Aortic aneurysm

An aortic aneurysm is a bulge in the aorta, the main artery that travels from the heart to supply blood to the rest of the body.

The most common location for an aortic aneurysm is the abdomen.

An aortic aneurysm can rupture, leading to blood loss and death, so you must go to the hospital immediately after  Symptoms appear.

What is aortic artery?

The aorta is the largest blood vessel in the body, as it extends from the heart through the middle of the chest and abdomen, so aneurysms can cause life-threatening bleeding.

How is aortic aneurysm treated?

What are types of aortic aneurysm?

Types of aortic aneurysm:

1. Abdominal aortic aneurysm: an abdominal aortic aneurysm when it occurs in the abdominal part of the aortic artery.

Aortic aneurysm treatment most commonly occurs in the abdominal aorta.

2. Thoracic aortic aneurysm: A thoracic aortic aneurysm occurs when there is an aneurysm in the thoracic part of the aortic artery.

3. Thoracoabdominal aortic aneurysm: It is called a thoracoabdominal aortic aneurysm when an aneurysm occurs in both the thoracic and abdominal portions of the aortic artery.

4. Dissecting aortic aneurysms: The aortic artery is like a three-layer sandwich.

There is a layer known as the intimal layer within the media, which is located within the adventitia layer.

This condition occurs when the inner layer of the aortic artery called the intima and blood under high pressure separate the inner and outer layers of the media to form a false lumen causing weakening and subsequent dilatation called aortic dissection or aortic aneurysm dissection.

What are risks associated with aortic artery aneurysms?

Aortic aneurysms can grow larger over time and can begin to cause symptoms as soon as they begin to increase in size.

It is noteworthy that when an aortic aneurysm becomes very large, it can cause serious bleeding that leads to immediate death without warning.

Blood clots are another risk if a person has an aortic aneurysm, as a blood clot can form inside the aneurysm, and small pieces of blood can break off from it and move through the body.

It is noteworthy that if part of the blood clot gets stuck in the brain or blood vessels in the heart, it may cause a stroke or heart attack.

It is added that blood clots can also obstruct blood flow to organs such as the kidneys and liver, preventing them from working and performing their function properly.

In addition, if part of the clot blocks blood flow in the legs, feet, and arms, blood clots can cause numbness, weakness, tingling, coldness, dizziness, or pain.

What are causes and risk factors of aortic artery aneurysms?

 1. Causes of abdominal aortic aneurysms:

In the past, it was believed that atherosclerosis was the main cause of this disease, but today it is believed that many causes lead to weaknesses in the walls of blood vessels, including:

1. Infections.

2. Genetic factors.

3. High blood pressure.

4. Disease in the arterial wall.

As for the weakness and degeneration of the wall, they result from a decrease in the amount of elastin and collagen in the wall due to enzymatic activity that leads to the disintegration of these proteins.

 2. Risk factors:

The most prominent risk factors that increase the chances of contracting the disease are:

1. Age: About 5% of people ages 50 and older develop aortic aneurysm.

2. Gender: The disease is more common among men than women, and the infection rate among men versus women is 1:9.

3. Smoking: Smoke increases the chances of contracting the disease.

4. Family history: The presence of the disease in a family member increases the chance of contracting it.

How to diagnose aortic aneurysm?

An abdominal aortic aneurysm is often discovered on a physical examination or imaging examination for any other reason.

To diagnose an abdominal aortic aneurysm, your doctor will examine you and review your and your family’s medical history.

How is aortic aneurysm diagnosed?

Tests to diagnose abdominal aortic aneurysm include:

1. Abdominal ultrasound examination.  This test is most commonly used to diagnose aortic aneurysm.  Sound waves are also used to show how blood flows through organs in the abdominal area, including the aortic artery.

2. Abdominal CT scan.

This scan uses X-rays to create cross-sectional images of the organ within the abdominal area.

It can create clear images of the aortic artery.

This test can also be used to detect the size and shape of the aneurysm.

3. Abdominal MRI.

This imaging test uses a magnetic field and computerized radio waves to create detailed images of the organ inside the abdominal area.

During some CT and MRI scans, a liquid called contrast material may be injected into a vein so that the blood vessels appear more clearly in the images.

Screen for abdominal aortic aneurysm:

The risk of abdominal aortic aneurysm is significantly increased among male smokers and overall any blood vessel disease.

Screening has different recommendations, but in general, they are:

1. Men between the ages of 65 and 75 who have smoked cigarettes at any time in their lives should undergo an abdominal ultrasound to research for blood vessel disease.

For men between the ages of 65 and 75 who have never smoked, whether they need an abdominal ultrasound depends on other risk factors, such as a family history of aneurysms.

2. Women who have never smoked generally do not need a screen to detect an abdominal aortic aneurysm.  There is not enough evidence whether women ages 65 to 75 who have ever smoked or have a family history of abdominal aortic aneurysm may benefit from screening.

You should consult your doctor about whether the test is appropriate.

What are treatment options of aortic aneurysm?

The decision of whether and when to correct an asymptomatic aneurysm depends on the risk associated with the aneurysm itself and the risk associated with the correction.

A. Small abdominal aneurysms that are discovered randomly and are asymptomatic, and the recommendation is usually to adhere to regular follow-up with ultrasound every 6 months.

It is also recommended at this stage to treat risk factors such as high blood pressure and quit smoke.

B. If during the follow-up period, the aneurysm increases by 0.5 cm in half a year or its diameter is greater than 5.5 cm, the recommendation is to perform a correction operation.

Aneurysm correction is the main treatment for symptomatic aneurysms or a high risk of rupture.

It will be implemented in one of two ways, each with its pros and cons.

The treating physician will provide you with the best treatment according to your medical condition:

1. Open surgeries: which is performed in the operating room under general anesthesia, and the duration of the operation is about 2-4 hours.

The vascular surgeon makes a longitudinal incision in the abdominal wall, replacing the affected portion of the artery with an artificial implant (implant over a stent).

After a surgical operation, you must stay in the hospital for about 5 days and the recovery process takes about a month.

2. Minimally invasive catheterization – performed in a catheterization room by an interventional radiologist but can also be performed in an operating room.

Depending on the doctor’s decision, it can be performed under local anesthesia, minimal sedation, or alternatively under general anesthesia.

With this method, it is not necessary to open the abdomen.

The procedure is performed through a small incision in the skin smaller than 1 cm in the groin area.

Through this route, metal leads are inserted into the groin arteries with catheters on them.

After evaluating the aneurysm, a stent (artificial stent over an implant) is inserted according to its dimensions and covers the diseased area, thus preventing further aneurysm.

At the end of the procedure, the opening in the artery is closed using state-of-the-art equipment designed to close the opening without surgery.

The hospital stay is 1-2 days shorter and the recovery process is short.

Nowadays most aneurysms are treated this way.