Aortic Aneurysm

What is an aortic aneurysm?

An aortic aneurysm is a weak spot that bulges out from the wall of the aorta. The aorta is the largest blood vessel in the body. It leads from the heart to the lower abdomen, where it branches into 2 arteries, one going down each leg. Aortic aneurysms usually happen in the abdomen and are called abdominal aneurysms. Some happen in the chest and are called thoracic aneurysms.

How does it occur?

When part of the wall of an artery gets weak, the blood vessel can bulge out. If the aneurysm keeps getting bigger, the wall of the aorta may rip open, or rupture. Sudden ruptures often end in death.

Atherosclerosis is the most common cause of aneurysms. Atherosclerosis is also called hardening of the arteries. Fat, cholesterol, calcium, and other substances from the blood build up inside the walls of the arteries. This buildup is called plaque. Plaque weakens the wall of the aorta. Pressure from the flow of blood can make the weakened wall start to bulge. High blood pressure may speed up the process, but it is not the cause.

Diseases such as infective endocarditis, Kawasaki's disease, Marfan syndrome, rheumatoid arthritis, Reiter's syndrome, and ankylosing spondylitis may cause aneurysms.

Aneurysms tend to run in families. Aneurysms get worse faster in smokers than in nonsmokers. Smokers are more likely to die from ruptured aneurysms than nonsmokers.

What are the symptoms?

An aneurysm may not cause symptoms for a long time. When you have symptoms, they may be different, depending on where the aneurysm is. For example,

• An abdominal aortic aneurysm might cause pain in the stomach, back, or groin.
• An aneurysm in the chest may make it harder to swallow or might cause chest pain if it presses on the lungs.

Sudden, very severe abdominal, back, or chest pain may mean that the aorta has burst. When the aorta bursts, it is an emergency.

How is it diagnosed?

Most aortic aneurysms are diagnosed by a healthcare provider during a routine exam. The aneurysm can be felt as a soft lump that pulses with each heartbeat. If your provider thinks that the aorta may be leaking or may have ruptured, a CT scan or echocardiogram may be done. Ultrasound, CAT, and MRI scans can measure the size of the aneurysm to check the risk for a rupture. (The larger the aneurysm, the greater the risk that it will leak or burst.) An angiogram, which is an X-ray picture of blood vessels, may also be done.

How is it treated?

Surgery usually is needed for aneurysms that cause symptoms or are bigger than 2 and 1/4 inches. An operation called aneurysmectomy and grafting may be done. The surgeon makes a cut in the abdomen or chest and puts a man-made patch (a graft) in the aorta.

Another way to repair an aneurysm is called endovascular grafting. A thin, flexible tube (catheter) is put through a blood vessel in the groin. At the tip of the tube is a deflated balloon covered by a tightly wrapped graft. Once the catheter is in the right place, the balloon is inflated and the graft opens. The graft is longer than the area of the aneurysm and sticks to the inside of the artery wall, protecting the aorta against rupture. This method is used only for nonemergency repair of an aneurysm. A ruptured aneurysm requires emergency surgery.

Smaller aneurysms need to be checked regularly. If you are in good health except for having the aneurysm, and if you have no symptoms, you may not need surgery. Your healthcare provider will help you know what treatment is right for you.

How long do the effects last?

Most aortic aneurysms grow slowly. Over many years, the walls slowly stretch and enlarge like a balloon. A normal aorta is about as wide and as tough as a garden hose. If the aneurysm does not grow much, you may live with a small aneurysm for years.

The risk of rupture increases with the size of the aneurysm. Emergency repair of a leaking or ruptured aneurysm often has complications, a longer recovery time, and a high death rate.

Successful surgery for an aortic aneurysm that has not ruptured usually results in full recovery. Aneurysms generally do not come back after surgery unless you have one of the unusual diseases that cause aneurysms in many parts of the body.

How can I help take care of myself?

Your provider will talk with you about lifestyle changes such as quitting smoking. You may need to keep taking medicines for high blood pressure. Contact your provider if you have any new symptoms.

What can help prevent an aneurysm?

• Have your blood pressure and blood cholesterol checked regularly.
• If you smoke, quit. Tell your healthcare provider if you need help quitting.
• If you are overweight, talk to your provider about losing weight.
• Exercise regularly according to your provider's recommendations.
• Switch to a low-fat, low-cholesterol, high-fiber diet. Your provider or a dietician can tell you which foods you should avoid.
• Find ways to reduce stress.
• If your provider approves, take an aspirin a day. However, check with your provider first. There may be reasons why you should not take aspirin. Your provider may prescribe other medicines that can slow the progress of artery disease.