Aortic Aneurysm

Aortic Aneurysm Overview

Aortic aneurysm describes an abnormal bulge in the wall of the aorta, the body’s largest artery. About the diameter of a garden hose, the aorta carries oxygen-rich blood from the heart and down through the chest and abdominal regions before dividing into the vessels that supply blood for the legs. Although aneurysms, which can bulge like an overinflated inner tube, can develop anywhere on the aorta, they most often occur in the abdomen abdominal aneurysms or in the chest cavity thoracic aneurysms. These can happen if the aortal walls become weakened through high blood pressure or the build up of fatty acids called plaque, a condition called atherosclerosis that is also a leading cause of heart attacks. Aging, diabetes and inherited diseases such as Marfan’s syndrome and Ehlers-Danlos syndrome may also contribute to the development of aneurysms.

Aneurysms are dangerous because they may rupture, bleeding within the abdominal or chest cavity. In addition to severe pain and bleeding, this often leads to death within minutes or hours.

Symptoms

Aneurysms are often asymptomatic until they are large or rupture. Often, they are found incidentally on a chest X-ray or computerized tomography (CT) scan during evaluations for lung disease or heart conditions. Symptoms may occur if the aneurysm presses against nearby organs or tissues. Chest pain and back pain are the two most common symptoms of large aneurysms, but other symptoms might include:

A pulsating bulge or a strong pulse in the abdomen
Cold or numbness in the extremities
Nausea and vomiting

In more severe cases, particularly when blood clots form and break off or if the aorta splits (aortic dissection), the symptoms may also include weakness, shortness of breath, rapid heartbeat, stroke and loss of consciousness.

Risk Factors

Patients who have a history of heart problems, smoking, weight issues or inactive lifestyles are at risk for aortic aneurysm. Aneurysms are four times more common in men than in woman. Wellstar especially recommends screening tests of aneurysms for men who are:

Ages 65 to 75 and have ever smoked
At least 60 years of age and have a first-degree relative (for example, a father or brother) who has had an aneurysm

Aortic Aneurysm Prevention

Aortic aneurysms are most often caused by damage to the artery walls due to atherosclerosis, or the hardening of the arteries. Atherosclerosis is caused by a buildup of cholesterol and other fatty deposits and also by hypertension (high blood pressure). Other causes include a congenital or genetic propensity for weakness of the arterial walls. The first step in prevention involves living a healthy lifestyle.

Reduce Your Risk of Aortic Aneurysms

You can lower your risk of developing an aortic aneurysm through several methods:

Eat a low-fat, low-cholesterol diet
Get active. Take part every day in an activity that increases your heart rate to the rate recommended for your age and overall condition. Wellstar recommends at least 30 minutes of rigorous activity each day.
Don’t smoke
Control your blood pressure
Understand your personal and family medical history. Some aneurysms may be hereditary. Knowing if your family has a history of aneurysms can help you and your Wellstar physician determine if and when you should begin screening.

Tests and Screenings

Often, aortic aneurysms are discovered when you undergo a medical test or procedure for another reason. A Wellstar physician may suspect the presence of an aneurysm based upon a pulsating abdomen on physical examination or a blood pressure difference between the two arms.

Aneurysms can be detected through x-ray or by imaging techniques including:

Echocardiography
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT) scan

In an estimated 20% of the cases, the first sign or symptom of an aneurysm comes immediately after a rupture that can lead to death within minutes or hours because of blood loss.

Aortic Aneurysm Diagnosis

If screening tests or check-ups reveal abnormal results, your Wellstar physician will perform further evaluations regarding an aortic aneurysm.

Procedures

Echocardiography
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT) scan

Aortic Aneurysm Treatment

Treatment for an aortic aneurysm depends on your health, the severity of the symptoms, the size and location of the aneurysm and whether it continues to grow. If it is a small aneurysm, your Wellstar physician might suggest a monitoring period to see if it gets any larger, or treatment with high blood pressure medication, such as beta blockers. Such medication helps lower blood pressure and, thus, decreases stress on the aortic wall. In addition to regular monitoring, your doctor may suggest improving your health, diet and lifestyle.

If the aneurysm is large or fast growing, you would need surgery to fix it.

In every case, your Wellstar physician will help you weigh the benefits of each treatment approach and make an experienced recommendation for the best outcome. You can feel confident your decision will be based on both your input and the expertise and recommendations of your experienced physician.

Abdominal aortic aneurysms are unlikely to rupture if they develop slowly, are less than two inches in diameter and cause no symptoms. Close monitoring might be the proper treatment with a scanning strategy of every six to 12 months. If your Wellstar physician determines that surgery is the necessary route, there are two main options, which your vascular surgeon will discuss with you:

Open surgery had been the long accepted procedure in treating an abdominal aortic aneurysm. In this procedure, a long incision is made in the abdomen. The blood flow in the aorta is stopped temporarily with the aid of an outside pump, which circulates blood throughout the body to keep other vital organs and tissues perfused properly. The damaged section of the aorta is removed and replaced by an artificial graft, which is sewn in by permanent suture material.
Endovascular surgery has become a more common treatment to repair an aneurysm without major surgery. In this less invasive treatment, a synthetic stent-graft is attached to the end of a thin tube (catheter) that is inserted into the bloodstream through the groin or leg and then threaded to the location of the aneurysm. Once in place, the graft is expanded. The stent reinforces the weakened section of the aorta, taking pressure off of the aneurysm.

Both procedures have proven to be successful, but both have their downsides. The open surgery, because of its complexity and the size of the incision, poses risks to the heart, brain, lungs and kidneys and comes with a considerable recovery time. Endovascular surgery often has fewer complications, but because of the relative newness of the procedure, the long-term outcomes may not yet be quite as well known.

Taking Care of Thoracic Aortic Aneurysms

Because of their proximity to the heart, thoracic aortic aneurysms have a greater potential for harm to the heart or other organs than abdominal aortic aneurysms. Although stenting of these aneurysms is possible, surgical repair most often requires a full cardiopulmonary bypass by a Wellstar vascular or cardiothoracic surgeon.

Ongoing Care for Aortic Aneurysms

Wellstar offers world-class, community-based physicians based in state-of-the-art medical centers and hospitals with access to the latest technologies and other medical resources. They are dedicated to:

Help you create and maintain healthy lifestyles
Offer advice to prevent illness and injuries
Provide early and appropriate care of acute illness to prevent its progression

Vascular Institute

Staffed by interventional cardiologists, interventional radiologists and vascular surgeons, the Wellstar Vascular Institutes at Kennestone, Cobb and Douglas hospitals provide accurate diagnosis and efficient treatment for vascular disease. The Wellstar Vascular Institute offers patient-focused care, minimally invasive treatment options and concentrated expertise.