Aortic Aneurysm, Symptoms, and Treatments

This type of aneurysm is also referred to as abdominal aortic aneurysm (AAA) or thoracic aortic aneurysm (TAA)

An aneurysm is a balloon-like bulge in an artery. Arteries are blood vessels that carry blood from your heart to your organs. Aortic aneurysms are aneurysms that occur in the aorta, the main artery carrying oxygen-rich blood to your body. This article focuses on two types of aneurysms that affect the aorta: abdominal and thoracic aortic aneurysms.

The aorta has thick walls that withstand normal blood pressure. However, certain medical problems, genetic conditions, and trauma can damage or weaken these walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm.

An aortic aneurysm can grow large and either rupture or split. A split is called a dissection and, like a rupture, is life-threatening. Early diagnosis and treatment may prevent serious or life-threatening complications. However, aortic aneurysms can develop and grow large before causing any symptoms. Doctors may be able to slow the growth of an aortic aneurysm with medicines or repair it with surgery if it is found before it ruptures or dissects.

There are two types of aortic aneurysm: thoracic aortic aneurysm and abdominal aortic aneurysm. Until recently, it was thought that thoracic aortic aneurysms and abdominal aortic aneurysms were due to the same cause. Now we know that the two types are separate diseases with different risk factors and causes.

Abdominal Aortic Aneurysm (AAA)

The most common place for an aneurysm is the part of the aorta that runs through the abdomen, called the abdominal aorta. The abdominal aorta provides oxygen-rich blood to the tissues and organs of the abdomen and lower limbs.

Thoracic Aortic Aneurysm (TAA)

A thoracic aortic aneurysm is a less common aneurysm that occurs in the chest portion of the aorta, above the diaphragm

Causes of Aortic Aneurysm

Aortic aneurysms are caused by a weakening of the aortic wall due to damage or injury. Many health conditions and lifestyle habits can put you at risk for damage to the aortic wall, including high blood pressure and smoking. A bulge may occur where the wall has been damaged and is weakened. If left untreated, the aortic wall will continue to weaken, and the bulge will grow. If it becomes large enough, the aortic aneurysm may rupture.

Risk Factors- Aortic Aneurysm

You may have an increased risk of developing an aortic aneurysm because of your age, family history, genes, lifestyle habits, medical conditions, or sex.

Age: Your risk for aortic aneurysms goes up as you age. Abdominal aortic aneurysms are most common in adults after age 65.

Family History and Genetics: Several familial or genetic conditions increase your risk for a thoracic aortic aneurysm. These include:

• Ehlers–Danlos syndrome
• Loeys–Dietz syndrome
• Marfan syndrome
• Turner syndrome
• Familial thoracic aortic aneurysms
• Bicuspid aortic valve (BAV), which is an abnormal aortic valve

Abdominal aortic aneurysms also run in families. One in 10 people with abdominal aortic aneurysms have a family history of abdominal aortic aneurysms. The chance of developing an abdominal aortic aneurysm is 1 in 5 for people who have a first degree relative with the condition, which means a parent, brother, sister, or child was affected.

Lifestyle Habits: Some lifestyle habits increase your risk of having an aortic aneurysm. These include:

• Cigarette smoking, which increases your risk for an aortic aneurysm, especially an abdominal aortic aneurysm. If you are a current smoker, an abdominal aortic aneurysm may grow more quickly and be more likely to rupture.
• Using stimulants such as cocaine
• Weight lifting

Medical Conditions: Medical conditions that are risk factors for aortic aneurysms include:

• Aneurysms of blood vessels in other parts of your body
• Chronic obstructive pulmonary disease (COPD)
• Cardiovascular conditions, such as atherosclerosis, ischemic heart disease, and peripheral artery disease
• High blood cholesterol
• High blood pressure, the leading risk factor for thoracic aortic aneurysms but also a risk factor for abdominal aortic aneurysm
• Infection, a risk factor for thoracic aortic aneurysms. Such a case is known as an infective thoracic aortic aneurysm and is usually caused by bacteria.
• Kidney conditions, such as chronic renal insufficiency, chronic kidney disease, and polycystic kidney disease
• Obesity
• Pheochromocytoma, a rare tumor of the adrenal gland that can lead to high blood pressure
• Trauma, such as from car accidents or falls, a risk factor for thoracic aortic aneurysms
• Vasculitis

Sex: Men are more likely than women to develop aortic aneurysms. However, an existing aneurysm is more likely to rupture at a smaller size in women than in men.

Who should be screened for Aortic Aneurysm

Certain groups of people may be screened for a thoracic aortic aneurysm. They include:

• People who have Marfan, Loeys–Dietz, Ehlers–Danlos, or Turner syndrome
• First-degree relatives of people who have a thoracic aortic aneurysm or a bicuspid aortic valve (BAV)–associated thoracic aortic aneurysm
• Relatives of people with familial thoracic aortic aneurysms who also have the genetic mutation

Certain groups of people who may be screened for abdominal aortic aneurysm include:

• Men and women 65 to 75 years old who have ever smoked or who have a first-degree relative who had an abdominal aortic aneurysm
• Men 65 to 75 years old who never smoked but have other risk factors, such as a family history of abdominal aortic aneurysms in any family member, other vascular aneurysms, or coronary heart disease
• Men and women more than 75 years old who are in good health, who have ever smoked, or who have a first-degree relative who had an abdominal aortic aneurysm.
• People who have peripheral artery disease, regardless of age, sex, smoking history, or family history

Signs, Symptoms, and Complications- Aortic Aneurysm

An aortic aneurysm may not cause any signs or symptoms until the aneurysm ruptures or dissects. The types of symptoms that occur before a rupture will depend on the location of the aneurysm and whether it has become large enough to affect other parts of your body. An aneurysm that ruptures or dissects is life-threatening.

Signs and symptoms

If you do have signs and symptoms of an aortic aneurysm, they may include:

• Difficult or painful swallowing if the aneurysm is pushing on your esophagus
• Difficulty breathing if it is pushing on your trachea, or windpipe
• Feeling full after not eating very much
• Hoarseness
• Pain in the neck, jaw, back, chest, abdomen or shoulder, depending on where the aneurysm is located
• Pulsating or throbbing feeling in your abdomen
• Shortness of breath if the aneurysm is pressing on your lung
• Swelling of the face, neck, or arms if the aneurysm is pushing on the superior vena cava. The superior vena cava is the main vein that returns blood from your upper body to your heart.

If you know you have an aortic aneurysm, it is important to know the signs and symptoms of a rupture, since quick treatment may be life-saving. Signs and symptoms of a rupture may include:

• Light-headedness
• Rapid heart rate
• Sudden, severe pain in your abdomen, chest, or back

Complications arising from Aortic Aneurysm

Complications from aortic aneurysms may be life-threatening and may include:

• Aortic dissection, which is a tear in the inner layer of the aortic wall. It causes blood to collect between the inner and middle layers of the aortic wall. This may lead to rupture of the aorta or not enough blood flow to your organs.
• Aortic insufficiency and aortic regurgitation, both of which occur when the aortic valve does not close properly because a nearby section of the aorta is enlarged. This allows some backward flow of blood back into the heart. As a result, your heart must work harder, which may lead to heart failure.
• Aortic rupture, which causes dangerous bleeding inside the body and can lead to shock
• Cardiac tamponade
• Kidney failure from lack of blood flow to the kidneys
• Lack of blood flow to the bowels, which causes inflammation and injury in the large intestine

Diagnosing Aortic Aneurysm

To diagnose an aortic aneurysm, your doctor will do a physical exam and an imaging test to confirm a screening test. An abdominal aortic aneurysm is diagnosed when your abdominal aorta is three centimeters or greater in diameter. The normal diameter of the thoracic aorta depends on your age, your sex, and which part of the thoracic aorta is measured.

Physical exam

During a physical exam, your doctor may do the following to look for an aortic aneurysm:

• Feel your abdomen to see whether an abdominal aortic aneurysm can be felt
• Listen to your heart for a heart murmur, softer heart sounds, or other changes in your blood flow that could be a sign of an aneurysm
• Check your pulse in your arms and legs to see whether it feels weaker than normal
• Look for signs and symptoms of medical conditions that are risk factors for an aortic aneurysm, such as Marfan or Ehlers-Danlos syndromes. This may include looking at your skin, muscles and bones, eyes, head and face, and heart.

Diagnostic tests and procedures

Different types of imaging studies may be used to diagnose your aortic aneurysm. Consider discussing the options with your doctor. Your doctor may order some of the following imaging tests to confirm or diagnose an aortic aneurysm:

• Computed tomography (CT) to provide information about the location, size and shape of an aneurysm. This may be the first test you get if you have sudden back or abdominal pain, if you already know you have an aortic aneurysm, or if your doctor feels a pulsating bulge in your abdomen while examining you. CT can provide information about the entire aorta, but for routine screening other diagnostic tests like echocardiography or ultrasound may be done first.
• Echocardiography to provide information about the size of the aortic aneurysm and about the thoracic aorta, which is close to heart. Other parts of the thoracic aorta are better seen with other imaging studies such as CT or magnetic resonance imaging (MRI).
• MRI to provide information about the size, shape, and location of the aneurysm
• Ultrasound to provide information about the size of the abdominal aortic aneurysm. If you have abdominal or back pain, an ultrasound can check for an abdominal aortic aneurysm or other possible causes of your pain. Once an aortic aneurysm is seen or suspected on ultrasound, you may have a CT scan or an MRI to provide more details about the shape or location of the aneurysm.

Tests for other medical conditions

Some conditions may mimic the symptoms of abdominal aortic aneurysms. To help diagnose an aortic aneurysm, your doctor may need to perform CT or ultrasound tests to find out whether your symptoms may be caused by other medical conditions, including:

• Appendicitis, inflammation of the appendix
• Cholecystitis, inflammation of the gallbladder often caused by gallstones
• Hiatal hernia, in which a small part of your stomach comes through the opening in your diaphragm
• Pancreatitis, inflammation of the pancreas
• Pericardial disorders, conditions that affect the sac that surrounds your heart
• Pulmonary embolism, a type of venous thromboembolism

Treatment- Aortic Aneurysm

Treatment for your aortic aneurysm will depend on its cause, its size and location, and the factors that put you at risk. Small aortic aneurysms may be managed with healthy lifestyle changes or medicine. The goal is to slow the growth of the aneurysm and lower the chance of rupture or dissection. Your doctor may treat other medical conditions that raise your risk for rupture or dissection, such as high blood pressure, coronary heart disease, chronic kidney disease, and high blood cholesterol. Surgery may be recommended to repair large aneurysms.

Healthy lifestyle changes

Your doctor may recommend heart-healthy lifestyle changes, such as the following:

• Quitting smoking to slow the growth of the aneurysm
• Heart-healthy eating to help lower high blood pressure or high blood cholesterol
• Managing stress to help control high blood pressure, especially for thoracic aortic aneurysms. Your doctor may also suggest that you avoid heavy weightlifting and powerful stimulants, such as cocaine.

Medicines

Your doctor may recommend medicines to treat an aortic aneurysm, including:

• Aspirin, especially if you have other cardiovascular risks
• Blood pressure medicines to lower blood pressure, slow down aneurysm growth, and lower the risk of rupture. These medicines include beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs).
• Statins to control cholesterol levels, and stop or slow the growth of aortic aneurysms

Procedures or surgery

Depending on the cause or size of an aortic aneurysm or how quickly it is growing, your doctor may recommend surgery to repair it. Rupture or dissection of an aneurysm may require immediate surgical repair.

• Open surgical repair is the most common type of surgery. You will be asleep during the procedure. Your surgical team first makes a large incision, or cut, in your abdomen or chest, depending on the location of the aneurysm, then removes the aneurysm and sews a graft in its place. This graft is typically a tube made of leak-proof polyester. Recovery time for open surgical repair is about a month.
• Endovascular aneurysm repair (EVAR) is less invasive than open surgical repair. This is because the surgical cut is smaller, and you usually need less recovery time. EVAR is used to repair abdominal aortic aneurysms more often than to repair thoracic aortic aneurysms. During the procedure, your surgical team 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.

Possible surgery-related complications

Complications of both types of aortic aneurysm repair can occur, and they may be life-threatening. These include:

• Bleeding and blood loss
• Blood clots in blood vessels leading to the bowel, kidneys, legs, or in the graft
• Damage to blood vessels or walls of the aorta when placing the stent graft. The stent graft may also move after it is placed.
• Endoleak, which is a blood leak around the stent graft into the aneurysm. Endoleak may cause rupture of the aneurysm if not treated.
• Gastrointestinal bleeding, which rarely occurs if an abnormal connection forms between the aorta and your intestines after the repair. Blood may show up in your stool, or your stool may be black.
• Heart complications such as heart attack or arrhythmia
• Decreased blood flow to the bowels, legs, kidneys or other organs during surgery. This may lead to injury to these organs.
• Infection of the incision or the graft
• Kidney damage
• Spinal cord injury which may cause paralysis
• Stroke