The aorta is the largest blood vessel in the human body. It originates from the left ventricle of the heart and extends down to the abdomen, where it splits into two smaller arteries. Several arteries extend from the aorta to deliver blood to the various regions of the body.
But some medical problems weaken the artery walls, can result in a weak aortic wall that bulges outward. This is called “aortic aneurysm”. In the worst case, an aneurysm can burst, or rupture. This causes bleeding and often leads to death within minutes to hours.
Aneurysms can form in any section of the aorta, but they are most common in the abdomen below the kidneys (Infrarenal abdominal aortic aneurysm).
What causes aortic aneurysm?
Normally, the wall of the aorta is very elastic. It can stretch and then shrink back as needed to adapt to blood flow. But some medical problems, such as high blood pressure and atherosclerosis (hardening of the arteries), weaken the artery walls. These problems, along with the wear and tear that naturally occurs with aging, can result in a weak aortic wall that bulges outward.
Aortic aneurysm is more common in elderly men. It is found approximately 2 - 5% in men after 50 years of age and 5 - 10% in men after 65 years. It can be detected by an ultrasonography. The risk is increased in patients who have coronary artery disease or peripheral vessels disease. Also, a family history of aortic aneurysm and tobacco use are risk factors for the development of an aortic aneurysm. As noted, the risk factors include; 65 - 75 year old men, smoking, hypertension, a family history of aortic aneurysm.
What are the symptoms?
Aortic aneurysms are usually asymptomatic. Sometimes a doctor finds them during exams, ultrasonography, or x-ray done for other reasons. People who do have symptoms complain of abdominal, chest, or back pain. The pain may come and go or stay constant. If an aneurysm ruptures, a patient may feel sharp or sudden pain and has an internal bleeding. It often leads to death within minutes to hours.
An aortic aneurysm can also lead to other problems. Blood flow often slows in the bulging section of an aortic aneurysm, causing clots to form. If a blood clot breaks off, it might block aorta blood flow to other organs. At times, aortic aneurysm might cause pressure or local compression to adjacent organs.
How do you know if you have an aortic aneurysm?
As aortic aneurysms are usually asymptomatic, a doctor might find them during annual physical examination or screening test. The Canadian Society for Vascular Surgery & American Association for Vascular Surgery recommend an ultrasound screening in high risk group as below.
- Ages 65 to 75 and have ever smoked
- At least 60 years old and have a first-degree relative (for example, father or brother) who has had an aneurysm
Experts also recommend computed tomography (CT) screening test for people who have a first-degree relative who has had a thoracic aortic aneurysm.
How aortic aneurysm are treated?
In asymptomatic patients, treatment of an aortic aneurysm is based on the size of an aneurysm, how fast it is growing, and the risk of rupture. If an aneurysm is large and fast-growing, a surgical treatment is indicated.
In patients who have symptoms such as chest or abdominal pain or compression of adjacent organs, a surgery is recommended.
Small aneurysms rarely rupture and are usually treated with high blood pressure medicine. This helps lower blood pressure and stress on aortic wall. In patients who are at risk of coronary artery disease, a doctor may suggest the patient to exercise more, eat a healthy diet, and stop smoking. If the patient has high cholesterol, a doctor may prescribe medicine to help lower cholesterol.
Currently, there are two methods of aortic aneurysm repair, open repair and endovascular aneurysm repair. Endovascular aneurysm repair is increasingly popular. It is less invasive procedure with less mortality rate while also providing long term efficacy as open repair.