Aortic Aneurysms: cause, symptoms, diagnosis, and treatment

What is an aortic aneurysm?

Aortic aneurysms (AA) are balloon-like bulges that occur in the aorta, the main artery carrying oxygen-rich blood to your body. Certain genetic or medical conditions can damage or weaken the thick walls of the aorta. The force of blood pushing against the weakened or injured walls can cause an aneurysm. 

If not treated, aneurysms can burst or rupture and can be life threatening. 

How common is aortic aneurysm in the USA?

Aortic aneurysms or aortic dissections were the cause of 9,904 deaths in 2019, of which 59% were men. 

Who are at risk of getting AA?

The US Preventive Services Task Force recommends that men aged 65 to 75 years old who have high blood pressure and ever smoked should get an ultrasound screening for abdominal aortic aneurysms, even if they have no symptoms. (https://www.cdc.gov/heart-disease/about/aortic-aneurysm.html) 

What causes AA?

• Atherosclerosis.
• Inflammation of the arteries.
• Inherited conditions, especially those that affect connective tissue (such as Marfan syndrome and Ehlers-Danlos syndrome).
• Injury to an aorta.
• Infections such as syphilis. 

What are the types and symptoms of AA?

1. Thoracic aortic aneurysm: this type of aneurysm can happen in the chest and can present with:
   1. Sudden, sharp pain in the chest and upper back
   2. Shortness of breath 
   3.  Dizziness or light-headedness
   4. Trouble breathing or swallowing.
   5. Rapid heart rate or tachycardia
2. Abdominal aortic aneurysm: happens in the abdominal part of the aorta and may present with following symptoms: 
   1. Throbbing or deep pain in the back or side.
   2. Pain in the buttocks, groin, or legs. 
   3. Feeling full even after a small meal. (https://my.clevelandclinic.org/health/diseases/16742-aorta-aortic-aneurysm) 

How is AA diagnosed?

A thorough medical history and physical exam should precede the following tests:

• Abdominal ultrasound to check the size of aneurysm either to diagnose or for follow-up. 
• Computed tomography (CT) and magnetic resonance angiogram (MRA) are used if the doctor needs a more detailed view than an ultrasound provides. This is important when information is needed about the aneurysm's relation to the blood vessels of the kidney or other organs. Your doctor needs this information especially before surgery. CT is used to watch the growth of a thoracic aortic aneurysm.
• Transthoracic or transoesophageal echocardiogram is an ultrasound used to diagnose a thoracic AA. 
• An angiogram can help to determine the size of aneurysm, detect aortic dissections, blood clots or other blood vessel involvement. (https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/aortic-aneurysm/diagnosis.html) 

How is AA treated?

Smoking cessation, healthy balanced diet, stress management and physical activity are basic lifestyle changes that are highly recommended whether the treatment comprises of medication or surgery. 

MEDICINES

• Aspirin maybe recommended if there are other cardiovascular risks. Since it is a blood thinner, risk of bleeding increases. 
• Blood pressure control medicines such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) can also lower the risk of AA.
• Statins can help to lower high cholesterol levels, thus reducing the risk of AA.

SURGERY 

• Endovascular aneurysm repair is done by cardiac catheterization and is less invasive than open surgery. The surgeon makes a small cut, usually in the groin, then guides a stent graft — a tube covered with fabric — through your blood vessels up to the aorta. The stent graft then expands and attaches to the aortic walls. A seal forms between the stent graft and the vessel wall to prevent blood from entering the aortic aneurysm. (https://www.nhlbi.nih.gov/health/aortic-aneurysm/treatment) 

Under general anesthesia, the aneurysm is removed and a graft is sewn in its place. This graft is typically a tube made of leak-proof polyester. Recovery time for open surgical repair is about a month.