Aortic-Aneurysm
WHAT IS AN ANEURYSM
An aneurysm is a bulge in the artery wall weakened by atherosclerosis (hardening of the arteries), smoking, hypertension, or other causes
Vessel walls balloon outward with the pressure of the blood flow inside.
If an aneurysm bursts, it can cause heavy, life-threatening internal bleeding.
Aneurysms can form in arteries throughout the body, but most occur in the aorta.
Starting in the heart and continuing through the chest and abdomen to the legs, the aorta is the body’s largest blood vessel.
If the aneurysm occurs
lower section of the abdomen, it is known as an abdominal aortic aneurysm (AAA)
lower portion of the chest, it is called a thoracic aortic aneurysm (TAA).
Involves aorta of chest and abdomen, it is known as thoraco-abdominal aortic aneurysm(TAAA)
Likewise name of the aneurysm varies depending upon the blood vessel it affects
Abdomen-aortic aneurysm(AAA)-
- Pulsing sensation in the abdomen
- Abdomen pain
- Back pain
- Swelling of legs
- Sudden pain and loss of movement and sensation in both legs
- Gradual decrease in kidney function
- Symptoms of mesenteric disease
Thoracic Aortic Aneurysm(TAA)/Thoraco Abdominal Aneurysm(TAAA)-
- Chest pain
- Neck pain
- Altered quality of voice
- Difficulty in breathing
- Sudden pain and loss of movement and sensation in both legs
- Gradual decrease in kidney function
- Symptoms of mesenteric disease
A burst aneurysm is a medical emergency.
Signs of a ruptured aneurysm include:
- Sudden, intense pain in the abdomen/chest
- Dizziness
- Sweating
- Low blood pressure
- Fast pulse
- Vomitting
- Blood on coughing/passing stools
- Sudden collapse and loss of consciousness
Who gets an aneurysm?
Smokers
Old age
History of aneurysms in their immediate family
Hypertension
Asthmatics
High cholestrol
Genetic
Connective tissue disordes(eg Marfans syndrome or Ehler Danlos syndrome)
Iodiopathic(unknown)
DIAGNOSIS
In most cases, an aortic aneurysm is detect during a routine clinical exam or ultrasound while testing for another condition.
CT scan-
CT Angiogram is a standard modality to obtain information and confirm diagnosis
Provides dimension of the aneurysm and also information on the surrounding structures
AORTIC ANEURYSM TREATMENT
Treatment for an aortic aneurysm depends on the size and severity of the condition, as well as the patient’s overall health.
Medications are often prescribed as an initial treatment to
help lower blood pressure, relax blood vessels
reduce the risk of rupture.
Correct raised Cholesterol
Aspirin (mild blood thinner) to reduce their risks of more Cardiovascular disease
Many remain small and never rupture(smaller than the treatment cut-off size). These are kept on surveillance using a doppler ultrasound scan or sometimes a CT scan
Large, fast-growing, leaking or painful aneurysms may require intervention.
70-80% with a leaking(ruptured) aneurysm will not survive.
Intervention options- Open surgery or Endovascular(minimally invasive) stent-grafting(EVAR/TEVAR)
Open Aneurysm Repair
Open aneurysm repair involves making an incision in the abdomen/chest, removing the section of the artery with the aneurysm, replacing the excised segment with a graft made of a synthetic tube and maintaining blood flow to important orangs.
This procedure places the body under much greater stress than an endovascular approach
However longterm outcomes are more successful with open repair
AORTIC ENDOVASCULAR STENT GRAFTING (EVAR/FEVAR)
In EVAR, astent graft (a fabric covered wire frame in the shape of a tube) is implanted in the artery to provide a strong new vessel wall through two small groin cuts.
The aneurysm generally shrinks around the stent as time passes.
In FEVAR, the stent used has holes along the wall of the stent, to allow for bloodflow to nearby visceral arteries(which supply blood to stomach,intestines,liver,spleen) or renal (kidney) arteries.
PREVENTION
Certain steps patients can follow to reduce the progress of increasing size of aneurysm and their risk of rupture. It is important to:
- Keep blood pressure under control
- Avoid or quit smoking
- Exercise regularly
- Lower cholesterol and fat
- Regular surveillance