What is an aortic aneurysm?

What is an aortic aneurysm?

Aorta caries oxygenated blood from heart to all other organs. Aneurysmal disease is the most common manifestation of the diseases involving aorta. By definition, aneurysm is an increase in diameter by 1.5 times its expected diameter. Aneurysm can develop in any segment of the aorta, but most commonly affects abdominal aorta.

Signs and symptoms

Most intact aortic aneurysms do not produce symptoms. As they enlarge, symptoms such as abdominal pain and back pain may develop. Untreated, aneurysms tend to become progressively larger and can present with life threatening complications.

Aneurysms can be found on physical examination. Medical imaging is necessary to confirm the diagnosis and to determine the anatomic extent of the aneurysm.

Complications of aneurysms

Aortic aneurysm weakens the wall of the aorta and finally leads to aortic rupture. In rupture, massive internal bleeding happens, and, unless treated immediately, shock and death can occur. The other fatal complication is dissection of the aorta. In dissection, the layers of the wall of the aorta are split. This can result in mal-perfusion to the brain or visceral organs or eventual rupture. In both the situations emergency intervention is warranted.

Risk factors for aneurysms

Primarily, an aortic aneurysm is caused by one of the two factors: Either an intrinsic abnormality in the wall of aorta (aortopathy), or the aging process (atherosclerosis). Other less common causes included trauma or infection. Common risk factors include Hypertension, Hypercholesterolemia, and Tobacco. 

Vulnerable population

Persons with intrinsic abnormality of aortic wall (aortopathy) like Marfan Syndrome and Bicuspid aortic valve are at increased risk of developing an aneurysm. Similarly, patients with Hypertension, Hypercholesterolemia, and Tobacco use are at increased risk.

Treatment options

Depending upon the location, morphology, and associated medical conditions, two treatment options are available. These are open surgery and endovascular. In open surgery, the involved dilated part is exposed and substituted with synthetic graft (Dacron or Gore-Tex).

Can Aortic Aneurysm be treated without surgery?

Endovascular therapy is the recent development in treatment of aortic aneurysms. Some of the aneurysms can be treated by means of endovascular therapy. In endovascular therapy, a special stent graft made of nitinol and covered with polyester film is inserted in the aneurysm lumen. This stent graft excludes the aneurysm from the circulation. Endovascular treatment does not require big surgical procedure and recovery is very fast.

Timing of intervention (Surgery or Endovascular)

Decision to repair an aortic aneurysm is based on the balance between the risks of aneurysm rupture without treatment versus the risk of the treatment itself. Any aneurysm, which presents with symptoms and manifestations, needs intervention. In case of asymptomatic aneurysms, the timing for intervention depends upon the location and size   of aneurysm. Depending upon the location, an aneurysm requires intervention when its diameter exceeds 5.5 cm or 6 cm. However, if there is a high risk of rupture or dissection (aortopathy, family history of dissection, or rapid enlargement), threshold for intervention is lowered. Similarly, if the patient needs open heart procedure for valvular lesions, aortic intervention is performed at lower diameter. 

Prevention and precautions

Patients with diagnosed aortopathy should be in regular touch with their doctor and diagnostic imaging should be done at prescribed intervals. Strict control of blood pressure is mandatory. Tobacco in any form is prohibited. Patients with diagnosed aneurysms should avoid intense physical sports and isometric exercise. Walking and light aerobic exercises can be pursued.