Description, Causes and Risk Factors:
An aortic aneurysm is an abnormal bulge in the wall of the aorta, the body's largest artery (the blood vessel that carries oxygen-rich blood). Roughly the diameter of a garden hose, this artery extends from the heart down through the chest and abdominal region, where it divides into a blood vessel that supplies each leg. Although an aneurysm can develop anywhere along your aorta, most occur in the section running through your abdomen (abdominal aneurysms). The rest occur in the section that runs through your chest (thoracic aneurysms).
The weakened artery wall may stretch as blood is pumped through it from the heart. The bulge or ballooning may be symmetrical (fusiform). Occasionally an aneurysm may occur because of a localized weakness of the artery wall (saccular). Enlargement of the aorta may be only mild in degree and termed "ectasia." In general, if the diameter of the aneurysm is more than 1.5 times the size of the normal aorta, it is called an aneurysm.
An aortic aneurysm is serious because - depending on its size - it may rupture, causing life-threatening internal bleeding. The risk of an aneurysm rupturing increases as the aneurysm gets larger. The risk of rupture also depends on the location of the aneurysm. Each year, approximately 30,000 Americans die of a ruptured aortic aneurysm. When detected in time, an aortic aneurysm can usually be repaired with surgery.
Aortic aneurysms are most often caused by damage to the artery's wall due to atherosclerosis, commonly known as hardening of the arteries. Atherosclerosis is caused by a buildup of cholesterol and other fatty deposits in the arteries and hypertension (high blood pressure).
Other causes of aortic aneurysms may include:
Weakening of the artery wall from smoking or high blood pressure.
Dissection or tearing of the artery wall.
Trauma (usually falls or motor vehicle accidents).
Sometimes the cause of an aneurysm is not clear.
Aneurysms may be hereditary.
Congenital weakness of the artery wall (something you are born with).
Most aortic aneurysms have no symptoms.Symptoms may occur, however, due to the aneurysm pressing on nearby organs or tissue, or if the aneurysm leads to dissection. Symptoms of dissection include severe tearing pain in the chest or back, stroke, cold or numb extremities, or abdominal pain.
The first step in diagnosis aortic aneurysm may be an abnormal chest X-ray. Other tests that may be done to diagnose an aneurysm include:
Computerized tomography (CT).
Magnetic resonance imaging (MRI).
Treatment for an aortic aneurysms depends on its size and location and your general health. If the aneurysm is small and you have no symptoms, your physician may suggest a "watch-and-wait" approach with regularly scheduled images of the aneurysm to check the size. However, if your aneurysm is large enough, or if the aneurysm is growing more than 1 centimeter (cm) per year, surgery may be your best option. Your healthcare provider will work with you to evaluate the risks of rupture and the risks of surgery.
Surgical options include:
Open abdominal or open chest surgery: The accepted standard treatment for aortic aneurysms once it meets the indications for surgery is replacement of that portion of the aorta with an artificial graft. Typically a graft is made from Dacron TM, a material that will not wear out. The graft is sewn in place with a permanent suture material.
The operation, including the incision that is made, depends on the location of the aneurysm. If the aneurysm is close to the aortic valve, an incision in the front of the chest such as a median sternotomy may be used. If the aneurysm is close to the valve, the aortic valve may have to be repaired or replaced. Surgery on the aortic arch is usually done from the front as well. If the aneurysm involves the descending thoracic aorta, which lies in the left chest, or the thoracic abdominal aorta, an incision on the left side of the chest will likely be required. If the aneurysm is confined to the abdomen, then an incision either in the abdomen, or on the side or flank may be used.
Endovascular surgery: In endovascular surgery, a synthetic graft (stent-graft consisting of a polyester tube inside a metal cylinder) is attached to the end of a thin tube (catheter) that is inserted into the bloodstream, usually through an artery in the leg. Watching the progress of the catheter on an X-ray monitor, the surgeon threads the stent-graft to the weak part of the aorta where the aneurysm is located.
Once in place, the graft is expanded. The stent-graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. The metal frame is expanded like a spring to hold tightly against the wall of the aorta, cutting off the blood supply to the aneurysm. The blood now flows through the stent-graft, avoiding the aneurysm. The aneurysm typically shrinks over time.
Aortic dissection. Aortic dissections may involve the ascending aorta alone, the descending thoracic and abdominal aorta alone, or the entire aorta. There is a risk of death depends on the extent of the dissection. It is highest for those aneurysms involving the ascending aorta. For that reason, most of these aneurysms are treated surgically as an emergency. Dissections of the descending thoracic aorta can often be treated with blood pressure control. The medical treatment of aortic dissection includes aggressive control of blood pressure and heart rate while the aorta heals. The risk of death with medical treatment of descending thoracic aortic dissection is about 10 percent. If surgery is required, however, the risk is higher at about 30 percent. Every effort is therefore made to treat these patients with medication.
Once the acute dissection has healed, adequate control of blood pressure may eliminate the need for surgery. Lifelong monitoring of diameter of the aorta is required because a previously dissected descending thoracic aorta may enlarge and rupture.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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