Care for Abnormal Bulging
As the largest artery in the body, the aorta is responsible for carrying oxygen-rich blood away from the heart to all other parts of the body. Where your aorta runs through your chest is called the thoracic aorta, and where it moves down through your abdomen is called the abdominal aorta. Some people experience just one type of aneurysm, but some experience both types of aortic aneurysms.
Each year, more than 200,000 people in the United States are diagnosed with an aortic aneurysm, and a ruptured aortic aneurysm is a leading cause of death.
Find an Aortic Aneurysm Specialist
What is an Aortic Aneurysm?
An abnormal bulging or enlargement of the wall of the aorta is called an aortic aneurysm. They can occur anywhere in the aorta?from the chest to the abdomen, and may be defined as a:
- Fusiform: Fusiforms are uniform in shape, appearing equally along an extended section and the edges of the aorta.
- Saccular aneurysm: Saccular aneurysms are small, lopsided blisters on one side of the aorta that form in a weakened area of your aorta?s wall.
Symptoms
The symptoms of an abdominal aortic aneurysm and a thoracic aortic aneurysm differ greatly. Many aortic aneurysms are asymptomatic, meaning they do not cause any symptoms until your aneurysm ruptures. Luckily, many are found when patients are being evaluated with a CT or MRI scan for other medical problems, and many are found during routine screenings.
Symptoms of an Abdominal Aortic Aneurysm
An abdominal aortic aneurysm affects the lower part of the aorta in your abdomen. You may experience symptoms including:
- Abdominal, back, or groin pain that is not relieved with pain medication or a change in position
- Pulsating enlargement
- Tender mass felt by a physician when performing a physical examination
Symptoms of a Thoracic Aortic Aneurysm
A thoracic aortic aneurysm affects the upper part of your aorta in your chest. You may experience:
- Coughing and hoarseness
- Difficulty breathing
- Pain in the jaw, neck, upper back, or chest
These symptoms are serious, and early diagnosis of an aneurysm is key to managing your condition and reducing the risk of rupture. If you are experiencing these symptoms, please call your doctor immediately.
Risks Factors of an Aortic Aneurysm
Unfortunately, aneurysms run in families. If a member of your immediate family has had an aortic aneurysm, you are 12x more likely to develop one, as well.
Other risk factors that contribute to the development of aortic aneurysms include:
- Age 65+, especially men
- Atherosclerosis - the hardening of your arteries
- COPD - chronic obstructive pulmonary disease
- Hypertension - high blood pressure causes increased pressure on the weakened portion of your aorta
- Infection or inflammation
- Inherited connective tissue disorders - Marfan syndrome, Ehlers-Danlos syndrome, or collagen vascular disease
- Smoking - more than 100 cigarettes in your lifetime
What causes an aortic aneurysm?
Typically, aortic aneurysms are caused by high blood pressure or a sudden injury. Smoking, traumatic injuries, or genetic factors can all contribute to an aortic aneurysm.
Diagnosis
We find most aortic aneurysms are discovered accidentally during CT and MRI scans for other medical problems. When an aortic aneurysm is suspected, your provider may order the following tests for an accurate diagnosis:
Abdominal Ultrasound
This non-invasive test can be used to screen (detect) an abdominal aortic aneurysm and estimate the overall size of your aneurysm.
It is not a good option for thoracic aortic aneurysms because the chest cavity is too large for them to be accurate.
CT or MRI Scan
Scanning the abdomen, chest, and pelvis with a CT or MRI scan accompanied by contrast dye can further enhance the characteristics of aneurysms and provide greater detail for your vascular surgeon to monitor the growth. It also allows them to make plans for surgical repair of your aneurysm, if necessary.
Treatment
Your treatment team at Rochester Regional Health is filled with expert providers trained extensively in treating conditions like arterial and venous aortic aneurysms both medically and surgically.
Treating an Abdominal Aortic Aneurysm
The goal of treating an abdominal aortic aneurysm is to prevent your aneurysm from rupturing. Your treatment may include watchful waiting or surgery. Your surgeon will recommend the right treatment for you based on an individualized assessment of your health and the size of your aneurysm.
Usually, with watchful waiting, you’ll have an echocardiogram, a CT scan, or an MRA scan at least six months after your aneurysm was diagnosed, and at regular follow-up exams. The size and the speed at which your aneurysm is growing will determine how often your provider wants to see you.
Your vascular surgeon may recommend surgery if your abdominal aortic aneurysm is 5 – 5.5 centimeters in size or larger, or if it is growing rapidly. The type of surgery recommended will depend on the size and location of your aneurysm, as well as your age and overall health.
Endovascular Repair
Minimally invasive endovascular repair is performed when your vascular surgeon inserts a catheter (a thin, flexible tube) through an artery in your leg and guides it to your aorta. A graft at the end of the catheter will be placed at the site of your aneurysm and then expanded and fastened into place. The graft will strengthen the weakened section of your aorta to prevent future rupture.
Open Abdominal Surgery
Open abdominal surgery involves removing the damaged part of your aorta and replacing it with a graft, which will be sewn into place.
Treating a Thoracic Aortic Aneurysm
The end goal for a thoracic aortic aneurysm is to prevent it from growing and rupturing. Your provider will recommend the best treatment for you based on your aneurysm's size and how quickly it is growing. Your treatment may include watchful waiting or surgery.
Usually, with watchful waiting, you’ll have an echocardiogram, a CT scan, or an MRA scan at least six months after your aneurysm was diagnosed, and at regular follow-up exams. The size and the speed at which your aneurysm is growing will determine how often your provider wants to see you.
If your descending thoracic aortic aneurysm is 5 – 5.5 centimeters in size or larger, surgery may be recommended. Today, most patients have endovascular surgery (a minimally invasive option), but sometimes open-chest surgery is recommended. Your provider will use your medical history, risk factors, and the size of your aneurysm to determine which surgery type is best for you.
Endovascular Aortic Aneurysm Repair (EVAR)
During an EVAR, a minimally invasive treatment option, your vascular surgeon will insert a catheter (a thin, flexible tube) into a blood vessel in your groin and guide it to your aorta. A graft attached at the end of the catheter will be placed at the aneurysm site where small hooks or pins will hold it in place. The graft will reinforce the weakened section of your aorta to prevent ruptures.
Open-chest Surgery
During this surgery, your vascular surgeon will remove the part of your aorta damaged by the aneurysm. The removed section will be replaced with a synthetic tube (called a graft), which will then be sewn into place. An open chest surgery may be necessary for some situations–your vascular surgeon will determine if it is right for you and your health.