• 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.

• The lower section of the abdomen is known as an abdominal aortic aneurysm (AAA)
• The lower portion of the chest is called a thoracic aortic aneurysm (TAA).
• Involves the aorta of the chest and abdomen, it is known as thoracoabdominal aortic aneurysm(TAAA).
• Likewise, the name of the aneurysm varies depending upon the blood vessel it affects.

• Aneurysms may expand slowly or quickly, or they may stay the same size for many years.
• They often develop without any warning signs.
• Sometimes, however, people experience symptoms depending on the site.

• Pulsing sensation in the abdomen.
• Abdomen pain.
• Back pain.
• Swelling of legs.
• Sudden pain and loss of movement and sensation in both legs.
• The 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.
• The gradual decrease in kidney function.
• Symptoms of mesenteric disease.

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 cholesterol
• Genetic
• Connective tissue disorders(eg Marfan’s syndrome or Ehler Danlos syndrome)
• Iodine pathic(unknown)

DIAGNOSIS

In most cases, an aortic aneurysm is detected during a routine clinical exam or ultrasound while testing for another condition.

• CT Angiogram is a standard modality to obtain information and confirm the 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.
• 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 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 long-term outcomes are more successful with open repair.

• In EVAR, an ascent graft (a fabric-covered wireframe 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 blood flow to nearby visceral arteries(which supply blood to the stomach, intestines, liver, spleen) or renal (kidney) arteries.

PREVENTION

Certain steps patients can follow to reduce the progress of increasing the size of the 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.