An aortic aneurysm is a dilatation of a part of the aorta, the main artery in the body. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the aorta is more dilated near the aneurysm there is a high risk of rupture. When rupture occurs it can lead to massive internal bleeding and subsequently to death.
Aneurysms can form in any section of the aorta, but they are most common in the abdominal area. These can also appear in the thoracic area and are known as ascending or descending aortic aneurysms.
Most aortic aneurysms do not cause symptoms. Sometimes the physician will find them during examinations performed for other diseases. If the patient complains of chest pain, abdominal or back pain, these might be caused by an aneurysm. The symptoms may come and go, or be constant.
In the worst case, an aneurysm can burst. This causes severe pain and bleeding and might lead to death within minutes and up to several hours.
Abdominal aortic aneurysm symptoms
Common symptoms include abdominal pain or discomfort, which may be constant or come and go.
Other symptoms include:
- Pain in the abdomen, the lower back, the flank of the kidney, sometimes the pain can spread to the testicles, legs or buttock. The pain may be acute, deep and might last for hours or days;
- A pulsating sensation in the abdomen;
- A “cold foot” sensation or a black or blue painful toe. This symptom can appear if a blood clot breaks and obstructs blood flow to the leg or feet;
- If there is an inflammatory aortic aneurysm the patient can experience fever or weight loss.
Thoracic aortic aneurysm symptoms
Symptoms usually occur when the aneurysm is situated in the aortic arch. These include:
- Chest pain, generally described as a deep and throbbing pain;
- Back pain;
- Cough or shortness of breath if the aneurysm is located near the lungs;
- Difficulty or pain while swallowing.
The symptoms of aortic aneurysm are similar to those of other diseases that cause chest or abdominal pain, such as coronary artery disease, gastroesophageal reflux and peptic ulcer.
An aortic aneurysm can lead to other problems as well. The velocity of blood flow decreases within the aneurised section and this might promote clotting. If a blood clot bursts in the chest it might travel to the brain and cause a stroke. If the clot bursts in the abdominal area, it might be carried by the blood flow to the legs or belly, blocking circulation.
Once a person is diagnosed with aortic aneurysm, the physician will evaluate:
- Whether the aneurysm requires to be repaired;
- Whether the patient will be able to stand a surgery or a procedure;
- Whether the patient should wait and keep the growth of the aneurysm under control.
The symptomatic aortic aneurysms
The treatment of aortic aneurysm is differentiated according to the size of the aneurysm and its growth rate over time. If a large aortic aneurysm is growing rapidly it will require a surgical intervention. A physician specialized in vascular surgery will repair the damaged blood vessel during a common surgery, a laparoscopy or another minimally invasive procedure.
Smaller aneurysms rarely rupture and are usually treated with medicine used to treat high blood pressure, typically beta-blockers. This medication decreases blood pressure and the pressure applied on the aortic wall. If you will not undergo surgery, laparoscopy or other minimally invasive procedures, you will have to get a routine Doppler ultrasound checkup to be aware if the aneurysm is getting bigger.
Even if the aneurysm does not grow or rupture, you have an increased risk of heart problems. Your physician may suggest that you exercise more, start a healthy diet and stop smoking. Your physician may also prescribe medicines that will help lower cholesterol levels.
The wall of the aorta is normally very elastic. It can stretch or shrink back as needed to adapt to the blood flow in the aorta. The artery wall is weakened by diseases such as high blood pressure or atherosclerosis (hardening of the arteries). These problems together with age can lead to an aortic aneurysm. Another cause may be genetic, if there is a history of aortic aneurysms in the family. People with Marfan syndrome, Ehlers-Danlos syndrome or other genetic diseases can have a weakened aortic wall. There is a high possibility that these persons have relatives with a history of aortic aneurysm. The wall of the aorta becomes stiffer with age, increasing the risk for an aortic aneurysm. Other causes of aortic aneurysm include trauma from accidents (for example car crashes) and infections such as endocarditis.
Major risk factors for aortic aneurysm are:
- Being over 65 years old;
- Being a male (risk is higher among males than females);
- High blood pressure;
- Family history of aortic aneurysm (up to third-degree relatives).
Abdominal aortic aneurysms are about 5 times more common in males than women. An aneurysm happens in about 3 to 9 out of 100 men who are over 50 years of age.
Call the emergency service (112) if there are signs of a ruptured aortic aneurysm:
- Sudden, severe pain;
- An extreme drop in blood pressure;
- Signs of shock, such as passing out, dizziness, weakness or inability to concentrate.
If you see an unconscious person, call the emergency service and start cardiopulmonary resuscitation. The operator can guide you on how to perform resuscitation until the arrival of the ambulance.
Call a physician immediately if you have:
- A pulsating mass in your abdomen;
- A sudden weakness in the lower extremities on one side of the body;
- Chest pain you have not experienced before;
- A cold foot or a black or blue toe for no apparent reason.
An aortic aneurysm is often diagnosed during examinations done for other reasons. In some cases it is diagnosed during a screening test for aneurysms. Screening tests are effective in early detection and treatment of the aortic aneurysm, avoiding the risk of major complications, and even death.
Experts recommend screening tests for aortic aneurysms for:
- Smokers over 65-75 years old;
- Persons over 60 years old who have a first-degree relative (such as parent or brother) who has had an aneurysm.
Statistically, men are more likely to develop an aortic aneurysm than women.
If your physician thinks that you might have an aneurysm he or she will recommend you to have other tests such as a Doppler ultrasound, a CT scan or an MRI to gather all necessary information about the aneurysm, such as location or dimension.
These are tests that are necessary in order to identify the exact location, size, and rate of growth of an aneurysm, and may include:
- The abdominal ultrasound: reveals whether the aneurysm is altered in size. If the aneurysm is large, you will need a follow-up and you may need an ultrasound every 6-12 months. If the aneurysm is small you will need an ultrasound every 2-3 years;
- The Computer Tomography (CT) and MRI are used to observe better details than those provided by the ultrasound. These give you more information about the aneurysm, nearby blood vessels or blood vessels that lead to the kidneys or other organs. All this information is necessary before any intervention;
- The echocardiogram is an ultrasound exam used in examining the heart. A transesophageal echocardiogram is used in case of thoracic aortic aneurysms;
- The Angiogram is used to visualize and record the size of the aneurysm and it is also helpful in identifying possible aortic dissections, blood clots or other blood vessels involvement within the area.