If you would like to know more about aortic aneurysm symptoms and diagnosis,and about aortic aneurysm treatment, read the following article for more information.
An aortic aneurysm is a dilation (ballooning) of part of the aorta. It usually causes no symptoms unless it ruptures (bursts). A ruptured aortic aneurysm is often fatal. An operation to repair an aneurysm may be advised if it is large and the risk of rupture is high.
What is the aorta?
The aorta is the largest artery (blood vessel) in the body. It carries blood from the heart and descends through the chest and the abdomen. Many arteries come off the aorta to supply blood to all parts of the body. At about the level of pelvis the aorta divides into two arteries, one going to each leg.
What is an aneurysm?
An aneurysm is where a section of an artery widens (balloons out). The wall of an aneurysm is weaker than a normal artery wall. The pressure of the blood inside the artery causes the weaker section of wall to 'balloon'. Aneurysms can occur in any artery, but they most commonly occur in the aorta. Most aortic aneurysms occur in the section of the aorta that passes through the abdomen. Sometimes they occur in the section going through the chest. Aortic aneurysms vary in size.
What causes an aortic aneurysm?
The usual cause is atheroma (atherosclerosis). Atheroma is a fatty substance that deposits within the inside lining of arteries. It can weaken the artery wall and allow it to form an aneurysm. (Atheroma is sometimes called 'furring of the arteries'.) Anyone can develop atheroma, but it develops more commonly with increasing age. Certain 'risk factors' also increase the chance of atheroma forming. They include: smoking, high blood pressure, diabetes, raised cholesterol level, taking little exercise, and obesity. These are the same risk factors that increase the chance of atheroma forming in the heart (coronary) arteries which can cause angina and heart attacks.
Rare causes of aortic aneurysms include injury and certain hereditary conditions that can affect the artery structure. For example, some people with Marfan's syndrome develop an aortic aneurysm.
How common are aortic aneurysms?
About 1 in 20 people in the UK over the age of 65 develop an aortic aneurysm. It is about 6 times more common in men than women. Aortic aneurysm is uncommon in younger people.
What is the concern about an aortic aneurysm?
The main concern is that the aneurysm might rupture (burst). The wall of the aneurysm is weaker than a normal artery wall and may not be able to withstand the pressure of blood inside. If it ruptures then severe internal bleeding occurs which is often fatal. Of course, most aortic aneurysms do not rupture - only a certain proportion (see below).
What are the symptoms of an aortic aneurysm?
- Often there are no symptoms. At the time of diagnosis, 7 in 10 people with an aortic aneurysm will not have had any symptoms due to the aneurysm.
- The ballooning of the aneurysm does not cause any symptoms unless it becomes large enough to put pressure on nearby structures.
- If symptoms do occur they are likely to be mild abdominal pains. There are many causes of mild abdominal pain. Therefore the diagnosis may be delayed unless the aneurysm is large enough to be felt by a doctor when he or she examines your abdomen.
- Sometimes small blood clots form on the inside lining of an aneurysm. These may break off and be carried down the aorta and block a smaller artery further on. These blood clots are called emboli and can be dangerous. For instance, complete blockage of an artery that supplies a foot may lead to loss of blood to part of the foot which can cause gangrene if left untreated.
How is an aortic aneurysm diagnosed?
- Sometimes a doctor feels the bulge of an aortic aneurysm during a routine examination of the abdomen. But, many aortic aneurysms are too small to feel.
- An x-ray of the abdomen (often done for other reasons) will show calcium deposits lining the wall of the aneurysm in some, but not all, cases.
- An ultrasound scan is the easiest way to detect an aortic aneurysm. This is a painless test. (It is the same type of scan that pregnant women have to look at the baby in the womb.) The size of the aneurysm can also be measured by ultrasound. As discussed later, it is important to know the size.
- More detailed scans, such as a CT scan, are only needed if your doctor needs to know whether the aneurysm is affecting any of the arteries that come off the aorta. For instance, if the aneurysm involves the arteries to the kidneys then surgeons need this information if they plan to operate.
What is the chance of an aortic aneurysm rupturing?
The chance of rupture is low if an aortic aneurysm remains small (less than 55 mm wide measured by ultrasound). There is about a 1 in 100 chance of rupture per year for a small aneurysm. If the aneurysm is wider than 55 mm then the chance of rupture rises sharply, and the risk increases with increasing size. (Much like a balloon - the larger you blow it up, the greater the pressure, the greater the chance it will burst.)
Should everyone with an aortic aneurysm have surgery?
The short answer is no. Surgical repair of an aortic aneurysm is a major operation and carries risks. A small number of people will die during, or shortly after, the operation. If you have a small aortic aneurysm, the risk of death caused by surgery is higher than the risk of rupture. So, surgery is usually not advised if you have an aortic aneurysm less than 55 mm wide. However, regular ultrasound checks may be advised to see if it gets bigger over time.
Surgery is commonly advised if you have an aortic aneurysm larger than 55 mm. For these larger aneurysms the risk of rupture is usually higher than the risk of surgery. However, if your general state of health is poor, or if you have certain other medical conditions, this may increase the risk of surgery. So, in some cases the decision to operate may be a difficult one.
Emergency surgery is needed if an aortic aneurysm ruptures.
What operations are performed?
There are two types of surgical operation to repair an aortic aneurysm.
- The traditional operation is to cut out the 'bad' piece of aorta and replace it with an artificial piece of artery (a graft). This is a major operation and, as mentioned, carries some risk. It is successful in most cases and the aneurysm is totally fixed. The long term outlook is good. The graft usually works well for the rest of your life.
- A newer technique allows the aorta to be repaired by a method called endovascular repair. In this method a tube is passed up from inside one of the leg arteries into the area of the aneurysm. This tube is then passed across the widened aneurysm and fixed to the 'good' aorta wall using metal clips. The advantage to this type of repair is that there is no abdominal surgery. This technique should therefore be safer and reduce the amount of time needed in hospital. The disadvantage is that up to 1 in 4 patients have to undergo a further operation at a later stage to refine the initial procedure.
Surgical techniques continue to develop and improve. Your local surgeon will advise about the pros and cons of surgery and the best option for you.
Screening for aortic aneurysm
Research studies suggest that a routine ultrasound scan is worthwhile for all men aged 65. This is because most people with an aortic aneurysm do not have symptoms. Following a routine test, surgery can be offered to people found to have an aneurysm over 55 mm wide. A routine scan is not yet national policy, but may become so in the future.
In summary
- Most aortic aneurysms cause no symptoms unless they rupture.
- Aortic aneurysms less than 55 mm wide have a low chance of rupture.
- Surgery is usually advised to prevent rupture if you have an aortic aneurysm wider than 55 mm.
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