The aorta is widely known as the largest artery in the body. It is responsible for carrying blood from the heart to all connecting arteries and supplying the body with the necessary amount of oxygenated blood. An aortic aneurysm occurs when any of the three aortic segments balloon or bulge, referring to either the ascending aorta, aortic arch, or descending aorta.
As an aneurysm continues to enlarge, the walls of the aorta stretch making them much thinner. The aortic aneurysm eventually reaches a point where it loses its ability to stretch any further. At this point, without any treatment it may rupture, causing potentially fatal bleeding. The Centers for Disease Control and Prevention (CDC) report that aortic aneurysms were responsible for the deaths of almost 10,000 Americans during one year and contributed to over 17,000 deaths. The medical terminology behind abdominal, thoracic and cerebral aortic aneurysms applies to which region the condition occurs.
It is possible that no symptoms may be present until the aneurysm has significantly enlarged, leaked or ruptured. However, sometimes symptoms are present. They may include a sharp pain in the back or side, fainting or shortness of breath. Sudden weakness on one side or paralysis could signal an aneurysm. Additionally, nausea, clammy skin and vomiting may occur. Difficulties in breathing or swallowing could also be symptomatic.
Who is susceptible?
Most abdominal aortic aneurysms occur in people over sixty-five years of age and men of that age are more likely to have them than women. Two-thirds of them occur in men. People with hypertension (high blood pressure) and smokers are also more likely candidates. Additionally, certain other conditions may be present that make the occurrence of abdominal aortic aneurysms more likely. These include COPD (chronic obstructive pulmonary disease), coronary artery disease, or inherited tissue disorders. Marfon syndrome and Ehlers-Danlos syndrome, which effect the body’s connective tissue, are inherited tissue disorders. Infection, inflammation and trauma have also been present and those with a first degree relative who has had an abdominal aortic aneurysm are considered to be at risk.
Tests that can confirm diagnosis are an abdominal ultrasound, computed tomography scan (CT scan) and an MRI (Magnetic resonance imaging). If an aneurysm has been discovered early and is still smaller than 5 centimeters, surgery may not yet be necessary. In this case, the vascular surgeon will closely monitor the growth of the aneurysm every 6-12 months by obtaining CT scans. Additionally, it is important to quit smoking and control your risk factors, such as keeping your blood pressure under control with medication.
Once an aneurysm has reached 5 centimeters, the risk of rupture is much higher and surgery is recommended. The two choices for treatment are Traditional Open Repair of AAA or Endovascular Repair. In the traditional open repair, a large surgical incision is made into the abdomen to directly visualize the aortic aneurysm. The aneurysm is opened and a cylinder-like tube known as a graft is sewn inside to repair it. Ultimately, the weakened area of the aorta is relined with a sleeve of material to strengthen it and prevent rupture of the aneurysm. Hospital stay with this procedure is about 5 days, with full recovery at 6 weeks.
The Endovascular Repair of AAA a less invasive approach than traditional surgery. It involves only a small incision in the groin. The procedure uses long thin tubes inside the body called catheters. Under guidance of an x-ray, a small catheter is placed through the groin incision and used to pass a cylinder-like tube called a graft up into the aneurysm. This graft is placed so that the ends fit neatly into the non-diseased portion of the artery at the opposite ends of the aneurysm. This is relining the weakened area of the aorta with a strong sleeve of material, thus preventing rupture of the aneurysm. Hospital stay for this procedure is about 1 day, with full recovery in about 1 week.
To learn more about abdominal aortic aneurysms and treatment options, log on to vascularhealthclinics.org.
Dr. Omar P. Haqqani is the Chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.