Aortic Aneurysm

An aortic aneurysm is a permanent widening of the cross-section of the aorta. This bulge is caused by a change (reduced elasticity) in the wall of the blood vessel.

The bulge can develop in any area of the aorta, the most common being below the renal vessels in the area of the abdominal aorta (abdominal aortic aneurysm), less common in the thoracic area.

The aneurysm can be completely asymptomatic, the danger lies in a bursting of the thinned, possibly calcified vessel wall (= rupture) and internal bleeding.

About one percent of the population over fifty (5 times more men than women) develop an abdominal aortic aneurysm. It is often discovered only by chance.

The main cause of aneurysms is the change in the vessel walls with increasing age. They become less elastic and can no longer cushion the high pressure that prevails in the aorta. As a result, the cross-section of the blood vessel widens, it "bulges out". Arteriosclerosis (=calcification of the vessels) and hypertension (=high blood pressure) favour the development of an aneurysm, because the already inelastic vessels suffer particularly from the high blood pressure. Up to ten percent of male hypertensive patients over the age of 65 have an abdominal aortic aneurysm.

Inflammations of the vessel walls caused by infectious diseases such as syphilis or tuberculosis and congenital diseases such as Marfan syndrome or Ehlers-Danlos syndrome, for which a weakness of the connective tissue is responsible, are also associated with high blood pressure.These are very rare causes of aneurysms and mainly affect the aorta in the chest (thoracic aortic aneurysm).

Most people with aortic aneurysms have no symptoms; a diagnosis is usually made by chance in the course of other examinations.

Above a certain size, an aneurysm can press on surrounding structures. Diffuse abdominal and back pain and dizziness may be symptoms of an abdominal aortic aneurysm, as well as a poorly palpable inguinal pulse of varying intensity. Sometimes a pulsatile lump can be felt through the abdominal wall. Chest pain, shortness of breath, hoarseness, difficulty swallowing, and coughing may be symptoms of a thoracic aneurysm.

The greatest danger is a rupture of the vessel wall. This danger increases with aneurysms larger than five to six centimetres. The walls are then stretched by 2 - 3 cm. In the case of a rupture, the severe internal blood loss can lead to circulatory shock, the affected person feels severe pain in the chest or abdominal area, which radiates into the back, as well as nausea and vomiting.

The diagnosis is often made by chance during a routine examination, for example, during ultrasound examinations, listening with a stethoscope may reveal unusual flow sounds. A pronounced abdominal aneurysm can be palpated as a swelling in slender people. A lung X-ray may reveal a bulging of the thoracic aorta, and a cardiac ultrasound will clearly show parts of the aorta.

Magnetic resonance imaging (MRI), computed tomography (CT) and possibly angiography may be used to clarify the incidental finding. An exact finding, which also covers the other risk factors, such as high blood pressure and arteriosclerosis stage, is necessary for therapy planning.

For small asymptomatic aortic aneurysms, smaller than 4 cm in diameter, it is sufficient to observe - once or twice a year ultrasound examination, as well as drug therapy with beta-blockers, antihypertensives, blood lipid-lowering agents. Diabetes is a risk factor and should be optimally controlled, smoking significantly worsens the elasticity of the vessels and must be stopped. Lifestyle changes include not lifting too heavy and proper breathing during physical exertion. Coughing increases pressure in the vessels, so asthma and chronic bronchitis should be well controlled.

Aneurysms over 5cm in diameter in the abdominal aorta and 5.5cm in diameter in the thoracic aorta must be treated directly, as the risk of rupture increases significantly.

Thoracic aneurysm

In an operation, the surgeon removes the aneurysm and inserts a prosthesis, a bridging device. If the aneurysm is close to the heart, an aortic valve may also need to be replaced with an artificial valve.

Abdominal aortic aneurysm

- During surgery in the abdomen, the surgeon removes the dilated part of the artery and replaces it with a vascular prosthesis.

- Stenting method: a small tube (stent) is pushed through the inguinal artery to the aneurysm, where it stabilizes the vessel. Currently the method of choice: due to the less invasive procedure, there are fewer postoperative complications.

The prognosis depends on the size of the aneurysm and the exact location of the bulge in the aorta. From a size of more than five centimetres, the risk of the vessel wall rupturing increases. Ruptured aortic aneurysms are acutely life-threatening and require immediate surgery. An emergency operation, which is then necessary, has a much worse prognosis than a preventive operation.

Aneurysms can be prevented with a healthy diet, plenty of exercise, not smoking, and control and therapy of blood pressure, blood sugar, and cholesterol levels. (Main risk factors: High blood pressure, diabetes, smoking, obesity and lack of exercise).