By Francis J. Caputo, MD
Assistant Professor of Surgery
Cooper Medical School of Rowan University
An aortic aneurysm is a bulge in the aorta that develops in areas where the aorta wall is weak. The aorta is the main blood vessel carrying oxygen-rich blood to other parts of the body. The pressure of the blood pumping through it causes the weakened section to bulge out like a balloon.
An aneurysm can develop in any section of the aorta, but the most common type is an Abdominal Aortic Aneurysm (AAA). It occurs in the part of the aorta that passes through the abdomen.
Thoracic Aortic Aneurysms occur in the part of the aorta located in the chest area. They may not produce symptoms until the aorta bursts, causing chest or back pain.
A Thoracic Aortic Dissection is a tear that causes a ballooning of the aortic wall which can then rupture. Symptoms include constant chest or upper back pain that may feel like a “tearing” pain.
Aneurysms can grow in size over time. As an aneurysm expands, it can start to cause symptoms. When an aneurysm gets too large, it can rupture and cause life-threatening bleeding or instant death without any prior warning.
A blood clot may also form in the aneurysm. Small pieces of a blood clot can break off and travel throughout the body. If a fragment of a clot gets stuck in the brain or a heart blood vessel, it can cause a stroke or a heart attack.
A frustrating fact is that most people with an abdominal aortic aneurysm do not have any symptoms at all. The aneurysm is usually discovered by X-ray during a routine exam for an unrelated health issue.
Many aortic aneurysms will grow slowly for years before they are large enough to cause symptoms. And even then, a large aneurysm may not cause any symptoms, thereby delaying a proper diagnosis.
When symptoms do occur, pain in the abdomen is most common. The pain may be occasional or constant. Some people describe a pulsing sensation in the abdomen which can be a warning sign of an AAA.
If an abdominal aortic aneurysm is suspected, your doctor may use ultrasound or CT scanning to investigate it. When an AAA is confirmed, a vascular specialist will use several imaging tests to gather more information regarding its size, shape and exact location in the abdomen. (CT scans and MRIs are typically used to diagnose thoracic aortic aneurysms.)
Per preventive screening guidelines from the Society for Vascular Surgery and the Society for Vascular Medicine and Biology, abdominal ultrasound screening is recommended for the following people:
- All men age 60 to 85
- All women age 60 to 85 who have cardiovascular risk factors
- All men and women age 50 and older with a family history of abdominal aortic aneurysm
Medicare now offers a one-time, no-cost abdominal ultrasound to qualifying seniors within the first 12 months of enrollment. Men or women who have smoked at least 100 cigarettes during their lifetime, as well as men and women with a family history of abdominal aortic aneurysm, also qualify for the Medicare screening.
Some of the same risk factors for a heart attack also increase the risk of abdominal aortic aneurysm, including:
- Plaque in the artery walls (atherosclerosis)
- High blood pressure
- Diabetes
- High cholesterol
- Smoking
- Family history of aortic aneurysm
Treatment of abdominal aortic aneurysms continues to evolve by offering patients more sophisticated solutions. The endovascular approach remains a preferred treatment for AAAs.
During an endovascular procedure, the surgeon inserts a stent-graft inside a catheter (a long, thin tube) and guides it to the site of the aneurysm. Once securely in place, the stent-graft creates a new passageway for blood flow without pushing on the aneurysm.
After an endovascular stent-graft is inserted, you must visit your doctor regularly to monitor its position with CT scanning.
For people who are not candidates for endovascular repair, open surgery is an option. During the procedure, a synthetic graft is stitched into place to connect it with the healthy aorta on either side of the diseased area. After surgery, the new synthetic section of the blood vessel functions like a normal, healthy aorta.
Again, your doctor will want to see you regularly to conduct a physical exam and run diagnostic tests. The doctor will use the information gathered from these visits to monitor the progress of your treatment.
If you have been diagnosed with an abdominal aortic aneurysm or have received treatment for an aneurysm, it’s important that you lead a heart-healthy lifestyle. It is up to you to take any prescribed medications, attend follow-up appointments and be an active member of your health care team.
You can help improve your health by:
- Quitting smoking
- Treating high cholesterol
- Managing high blood pressure and diabetes
- Exercising regularly
- Eating a heart-healthy diet
- Maintaining a healthy weight
- Reducing stress and anger
- Taking prescribed medications as directed
- Following up with your doctor for regular visits
The Before-and-After of a Patient With an AAA
Shown below, a before-and-after view of a patient’s large abdominal aortic aneurysm with a minimally invasive delivery system in place before deployment. The completed repair, on the right,shows complete exclusion of the aneurysm, greatly reducing the patient’s risk of rupture. This patient went home the following morning and back to work the following week.
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