Aortic Aneurysm: Causes, Symptoms, Diagnosis, and Treatment

Aortic aneurysm is an abnormal bulge in the artery wall. This can happen because of high blood pressure in the arteries which pushes out the walls of the arteries, creating bulges or blood vessels to bulge like balloons.

What Is Aortic Aneurysm?

Aneurysms can form throughout the body’s blood vessel tissue, however, this most often occurs in the aorta. The aorta is the largest artery in the body. The aorta carries blood from the heart throughout the body.

Important to know, aortic aneurysm can occur in two main places, namely:

  • Abdominal aortic aneurysm (abdomen) occurs in the part of the aorta that passes through the middle to the stomach down.
  • Chest aortic (thoracic) aneurysm occurs in the aorta as it passes through the chest cavity. Compared to abdominal aortic aneurysms, this type of aorta is less common.

If the risk of aneurysm rupture is relatively small, it poses no threat. However, aneurysms will increase the risk for:

  • Atherosclerotic plaque formation at the site of the aneurysm. This causes the weakening of the artery walls
  • Blood clots can form in these areas and increase the chance of stroke
  • Aneurysm size increases, causing arterial walls to press against other organs.
  • Ruptured aneurysm. Because the walls of the arteries are thinning it can make it burst. Rupture of the aortic aneurysm is something that can be life threatening.

Causes of Aortic Aneurysm

Until now, the cause of aneurysm is not known with certainty. However, certain factors have been shown to increase risk.

The following are the causes of abdominal aortic aneurysms, including:

1. Smoking

Smoking seems to increase the risk of aneurysm. Smoking can damage the aorta and weaken the aortic wall.

2. Hardening of the arteries (atherosclerosis)

Atherosclerosis occurs when fat and other substances accumulate in the walls of blood vessels. This condition can also increase the risk of aneurysms.

3. High Blood Pressure

High blood pressure or hypertension can increase the risk because it can damage and weaken the aortic wall.

4. Vascular disease in the aorta

Aneurysms can be caused by diseases that cause blood vessels to become inflamed.

5. Trauma

Trauma, like having a car accident, can cause aneurysms.

6. Heredity

In some cases, abdominal aortic aneurysms can be passed down for generations.

Risk Factors

Some conditions that increase abdominal aortic aneurysm are:

  • Local injury to the arteries.
  • Congenital abnormalities such as Marfan syndrome or the presence of a bicuspid aortic valve at birth which causes weakening of the arterial wall
  • In rare cases, aortic aneurysm can also be caused by syphilis.
  • Male.
  • Obese or overweight.
  • Above 60 years old.
  • Have a history of heart disease.
  • Have high blood pressure, especially if you are between 35 and 60 years old.
  • Rarely physical activity.
  • Have experienced trauma to the abdomen or other damage to the midsection.

While the causes of thoracic aortic aneurysm are:

1. Problems with the Heart Aortic Valve

Sometimes people who have problems with the aortic valve have an increased risk. This is especially true for people born with a bicuspid aortic valve, meaning that the aortic valve has only two peak points.

2. Untreated infections

Although this is a rare cause of thoracic aortic aneurysm, you can develop this condition if you have an untreated infection such as syphilis or salmonella.

3. Plaque buildup in the arteries

The accumulation of fat and other substances that can damage the lining of blood vessels (atherosclerosis) increases the risk of aneurysm. This condition is more common in older people.

Symptoms of Aortic Aneurysm

Aneurysms often do not cause symptoms at all. However, if there are, symptoms include:

  • Pain in the chest, stomach, to the back.
  • Thoracic aneurysms can cause shortness of breath, hoarseness, coughing (due to pressure on the lungs and airways), and difficulty swallowing (pressure on the esophagus).
  • Rupture of aneurysm can cause loss of consciousness, stroke, shock, or heart attack.

When is the Right Time to See a Doctor?

Immediately see a doctor if you experience symptoms of aneurysms like the following:

  • Sudden pain in the stomach or back.
  • The pain spreads from the stomach or back to the pelvis, legs, or buttocks.
  • Excessive sweating.
  • Increased heart rate.
  • Loss of consciousness.

Some of the symptoms above are signs that the aneurysm is ruptured, this condition must be treated immediately because it can be life threatening.

Aortic Aneurysm Diagnosis

Aneurysm diagnosis is difficult because it often has no symptoms. A doctor may find it accidentally during another physical examination.

The following are common diagnoses of abdominal aortic aneurysms:

  • Abdominal Ultrasound

This test is most often used to diagnose abdominal aortic aneurysms. You will be asked to lie down and your doctor will move the transducer around the abdomen to send images to the screen.

  • CT scan

This test can provide clear imaging of the aortic condition and detect the size and shape of the aneurysm. A dye may be injected into a vein so that the condition of the arteries is more visible during imaging.

  • Magnetic Resonance Imaging (MRI)

MRI is an imaging test that can be used to diagnose aneurysms and determine their size and location. The doctor can inject a dye into the blood vessels to help the blood vessels be more visible.

Whereas a common diagnosis of thoracic aortic aneurysm is:

  • Chest X-ray

By looking at chest X-ray images, doctors can suspect that you have an aneurysm.

  • Echocardiogram

This technique is often used to filter out aneurysms caused by heredity. Echocardiograms use sound waves to directly see the condition of the heart and ascending aorta. In addition, this examination can also show how well the heart chamber and valves are working.

Complications of Aortic Aneurysm

In general, the greater the aneurysm and the faster it grows, the greater the risk of rupture. Signs and symptoms of aortic abdominal aortic rupture are:

  • Sudden, intense and persistent abdominal or back pain.
  • Low blood pressure.
  • Fast pulse.

This condition also puts you at risk of developing blood clots in the area. If a blood clot is released from the inner wall of the aneurysm and clogs blood vessels elsewhere in the body, it can cause pain or block blood flow to the legs, kidneys, or stomach organs.

While the complications of thoracic aortic aneurysm are:

  • Difficulty breathing.
  • Lost consciousness.
  • Trouble swallowing.
  • Weakness or paralysis on one side of the body, difficulty speaking, or other signs of stroke.

Aortic Aneurysm Treatment

Treatment goals — whether medical monitoring or surgery — aim to prevent aneurysm rupture. In addition, the treatment that can be done also depends on the size of the aneurysm and how fast it grows.

The following are abdominal aortic aneurysm treatments that can be done:

Operation

This procedure is generally done if the aneurysm has reached a size of 4.8 to 5.6 cm or if it is growing rapidly. In addition, this procedure is done if you have symptoms of stomach pain, have a leak, or appear pain.

Depending on several factors such as the location and size of the aneurysm, your age, and other health conditions, repair options might include:

  • Open stomach surgery

This procedure is carried out by removing a damaged part of the aorta and replacing it with a synthetic hose (graft). The recovery process for this procedure will likely take a month or more.

  • Endovascular repair

This procedure is done by attaching a synthetic graft to a thin tube (catheter) that is inserted through an artery in the leg and tied to the aorta. The hose which is covered by a metal support is placed at the site of the aneurysm, is extended and fastened in place. This method strengthens the weakened aorta to prevent aneurysm rupture.

After endovascular surgery, you will need routine imaging tests to ensure that the repair does not leak.

Meanwhile, if your thoracic aortic aneurysm is small, your doctor can recommend treatment, monitoring with imaging, and managing the condition. The following are some treatments that can be done, including:

  • Beta blockers

Beta blockers reduce blood pressure by slowing the heart rate. People with Marfan syndrome, this drug can reduce how quickly aortic widening. Examples of beta blockers include metoprolol, atenolol, and bisoprolol.

  • Angiotensin II receptor blockers

Your doctor may also prescribe these medicines if beta blockers are not enough to control blood pressure or you cannot take beta blockers.

These medicines are often recommended for people who have Marfan syndrome, even if they don’t have high blood pressure. Examples of angiotensin II receptor blockers include losartan, valsartan, and olmesartan.

  • Statins

These drugs can help lower cholesterol, help reduce blockages in the arteries, and reduce the risk of aneurysm complications. Examples of statins include atorvastatin, lovastatin, simvastatin, and others.

Prevention of Aortic Aneurysms

The following are some steps that can be taken to prevent or maintain aortic aneurysm from deteriorating, including:

  • Do not use tobacco. Stop smoking or chewing tobacco and avoid cigarette smoke.
  • Eat healthy food. Focus on foods such as fruits, vegetables, whole grains, poultry, fish and low-fat dairy products. Also avoid saturated fats, trans fats, and limit salt.
  • Keep your blood pressure and cholesterol under control. If the doctor has prescribed medicine, take it as directed.
  • Regular exercise. Try to get at least 150 minutes a week of moderate aerobic activity. If you are not used to being active, start slowly. Talk to your doctor about what type of exercise is right for you.

Source

  • Brindles Lee Macon and Elizabeth Boskey, PhD. 2017. Abdominal Aortic Aneurysm. (Accessed December 17, 2019)
  • Rahimi, Saum A, MD, FACS. Abdominal Aortic Aneurysm Clinical Presentation.clinical#b3. (Accessed December 17, 2019)

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