• Aortic Aneurysm

    (AAA; Abdominal Aortic Aneurysm; Aneurysm, Abdominal Aortic; Thoracic Aortic Aneurysm; Aneurysm, Thoracic Aortic)

    Definition

    An aortic aneurysm is a weak, bulging area in the wall of the aorta. The bulging develops from a weakness or defect in the aortic wall. It tends to get bigger with time. The aorta is the body's largest artery. It carries blood from the heart and delivers it to the rest of the body. The aorta travels through the chest (thoracic aorta) and the abdomen (abdominal aorta).
    The greatest danger is that an aneurysm will rupture. This will cause heavy, uncontrollable bleeding (hemorrhage). Aortic aneurysms can also occur with aortic dissection. Dissection is defined as a small tear in the aortic wall. Blood from the aneurysm can leak through this tear and spread between the layers of the aortic wall. This leads to eventual rupture of the vessel.
    Aneurysms can develop anywhere. They are most common in the aorta, iliac artery, and femoral artery.
    Abdominal Aortic Aneurysm
    Abdominal Aortic Aneurysm
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Atherosclerosis is frequently associated with aneurysm. However, it is not thought that this disease alone causes the growth of an aneurysm. It is believed that other factors, such as high blood pressure or connective tissue disorders, must be present for an aneurysm to form.

    Risk Factors

    Risk factors that increase your chance of getting an aortic aneurysm include the following:

    Symptoms

    Many aneurysms do not have symptoms. They are detected during a routine physical exam or during x-ray evaluation for another disorder.
    Symptoms may occur when the aneurysm grows or disrupts the wall of the aorta. Symptoms depend on the size and location of the aneurysm and may include:
    • Pain in the abdomen or in the lower back
    • Boring, gnawing, or constant pain occurring over hours or days
    • Sudden onset of severe stabbing pain
    • Unusual sensation of pulsing in the abdomen
    • Cough, shortness of breath (thoracic aortic aneurysm)
    • Fainting
    • Hoarseness
    • Difficulty swallowing
    • Coughing up blood
    • Weight loss
    • Chest pain

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. Pain is the symptom that will most likely cause you to go to the doctor. Most aortic aneurysms are discovered during a routine physical exam.
    Your doctor may need pictures of your heart. This can be done with:

    Treatment

    Treatment includes surgery or stenting.

    Surgery

    Surgery to repair an aortic aneurysm is called aneurysmectomy. It involves removing the portion of the aorta that contains the aneurysm and replacing it with a mesh graft.
    With aneurysms of the thoracic aorta, the aortic valve may also be affected and need to be replaced or repaired. If the aneurysm involves important branches of the aorta, these vessels may either be repaired or bypassed.
    When deciding whether to operate, the doctor will consider:
    • Your age
    • Your general health
    • Your symptoms
    • The size of your aneurysm
    • Associated disease (eg, kidney failure, stroke)
    • If the aneurysm has ruptured or not
    • If you've had a recent heart attack

    Stenting

    Depending on where the aneurysm is located and how complex it is, stenting may be done. A stent-graft is a polyester tube covered by a tubular metal web. The stent-graft is inserted through a small incision in the upper thigh into the aorta. Using x-ray, it is guided through the aorta to the site of the aneurysm. With the stent-graft in place, blood flows through the stent-graft instead of into the aneurysm, eliminating the chance of rupture.

    Prevention

    There are no guidelines for preventing an aneurysm because the cause is not known. However, you can reduce some of your risk factors by following these recommendations:
    • Eat a healthful diet that is low in saturated fat and rich in whole grains, fruits, and vegetables.
    • Don't smoke. If you smoke, quit.
      • The US Preventive Services Task Force recommends that men aged 65-75 who have ever smoked be screened once for abdominal aortic aneurysm with ultrasound. This is a painless procedure that gives a picture of the abdomen using sound waves. Early detection of abdominal aortic aneurysm in this group has been shown to reduce mortality from this condition.
    • Maintain a healthy weight.
    • Begin a safe exercise program with the advice of your doctor.
    • Seek treatment for high blood pressure, syphilis, and other infections.
    • If you have Marfan syndrome, see your doctor regularly for monitoring and CT scans.

    RESOURCES

    American Heart Association http://www.heart.org/

    The National Heart, Lung and Blood Institute http://www.nhlbi.nih.gov/

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca/

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/

    References

    Abdominal aortic aneurysm (AAA). EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 26, 2012. Accessed November 6, 2012.

    Braunwald E. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, PA: WB Saunders Company; 2001.

    Sabiston DC, Townsend CM. Sabiston Textbook of Surgery. 16th ed. Philadelphia, PA: WB Saunders Company; 2001.

    Screening for abdominal aortic aneurysm: recommendation statement. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm. Published February 2005. Accessed November 6, 2012.

    Thoracic aortic aneurysm (AAA). EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 2, 2012. Accessed November 6, 2012.

    7/21/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Thompson SG, Ashton HA, Gao L, Scott RA, Multicentre Aneurysm Screening Study Group. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ. 2009;338:b2307.

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