An aortic aneurysm is a bulge in the aorta , the main artery that runs from the heart to supply blood to the rest of the body. The most common location for an aortic aneurysm is the abdominal cavity. Aortic aneurysms can rupture and cause catastrophic blood loss and death.
If you receive immediate medical attention, emergency surgery can save your life. Aortic aneurysm diagnosed before the rupture can also be corrected with surgery with a good prognosis.
Symptoms of aortic aneurysm
An aortic aneurysm can cause symptoms that get worse and worse before the rupture. Often when the aortic aneurysm is enlarged, symptoms appear for the first time or get worse.
Symptoms may indicate an increased chance of rupture. The symptoms of a ruptured aortic aneurysm are relatively dramatic and progress rapidly within minutes.
In most cases, when an aneurysm ruptures, it occurs without any prior symptoms.
The aorta itself is a large blood vessel that exits the heart and carries oxygenated blood to the body. Many small arteries branch off from it. However, the two areas most prone to developing an aortic aneurysm are the abdominal aorta, which is located behind the abdomen, and the thoracic aorta, which is located behind the ribs.
Regardless of where the aneurysm occurs in the aorta, the pain is often described as "sharp, tearing pain."
Abdominal aortic aneurysm
The abdominal aorta is the most common area of aortic aneurysm, and this type of aneurysm is often called an AAA (abdominal aortic aneurysm). Symptoms can be subtle (or no symptoms before the tear) and can include:
- Back pain in the middle and lower back.
- Abdominal pain and discomfort
- Palpitation sensation in the abdomen.
Thoracic aortic aneurysm
A thoracic aortic aneurysm is a portion of the aorta that has recently exited the heart and is located in the chest. As with AAA, symptoms can be subtle (or they can be asymptomatic until ruptured) and include:
- Chest pain
- Back pain
Rupture of aortic aneurysm
When an aortic aneurysm ruptures, symptoms can progress rapidly. The most common symptoms of a ruptured aortic aneurysm are not necessarily similar to those of an unruptured aortic aneurysm, although pain may occur in the area of the aneurysm. Symptoms include:
- Dizziness, dizziness, and blurred vision.
- Severe weakness
- Severe pain in the chest, abdomen, or back.
- Loss of consciousness
Aortic aneurysm that affects other organs.
Blood clots can form when an aortic aneurysm occurs. If these blood clots break loose and travel to other parts of the body, they can cause organ damage, such as stroke , kidney failure, or heart attack . Symptoms vary and can include chest pain, vision loss, and blood in the urine.
An aortic aneurysm can develop when the walls of the aorta weaken. This can happen over time as a result of diseases and conditions that tend to affect all the blood vessels in the body, not just the aorta.
Weakness in the aorta causes swelling, leading to a predisposition for blood to break down or clot. The physical pressure of an aneurysm on nearby organs can cause some notable symptoms, while blood loss from a ruptured aneurysm causes more serious and life-threatening consequences.
Main risk factors
- Smoking is by far the main risk factor for aortic aneurysm . Smokers have five times more cases of aortic aneurysm than non-smokers .
- Aging (aortic aneurysms are rare in people younger than 60 years old).
- Male gender (aortic aneurysms are much more common in men than in women ) .
- Prolonged high blood pressure (or hypertension ), especially if left untreated, can increase the risk of aneurysm formation.
- Hardening of the arteries, or atherosclerosis that results from high cholesterol and hypertension, predisposes to aortic aneurysm, making the artery walls uneven and prone to weakening.
- A family history of aortic aneurysm is a major risk factor .
- Certain genetic diseases can increase the risk of aortic aneurysm due to the weakness of the blood vessels caused by these conditions. Marfan syndrome, Ehlers-Danlos syndrome, Takayasu arteritis, bicuspid aortic valve, Lois-Deitz syndrome, familial thoracic aortic aneurysms, and polycystic kidney disease increase the risk of aortic aneurysms.
- Trauma to the abdomen or chest can cause an aortic aneurysm to develop or rupture.
Risk factors for breakage
It is difficult to predict whether an aortic aneurysm will rupture. Worsening symptoms, a large or increasing size of the aneurysm, and signs of slow bleeding on images indicate a greater chance of rupture. Sudden drops in blood pressure or serious infections can also increase the chance of an aortic aneurysm rupturing.
The initial symptoms of an aortic aneurysm are often due to a rupture, which can be fatal. If you have an aortic aneurysm, your outlook will be much better if the aneurysm is diagnosed before it causes any symptoms. These are the diagnostic methods:
- Screening tests: Most previously ruptured aortic aneurysms are diagnosed when people suspected of being at high risk undergo specific screening tests, even if there are no symptoms or signs on physical exam. A US Preventive Services Task Force has developed guidelines for the detection of aortic aneurysms based on age, sex, and smoking.
- Physical exam: In about 33 percent of people with AAA, a pulsating mass can be found, which is a large, throbbing area deep in the abdomen. Because a blood vessel is even harder to find if you have a chest aneurysm, identification on physical exam is much lower with a chest aneurysm.
- Chest X-ray: Generally, a chest X-ray is not the test that your healthcare provider would order if you are at risk for an aortic aneurysm. However, many aneurysms are first detected with conventional chest x-rays, which may have been prescribed for a reason other than the detection of aortic aneurysms.
- Ultrasound examination : Ultrasound is a type of examination that can detect abnormalities in the movement of fluids and the anatomical structure of the body. Ultrasound examinations are considered particularly sensitive in diagnosing aortic aneurysms. It is a safe and relatively rapid diagnostic test that can also be useful in emergency situations.
- CT: Another imaging test, CT, can detect changes in the structure of the aorta and can be helpful in planning surgery.
- MRI: MRI, like CT scan, is an imaging test that can reveal anatomical abnormalities. Depending on the specifics of your aneurysm, an MRI or CT scan may be chosen to assess the condition of the aorta.
If you've been told you have an aortic aneurysm, you and your healthcare provider will need to choose the best treatment . Two approaches to treating an aneurysm include surgery to prevent rupture or close monitoring over time. To a large extent, this decision will depend on the perceived likelihood of aneurysm rupture and the perceived risk of surgery.
The likelihood of a ruptured aortic aneurysm largely depends on two factors:
- Aneurysm size
- Growth rate
The size of the aortic aneurysm is considered the best indicator of the risk of rupture and can be measured with ultrasound, CT, or MRI.
Aneurysms larger than 5.5 cm in diameter in men or larger than 5.2 cm in women are more likely to rupture than smaller aneurysms .
If these diameter thresholds have been reached, the risk of rupture is greater than 40 percent within five years, and surgery is often recommended. Below these thresholds, the risk of rupture may be closer to the risk of complications after surgery, so surgery may not be recommended.
Repair of the aneurysm requires surgery. There are several methods of surgical repair, including the so-called open repair and another approach, endovascular repair. Your surgeon will plan your procedure to give you the best chance for an effective and safe recovery with the minimum of complications.
Many people with aortic aneurysms have other cardiovascular diseases due to age and other risk factors, so the risks associated with surgery are often not trivial. In general, the risk of death from a surgical procedure is usually 1 to 8 percent or less, but the risk of surgery must be carefully assessed for each individual .
If surgery is not recommended, the size of the aneurysm should be evaluated periodically.
If the aneurysm increases in size by more than 0.5 cm per year, the risk of rupture is much higher. Surgery is generally recommended even if the overall size of the aneurysm is still less than 5.0 or 5.5 cm.
Rupture of aortic aneurysm
A ruptured aortic aneurysm is a surgical emergency. If this happens to you or your loved one, immediate medical stabilization and surgery are needed. In addition to repairing the aneurysm, excessive blood loss and exposure to other organs must also be controlled.
Aortic aneurysm is more likely if you have certain risk factors. Some risk factors, such as age and genetic predisposition, cannot be controlled. However, other risk factors can be modified or controlled, greatly reducing your chances of developing an aortic aneurysm .
Here are some of the steps you can take to reduce your risk:
- Don't smoke: Smoking is a major risk factor for all vascular diseases, including aortic aneurysms. The only effective way to reduce the harm caused by smoking is to quit smoking.
- Control of blood pressure: High blood pressure is a major cause of vascular disease, and maintaining normal blood pressure through diet, stress management, or medication reduces the chances of developing an aortic aneurysm.
- Control Your Cholesterol Levels – High cholesterol levels lead to atherosclerosis, which means hardening of the arteries. Atherosclerosis is one of the main causes of aortic aneurysm. There are several ways to lower high cholesterol levels. Certain medications can lower cholesterol levels, and a healthy diet high in fiber and low in unhealthy fats can also lower cholesterol in some people.
- Get regular medical care – Regular visits to the doctor are important. Your healthcare provider may discover that you may be at risk for an aortic aneurysm and may need a screening test. Also, if you visit your doctor regularly, problems that can increase your risk for aortic aneurysm, such as high blood pressure and high cholesterol levels, can be caught and treated early.
A ruptured aortic aneurysm is a serious life event that can lead to death. Aortic aneurysms often do not cause symptoms, making screening tests an important aspect of maintaining health, especially if you have risk factors such as smoking, old age, hypertension, and atherosclerosis.
If you have an aortic aneurysm, the decision about whether you need treatment and the details of the procedure itself require a high-level consultation with a vascular surgeon. The operation is considered a serious procedure. However, after surgery, most people do well with treatment and do not have a ruptured aortic aneurysm.
If you or a loved one is recovering from a ruptured aortic aneurysm, that recovery will take time, and a ruptured aortic aneurysm can have long-term consequences.