Many health risks often go unnoticed because they are asymptomatic, meaning no noticeable symptoms are exhibited or experienced by the patient. Asymptomatic disease can be particularly problematic because its progression goes unnoticed to the point where it poses a very serious health risk to individuals – such is the case with aortic aneurysms.
The aorta is a large artery that carries blood from the heart, through the abdomen, and to the legs. The upper part of the aorta is referred to as the thoracic aorta and is made up of three segments: The ascending aorta, aortic arch, and descending aorta. The lower part of the aorta is referred to as the abdominal aorta.
An aneurysm occurs when there is a bulging or ballooning in any of the aortic segments. Similar to a balloon, as an aneurysm continues to enlarge, the walls of the aorta stretch and become thinner. When this occurs in the upper aorta, it is medically referred to as a Thoracic Aortic Aneurysm (TAA). When this occurs in the lower aorta, it is medically referred to as an Abdominal Aortic Aneurysm (AAA).
Over time, an aortic aneurysm will reach the point where it loses its ability to stretch any further. At this point, much like how a balloon will burst when stretched too far, an aortic aneurysm will rupture, causing potentially fatal bleeding in the thoracic or abdominal region.
There are many factors that can put someone at risk of developing an aortic aneurysm. These vary significantly depending on the location of the aneurysm itself. Family history of vascular disease and aortic aneurysm are also risk factors, meaning that aneurysms can run in a family blood line.
A history of tobacco use, having coronary artery or heart disease, high blood pressure, diabetes, COPD (chronic obstructive pulmonary disease), or being over the age of 55 also increases the risk of developing an aortic aneurysm.
It is common that no symptoms exist until the aneurysm has enlarged significantly, is leaking, or has ruptured. When this occurs, reported symptoms may include neck, chest, or back pain; swelling of the head, neck, or arms; and wheezing, coughing, or shortness of breath.
Ruptured aneurysms carry a 90% mortality rate – one half of people whose aneurysms rupture will die instantaneously, and the other half more than likely won’t survive, even if they’re able to make it to the hospital.
Depending on the location of the aneurysm, healthcare professionals can employ computed tomography scan (CT), magnetic resonance imaging (MRI), echocardiogram and abdominal ultrasound to confirm whether or not an aneurysm exists.
If an aneurysm is discovered early and is still relatively small (under 5 centimeters), surgery may not necessarily be required. In this case, the growth of the aneurysm will be closely monitored via CT scan every 6-12 months. If an aneurysm grows to be more than 5 mm every 6 months, the growth rate would be considered to be too great, and would warrant early intervention.
Once an aneurysm reaches 5 centimeters, the risk of rupture becomes much higher and surgery is recommended. A vascular surgeon can discuss complications and risks, as well as help to decide what is the best option for treatment.
There are two choices for treatment if surgery is required. Traditional open repair requires an incision to expose the diseased portion of the artery. The aneurysm is opened and a cylinder-like tube called a graft is placed within the aorta to repair it. Patients generally recuperate in the hospital for 5-7 days following open procedures, with full recovery in six weeks.
Endovascular repair is a less invasive approach than traditional surgery, as it only involves a small incision in the groin. Endovascular repair uses long thin tubes inside the body called catheters to place a graft in the artery to repair the aneurysm. Hospital stay for this procedure is about one day, with full recovery in about one week.
In my personal practice, 80% of my patients undergo the endovascular or non-invasive repair. In fact, in my experience with ruptured aneurysms, my patients have experienced tremendous survival rates, in part to emergent intervention and endovascular therapy.
A key factor in determining whether someone is a candidate for less-invasive endovascular repair is the size, shape and anatomy of the aneurysm, as well as the overall health of the patient. If the anatomy is not suitable for an endovascular repair, a more traditional approach with open surgery would be required.
To reduce the risks of developing an aortic aneurysm, it is important to manage controllable risk factors, such as keeping your blood pressure and diabetes under control, and quitting smoking.
A patient at risk of developing an aortic aneurysm should confer with their healthcare provider about whether they could benefit from vascular screening. Most insurances will cover vascular screening with a physician’s referral.
It is important to catch an aortic aneurysm early on so that it can be monitored and given appropriate treatment. Because of the condition’s asymptomatic nature, discovering an aortic aneurysm before it bursts might just save a life.