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What is an aortic aneurysm?


Eric Cohen, M.D.

An aortic aneurysm is a weakened and bulging area in the aorta, the major blood vessel that feeds blood to the body. The aorta, about the thickness of a garden hose, runs from your heart through the center of the chest and abdomen. Because the aorta is the body's main supplier of blood, a ruptured aortic aneurysm can cause life-threatening bleeding.

Most small and slow-growing aortic aneurysms don't rupture; but large, fast-growing aortic aneurysms may. Depending on the size and rate at which the aortic aneurysm is growing, treatment may vary from watchful waiting to emergency surgery.

Symptoms

Aortic aneurysms often increase in size and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Others expand at a faster rate, which increases the risk of rupture. How quickly an aortic aneurysm may grow is difficult to predict. As an aortic aneurysm grows, some people may notice:

• A pulsating feeling near the navel, if the aneurysm occurs in the abdomen
• Tenderness or pain in the abdomen or chest
• Back pain

Aneurysms can develop anywhere along the aorta, but most occur in the abdomen and are called abdominal aortic aneurysms. Aneurysms that occur in the part of the aorta that's higher up in your chest are called thoracic aortic aneurysms.

An aortic aneurysm is different from a condition called aortic dissection. Aortic dissection often occurs in the same place many aneurysms occur. In aortic dissection, a tear occurs in the wall of the aorta. This causes bleeding into and along the aortic wall and, in some cases, completely outside the aorta (rupture). Aortic dissection is a life-threatening emergency.

Risk factors

Aortic aneurysm risk factors include:

• Age: Abdominal aortic aneurysms occur most often in people age 60 and older.
• Tobacco use: Tobacco use is a strong risk factor for the development of an aortic aneurysm. The longer you've smoked or chewed tobacco, the greater your risk.
• High blood pressure: Increased blood pressure damages the blood vessels in the body, raising your chances of developing an aneurysm.
• Atherosclerosis: Atherosclerosis, the buildup of fat and other substances that can damage the lining of a blood vessel, increases your risk of an aneurysm.
• Being male: Men develop aortic aneurysms five to 10 times more often than women do. However, women with aortic aneurysms have a higher risk of rupture than do men.
• Race: Aortic aneurysms occur more commonly in whites than in people of other races.
• Family history: People who have a family history of aortic aneurysm are at increased risk of having one. People who have a family history of aneurysms tend to develop aneurysms at a younger age and are at higher risk of rupture.

Diagnosis

Most abdominal aortic aneurysms are found during an examination for another reason. For example, during a routine exam, your physician may feel a pulsating bulge in your abdomen. Aortic aneurysms are often found during routine medical tests, such as a chest X-ray or ultrasound of the heart or abdomen, sometimes ordered for a different reason. If your physician suspects that you have an aneurysm, specialized tests can confirm it. These tests might include an ultrasound, CT scan or MRI.
Because aortic aneurysms often don't cause symptoms, anyone age 60 and older who has risk factors for developing an aortic aneurysm should consider regular screening for the condition. Men ages 65 to 75 who have ever smoked should have a one-time screening for abdominal aortic aneurysm using abdominal ultrasound. Men age 60 and older with a family history of abdominal aortic aneurysm should also consider screening.

Surgical Repair

The goal of treatment is to prevent your aneurysm from rupturing. Generally, your treatment options are to watch and wait or to have surgery. Your decision depends on the size of the aortic aneurysm and how fast it's growing.

• Open Surgery: When surgery is required to repair an aortic aneurysm, the surgeon removes the damaged section of the aorta and replaces it with a synthetic tube (graft), which is sewn into place. This procedure requires open-abdominal or open-chest surgery, and it make take several months to fully recover.

• Endovascular surgery: During this less-invasive procedure, physicians attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in the leg that threaded up into the aorta. Recovery time for people who have endovascular surgery is shorter than for people who have open-chest or abdominal surgery - about one or two weeks compared with six weeks with open surgery. Research has shown that people who have endovascular surgery also have lower rates of death and complications due to their aneurysms.

Prevention

There are no medications to prevent an aortic aneurysm. Researchers think that statin medications and some antibiotics can slow the growth of small aortic aneurysms. The best approach to prevent an aortic aneurysm is to keep blood vessels as healthy as possible. That means taking these steps:

• Keep your blood pressure under control.
• Don't smoke.
• Get regular exercise.
• Reduce cholesterol and fat in your diet.

It's especially important to quit using tobacco because smoking or chewing tobacco can increase the chances your aneurysm will grow. If you have some risk factors for aortic aneurysm, talk to your physician. If you are at risk, your physician may recommend additional measures including medications to lower your blood pressure and relieve stress on weakened arteries. You also may want to consider ultrasound screenings every few years.

Dr. Eric Cohen, interventional cardiologist, is the medical director of Peripheral Vascular Intervention at the Heart & Vascular Center of Northern Arizona. Dr. Cohen specializes in vascular care and the treatment of peripheral arterial disease and limb salvage.

The Heart & Vascular Center of Northern Arizona (HVCNA) is a partnership between Flagstaff Medical Center and Verde Valley Medical Center. It combines physician office practices with extensive hospital-based services including diagnostic and interventional cardiology procedures and open heart surgery. HVCNA offices are located in Flagstaff, Cottonwood, Camp Verde, Sedona and Winslow.

 For more information on the Heart & Vascular Center of Northern Arizona, visit NAHeartCare.com. To schedule an appointment with Dr. Cohen or one of the world-class physicians at the Heart & Vascular Center, call 877 928-WELL.



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