An aortic aneurysm is a dangerous condition where the aorta, the largest blood vessel in the body, develops a bulge or swelling that can potentially rupture. An aortic aneurysm is considered a medical emergency, so knowing the warning signs is critical for getting timely treatment and preventing a life-threatening rupture.
What is an aortic aneurysm?
The aorta is the main artery that carries blood from the heart to the rest of the body. It originates from the left ventricle of the heart and extends down through the chest and abdomen. An aortic aneurysm occurs when a weak spot in the aorta wall causes it to bulge or swell abnormally.
There are two main types of aortic aneurysms:
- Thoracic aortic aneurysms – occur in the section of the aorta running through the chest.
- Abdominal aortic aneurysms – occur in the section of the aorta running through the abdomen.
An aneurysm tends to weaken the aorta wall and may eventually rupture if left untreated. A ruptured aortic aneurysm causes life-threatening internal bleeding.
What causes an aortic aneurysm?
There are several factors that can contribute to the formation of an aortic aneurysm, including:
- Atherosclerosis – Hardening and plaque buildup in the arteries, which can damage and weaken the aorta wall.
- High blood pressure – Chronic high blood pressure increases pressure on the aorta and can cause bulging.
- Smoking – Chemicals from cigarette smoke damage the aorta wall and accelerate atherosclerosis.
- Infection – In rare cases, infections may infect and inflame the aorta wall.
- Inherited connective tissue disorders – Genetic conditions like Marfan syndrome and Ehlers-Danlos syndrome weaken blood vessels.
- Trauma – Major trauma, like from a car accident, can injure the aorta.
- Family history – Having close relatives with an aortic aneurysm increases your risk.
- Advanced age – The aorta weakens over time, increasing risk of aneurysms.
Men, especially those over age 65, have a higher risk of developing aortic aneurysms. When no specific cause is found, an aneurysm may be associated with the general aging and weakening of the aorta.
What are the warning signs and symptoms?
Many aortic aneurysms do not cause any symptoms initially and go unnoticed. Symptoms tend to appear once an aneurysm grows bigger or begins to leak or rupture. Warning signs to look out for include:
- Pulsing sensation in the abdomen – Feeling a throbbing or pulsating feeling near the navel or abdomen.
- Persistent abdominal or back pain – Pain that lasts for a prolonged time rather than coming and going.
- Sudden, intense abdominal or back pain – This sign demands immediate emergency care as it can indicate a leak or imminent rupture.
- Abdominal swelling or fullness – The swelling of the aneurysm may be noticeable.
- Low blood pressure – Ruptured aneurysms can cause blood pressure drops.
- Rapid heart rate – Heart speeds up to compensate for blood loss.
- Sweating and clamminess – Due to blood loss and lowered blood pressure.
- Fainting – Loss of consciousness from severely lowered blood pressure.
Symptoms specific to a thoracic aortic aneurysm may include:
- Coughing – An aneurysm pressing on the windpipe can trigger coughing spells.
- Hoarseness – Pressure on the larynx nerve can cause voice changes.
- Difficulty swallowing – Large aneurysms can obstruct food passing through the esophagus.
- Chest pain – Pain may indicate the aneurysm is leaking or about to burst.
How are aortic aneurysms detected?
In many cases, aortic aneurysms are found incidentally when tests are done to check for other medical issues. Some of the imaging tests used to diagnose aortic aneurysms include:
- Ultrasound – An abdominal ultrasound uses soundwaves to check for aneurysms in the abdominal aorta.
- CT scan – Provides detailed 3D images that precisely reveal aneurysms in the chest or abdomen.
- MRI – Magnetic resonance imaging provides clear views of the aorta and surrounding structures.
- Chest X-ray – Can detect thoracic aortic aneurysms appearing as widening of the mediastinum.
- Echocardiogram – An ultrasound of the heart may reveal a bulging aortic root.
Screening tests for abdominal aortic aneurysms are recommended for men 65-75 years old who have smoked because they are at higher risk. Once an aneurysm is detected, imaging tests are done periodically to monitor its size and growth rate.
What size aneurysm is considered dangerous?
The risk of rupture increases as an aneurysm enlarges in size. Recommended thresholds for surgery are:
- Abdominal aortic aneurysms larger than 5.5 cm (about 2.2 inches).
- Thoracic aortic aneurysms larger than 5.5 to 6 cm.
However, smaller aneurysms below these sizes can also sometimes rupture and leak. Factors like the rate of growth, symptoms, and medical history help determine the risk for smaller aneurysms.
Can aortic aneurysms be prevented?
There are measures you can take to reduce the chances of developing an aortic aneurysm:
- Quit smoking – Avoid tobacco as smoking is a major preventable risk factor for aneurysms.
- Control blood pressure – Keep blood pressure below 140/90 mm Hg through diet, exercise, and medication if needed.
- Lower cholesterol – Managing cholesterol and lipids can reduce atherosclerosis.
- Maintain a healthy weight – Obesity strains the cardiovascular system.
- Exercise regularly – Exercise conditions the heart and arteries.
- Eat healthy foods – A heart-healthy diet with fiber, lean protein, fruits and vegetables benefits heart health.
- Limit alcohol – Heavy alcohol use deteriorates artery health.
- Manage stress – Chronic stress takes a toll on cardiovascular health.
Getting screened and tested regularly can help detect aneurysms early when they are small. This allows monitoring and preventive treatment before rupture occurs.
How are aortic aneurysms treated?
The main treatments for aortic aneurysms are:
- Medications – Blood pressure medications like beta blockers reduce pressure on the aorta to prevent further swelling.
- Surgery – The damaged section of aorta is repaired or replaced with a graft.
- Stent graft – A tube with stents is placed through catheters to reinforce the aneurysm from inside.
Doctors determine the best treatment approach based on factors like the size, location, shape, and rate of growth of the aneurysm. Small, stable aneurysms may just be monitored, while large, rapidly growing ones require urgent surgery.
Open surgical repair
This invasive surgery involves opening up the chest or abdomen to access the aneurysm directly. The aneurysmal part of the aorta is replaced with a synthetic blood vessel graft. This is major surgery and requires a hospital stay of a week or more along with several months of recovery. Risks include bleeding, stroke, and death.
Endovascular stent graft
This minimally invasive procedure inserts a stent graft compressed inside a catheter that is threaded through the arteries to the aneurysm site. Once in position, the stent graft deploys and seals off the aneurysm. This reduces strain on the weak aorta wall and prevents rupture. Recovery time is much shorter than open surgery. Risks include graft movement or leaks.
| Open Surgery | Endovascular Stent Graft |
|---|---|
| Invasive procedure | Minimally invasive procedure |
| Long recovery time | Shorter recovery time |
| Higher complication risks | Lower risks generally |
| Replaces aneurysm with graft | Reinforces aneurysm internally with graft |
What is the outlook for an aortic aneurysm?
The outlook for an aortic aneurysm depends greatly on early detection. Small aneurysms that are detected early before causing symptoms have a favorable outlook with proactive monitoring and treatment. However, the mortality rate is very high for ruptured aortic aneurysms.
- About 15% of people with a ruptured abdominal aortic aneurysm survive long enough to make it to the hospital.
- Of those who make it to the hospital, about 50% survive surgery.
- Overall, only 7-10% of patients survive a ruptured abdominal aneurysm.
Greater awareness of the risks and warning signs allows patients and doctors to identify aneurysms before an emergency rupture occurs. Following up with screening and imaging tests as recommended is key for tracking aneurysm growth and determining the best treatment approach. With appropriate preventive care, careful monitoring, and proactive treatment, patients can benefit from good outcomes. However, the outlook remains poor if emergency surgery is needed for a rupture.
Conclusion
Aortic aneurysms are a potentially life-threatening vascular condition. Knowing the risk factors, signs and symptoms can help obtain screening if you are at higher risk. If you experience any warning signs, seek prompt medical evaluation as early detection and treatment are critical for preventing rupture. Work with your doctor to control risk factors like high blood pressure and atherosclerosis. Staying vigilant about monitoring known aneurysms allows preventive steps to be taken before catastrophe strikes. While aortic aneurysms are serious, the outlook greatly improves when they are caught early and managed proactively.
