life-threatening emergency.

Risk factors

Risk factors for aortic aneurysms include:

Age. Abdominal aortic aneurysms usually occur in people 60 years of age and older.

Cigarette. Smoking is a strong risk factor for aortic aneurysm development. Children who have smoked or chewed tobacco have a bigger risk.

Hypertension. High blood pressure often damages blood vessels in the body, increasing the chance of developing an aneurysm.

Atherosclerosis. Atherosclerosis, the accumulation of fat and other substances can damage blood vessel walls, which increases the risk of aneurysms.

Male. Men are five to 10 times more likely to develop an aortic aneurysm than women. However, women with aortic aneurysms have a higher risk of rupture than men.

Race. Aortic aneurysms are more common in Caucasians than in people of other races.

Family. People with a family history of aortic aneurysms are at increased risk. People with a family history of aneurysms tend to develop aneurysms at a younger age and have a higher risk of rupture.

Complications

Cuts in the wall of the aorta (dissection) and rupture of the aorta are the main complications of an abdominal aortic aneurysm. Rupture of an aortic aneurysm can lead to life-threatening bleeding. In general, the larger the aneurysm, the greater the risk of rupture.

Signs and symptoms

Sudden, severe, and persistent pain in the abdomen, chest, or back.

Pain spreading to the leg.

Sweating.

Dizzy.

Low blood pressure.

Rapid pulse.

Loss of consciousness.

Shortness of breath.

One complication of an aortic aneurysm is the risk of blood clots forming. Small blood clots can develop in the area of ​​the aortic aneurysm. If the blood clot breaks off from the sidewall of the aneurysm and the clot travels elsewhere in the body, it can cause pain or block blood flow to the legs, toes, or organs in the abdomen.

Preparations for medical examination

Many aortic aneurysms are found during a routine physical exam, or while your doctor is looking for other causes. If you have an aortic aneurysm, your doctor will ask if anyone in your family has had an aortic aneurysm.

Know the size of the aneurysm, whether your doctor has noticed any changes, and how often to see it and monitor it.

If an abdominal ultrasound is to diagnose an aortic aneurysm, your doctor will likely tell you not to eat or drink anything 9 to 12 hours before the ultrasound. Most ultrasounds are done in the morning so you can eat right after.

Tests and diagnostics

Most abdominal aortic aneurysms are found on examination for other reasons. For example, during a routine exam, the doctor may feel a pulse in the abdomen, although the doctor will probably not see signs of an aneurysm through the stethoscope. Aortic aneurysms are often found during routine medical checkups, such as chest X-rays or echocardiograms of the heart or abdomen, sometimes for another reason.

If your doctor suspects an aortic aneurysm, specialized testing can confirm it. These tests may include:

Echocardiography. Uses sound waves to create an image of the heart. An echocardiogram shows the chambers and valves of the heart in working order. Occasionally, to be able to see the aorta, your doctor may recommend a transesophageal echocardiogram, in which sound waves are generated from inside the body by a device inserted down the esophagus.

Stomach supersonic. May help diagnose an abdominal aortic aneurysm. This test is painless, lying on your back on a table and warm gel is applied to the abdomen. The gel helps eliminate the formation of air pockets between the body and the instrument the technician uses to view the aorta, called a transducer. The technician presses the transducer to the skin on the abdomen, moving it from area to area. The probe sends images to a computer screen to check for potential aneurysms.

Computed tomography (CT scan). This test is painless and can give your doctor a clear picture of the aorta. During a CT scan, you lie on a table inside a machine called a rig. Radiation passes through the body and converts it into an electrical signal. The computer collects this signal and assigns it a different color, from black to white, depending on the signal strength. The computer then assembles the images and displays them on the computer screen.

Magnetic resonance imaging (MRI). An MRI is an imaging test. Most MRI machines have a large magnet shaped like a pie or tunnel. Lie on the table that slides into the tunnel. The magnetic field of atomic particles in some cells. When radio waves are emitted against these connective particles, it produces a different signal according to the type of tissue. Your doctor can use the images produced by the signals to see if an aneurysm is present.

Check regularly for people at risk for abdominal aortic aneurysms. Because aortic aneurysms often cause no symptoms, anyone age 60 and older who has risk factors for developing an aortic aneurysm should consider regular screening for this condition. Men aged 65-75 years who are former smokers should have a one-time screening for abdominal aortic aneurysms using abdominal ultrasound. Men of age 60 and older with a family history of abdominal aortic aneurysms should also consider testing.

The problem that causes aneurysms to occur in the chest (thoracic aortic aneurysm) can run in families. Because of this, your doctor may recommend tests to check your thoracic aorta if there are family factors, such as a brother, son, or daughter, Marfan syndrome, or heart problems. Others can cause a thoracic aortic aneurysm. Additional tests to check for thoracic aortic aneurysms include:

Image. Your doctor may recommend an echocardiogram or imaging test to check for Marfan syndrome or other conditions of the thoracic aorta. If your doctor finds an enlarged aorta or an aneurysm, imaging tests may be needed within six months to make sure the aorta is not growing larger.

Genetic testing. One of the causes of thoracic aortic aneurysms, Marfan syndrome is an inherited one. Currently, there is no single genetic test that can definitively indicate a diagnosis of Marfan syndrome. However, genetic testing can aid in the diagnosis of Marfan syndrome, especially if there are no symptoms. Alternatively, genetic testing and genetic counseling may be considered before starting a family, to see the chance that Marfan syndrome is passed on to children in the future.

Treatments and drugs

The goal of treatment is to prevent the aneurysm from expanding. In general, the treatment options are to watch and wait or have surgery. The decision depends on the size of the aortic aneurysm and how fast it grows.

Here are general guidelines for managing abdominal aortic aneurysms

Small aneurysm. If the abdominal aorta is small, about 4 cm in diameter or smaller, and asymptomatic, your doctor may suggest continued monitoring rather than surgery. In general, surgery is not necessary for small aneurysms because the risk of surgery outweighs the risk of rupture.

If this method is chosen, doctors will monitor the aneurysm with periodic ultrasounds, usually every 6 to 12 months, and encourage immediate reporting of abdominal or back pain begins, a potential sign of peel off or break.

Moderate aneurysm. Measures for moderate aneurysms, between 4 and 5.5 cm, the risks of surgery versus waiting and watching are unknown. It will be necessary to discuss the benefits and risks of waiting versus surgery and make a decision with your doctor.

An aneurysm that is large or rapidly growing. If you have an aneurysm that is large 5.5 cm or is growing rapidly more than 0.5 cm over six months, is bleeding, or is painful, surgery may be needed. Surgery to repair an aortic aneurysm involves removing the damaged part of the aorta and replacing it with a synthetic tube. This procedure requires open abdominal or thoracic surgery and will take several months to fully recover.

There may also be a less invasive procedure called endovascular (endovascular) repair to repair the aneurysm. Doctors attach a synthetic tube attached to the end of a catheter that is passed through an artery in your leg and threaded up the wall of the aorta. A needle-covered mesh tube graft provides support, at the site of the aneurysm, and secures it with hooks or stitches. Grafting contributes to further strengthening, avoiding weakening of the aorta to avoid rupture of this artery.

Recovery time for people with angiography is shorter than for those with open thoracotomy or abdominal surgery, about one or two weeks compared to six weeks with open surgery. Research shows that people who have had endovascular surgery also have fewer deaths and other complications from aneurysms.

Treatment of thoracic aortic aneurysm

If a thoracic aortic aneurysm is present, surgery is usually recommended. If the aneurysm is 5.5 cm or larger. If you have Marfan syndrome or a family history of aortic surgery, your doctor may recommend surgery for a smaller aneurysm.

For people with Marfan syndrome, beta-blockers are indicated to slow the growth of thoracic aortic aneurysms.

Although it is possible to repair a ruptured aortic aneurysm with emergency surgery, the risks are much higher and there is little chance of survival. Many people with ruptured aortic aneurysms die before reaching the hospital.

Recommendations for surgical treatment of a thoracic aortic aneurysm depend on whether the condition is present, such as Marfan syndrome, and the location of the aneurysm.

Prevention

There is no medication that can stop an aortic aneurysm. Researchers think that statins and some antibiotics might slow the growth of small aortic aneurysms. There is also some evidence that angiotensin-receptor blockers - losartan may prevent aneurysm formation.

Now, the best way to prevent aortic aneurysms is to keep the blood vessels as healthy as possible. That means the following steps:

Keep blood pressure under control.

No smoking.

Do exercise regularly.

Reduce cholesterol and fat in the diet.

It is especially important to quit smoking because smoking or chewing tobacco can increase your chances of developing an aneurysm.

If you have certain risk factors for an aortic aneurysm, talk to your doctor. If at risk, your doctor may recommend additional measures, including medications to lower blood pressure and relieve stress on weakened arteries. You may also consider having an ultrasound test every few years.