Aortic Aneurysm

Aortic aneurysm is a potentially very dangerous condition. Its symptoms are mostly vague and its first manifestation may be the death of affected person.

Definition

An aneurysm is a bag-like dilation of an artery. It's not a rule but this condition usually tends to have weakened wall with increased risk of rupture due to blood pressure. When an aneurysm sac emerges, it constantly (but slowly) grows. It will never stop and the bigger it is the more risk of a rupture threatens. Aortic aneurysm is a bulge of the largest artery in our body. The aorta comes from the heart and runs through the chest and diaphragm into the abdomen and pelvis where it branches into two iliac arteries. During its way through our body it gives rise to all important arteries supplying upper limbs, head, neck and internal organs with blood, nutrients and oxygen. There is a very high pressure in aorta but on the other hand its wall is rigid and durable.

Causes

Aortic aneurysms are typically located in its abdominal part. More factors contribute to their occurrence. There are factors affecting the vascular wall such as the process of atherosclerosis, untreated high blood pressure and older age. Joint effect of these risk factors stays behind the majority of aortic aneurysm formations.

 

In thoracic part of aorta an aneurysm is less common and it is not so typically caused by atherosclerosis. Historically a thoracic aortic aneurysm was a complication of late stages of untreated syphilis. Syphilis in its third stage damages aortic wall very badly, the wall weakens and blood pressure creates an aneurysm sac. It is however unbelievably rare to diagnose a third syphilitic stadium in developed countries.

 

Note: There is also a term named dissecting aortic aneurysm. It is an incorrect description of a condition called aortic dissection which typically occurs by so called Marfan syndrome.

 

Aortic aneurysm
This picture shows the expansion of the abdominal aorta located near the renal arteries

 

Symptoms

Growing aneurysm usually has no typical symptoms. Large aneurysms can be felt as a pulsating mass in the abdomen. Clear manifestations of the aneurysm emerge when it bursts. In a typical case there is a sharp abdominal pain with signs of loss of large amounts of blood that pours into the abdominal cavity. A typical shock condition starts. Affected person has a rapid pulse with palpitations, rapid breathing, low blood pressure and pale and cold skin.

 

A serious blood loss leads to unconsciousness, hypoperfusion of brain, coma and death. When there is a person with previously not diagnosed aortic aneurysm a large aneurysm, he or she has virtually no chance to survive a sudden rupture.

 

Sometimes, however, a rupture of an aneurysm is preceded by only a small blood leak. Then bleeding stops for few days until the complete rupture comes. The small leak often presents as an episode of unspecific abdominal pain. If at this point a doctor diagnoses the aneurysm, there is a chance to save the affected person.

Diagnosis

A really big aneurysm can sometimes be diagnosed by abdominal palpation as a pulsating object, or by a stethoscope auscultation (a loud murmur). More reliably an aneurysm is detected, diagnosed and measured by an ultrasound or by abdominal computed tomography.

Prevention

As prevention it is suitable to avoid risk factors of atherosclerosis. You will find more information in relevant article.

Treatment

When there is only a small aortic aneurysm it can be only observed by repeated ultrasound examinations. As secondary prevention we prescribe antihypertensives and drugs slowing the process of atherosclerosis (drugs lowering levels of blood fats and cholesterol). The medication alone, however, does not solve the situation, and when the aneurysm grows too big it is important to solve it by an endovascular method or by open surgery. The endovascular intervention (i.e. without opening the abdominal cavity) is a procedure during which a stent is inserted in the aneurysm sac and bridges it. The second option is a surgical solution. There are more methods but in principle it is important to somehow remove the aneurysm sac and reconstruct and strengthen the artery wall.