There are many risks associated with an aortic aneurysm. Several behavioral measures can help prevent an aortic aneurysm before it happens.
What is aortic aneurysm?
Infographic showing the anatomy and location of an aneurysm in the brain and its surgical treatment. Click image to enlarge. An aortic aneurysm is a widening of the blood vessel (aneurysm) that occurs in the aorta. In most cases, an aortic aneurysm shows a sac-like or spindle-like shape. In medicine, a distinction is made between aortic aneurysm that occurs at the level of the abdomen and aortic aneurysm that develops at the level of the chest. According to statistical data, the abdominal aorta is most frequently affected by an aortic aneurysm. Aortic aneurysm is comparatively common in people of older age. It is estimated that about 1-2% of German citizens are affected (often unknowingly). However, an aortic aneurysm is not always accompanied by noticeable symptoms (pain); such a symptom-free aortic aneurysm is also referred to as an asymptomatic aortic aneurysm. As the size of an aortic aneurysm increases, so does the risk that a rupture will occur at the aortic aneurysm; if this occurs, a so-called ruptured aortic aneurysm is present.
Causes
One reason that older people in particular are affected by aortic aneurysm is the decreasing elasticity of the vessel walls with age. Because the aorta is exposed to comparatively high blood pressure, the less elastic vessel walls react by forming an aortic aneurysm. Aortic aneurysms are also favored by various risk factors, such as calcification of the vessels (also known as arteriosclerosis). High blood pressure is another factor that can be causally involved in an aortic aneurysm. In men in particular, a hereditary component is also assumed: Men with a family history of the disease have a higher risk of developing an aortic aneurysm themselves. Rarely, an aortic aneurysm can be caused by inflammation of the vessel walls; such inflammatory processes can be consequences of tuberculosis or syphilis, for example. Genetic defects can also promote aortic aneurysm in individual cases.
Symptoms, complaints, and signs
As a rule, an aortic aneurysm leads to many different complaints. These depend greatly on the region affected, so it is not possible to make a general prediction about symptoms. If the aortic aneurysm occurs in the chest, in most cases there is a strong cough and further also hoarseness. In severe cases, these symptoms are also accompanied by shortness of breath, so that the affected person may also lose consciousness. Likewise, swallowing difficulties or circulatory disturbances may occur. In many cases, patients also suffer from chest pain. An aortic aneurysm in the abdomen usually leads to a strong urge to urinate and also to severe back pain. This can lead to restrictions in movement and thus also to limitations in the daily life of the affected person. The back pain often spreads to the legs as well. Furthermore, the aortic aneurysm in the abdomen can cause diarrhea or constipation. As a rule, these are not the only symptoms. Other complaints may also depend on the manifestation of the disease, so no universal prediction is possible in this case.
Diagnosis and course
Often, an aortic aneurysm is diagnosed by chance during routine examinations. One diagnostic procedure by which an aortic aneurysm in the abdomen, for example, can be detected is ultrasonography. This procedure allows imaging of structures inside the body. An aortic aneurysm can also be detected with the help of MRI (magnetic resonance imaging) or CT (computer tomography). If an aortic aneurysm is very pronounced in the abdomen, it can often also be felt by the doctor in slim people. An aortic aneurysm carries the risk of rupture (rupture) as it progresses. If such a complication occurs, the ruptured aortic aneurysm can be fatal.
Complications
Complications caused by an untreated aortic aneurysm depend on the location and severity of the aneurysm.By far the most threatening complication is rupture of the aorta with immediate hemorrhage into the chest or abdomen. The risk of such immediately life-threatening complications increases with the size of the aneurysm. For example, if the bulge in the abdominal aorta exceeds 5 to 5.5 centimeters in diameter, the risk of aortic rupture increases steeply. Because symptoms of an aortic aneurysm that is less than 4 to 4.5 centimeters in diameter range from nonspecific to not noticeable, treatments are usually not performed until the aneurysm is larger. Either open surgery or endovascular therapies are recommended. Both types of surgery carry certain different risks of complications. Most importantly, there is also a risk of late complications. For example, in very rare cases, infections can occur within approximately three years. In the case of using one of the endovascular therapies, there is a low risk. This can be manifested by gradual leakage at the junctions of the artificial aortic stent with the natural tissue, which may require a repeat procedure. In very rare cases, aortoenteric fistula formation has been observed as a further complication.
When should you go to the doctor?
Aortic aneurysm – as bulges in the aorta are called – affects older people more often than children, adolescents, or young adults. In most cases, those affected are unaware that an aneurysm has formed in their aorta because it does not always cause symptoms or the nonspecific symptoms have been misinterpreted. Often, the aneurysms are discovered by chance during an ultrasound examination. There are no generally valid answers to the question of whether or when an aortic aneurysm must be treated. As a rule, the bulges do not require treatment until they reach a size of 4 to 4.5 centimeters. With such large and even larger aneurysms, there is a risk of a tear (rupture) forming in the aortic wall due to pulsatile blood pressure. This leads to immediate life-threatening internal bleeding that is difficult to stop. The risk of developing an aortic aneurysm is greatly increased in individuals whose arteries have arteriosclerotic changes in the vessel walls. If there are clear symptoms such as chronic cough, hoarseness, shortness of breath and circulatory problems, for example, an examination of the aorta by ultrasound is recommended. The same recommendation applies to complaints such as frequent urination, nonspecific back pain, constipation and diarrhea, which can also occur in alternation. Ultrasound examinations can also take place at the family doctor’s office, provided he has a suitable ultrasound machine.
Treatment and therapy
The manner in which an aortic aneurysm is appropriately treated medically depends, among other things, on the degree to which an aortic aneurysm is symptomatic. In the case of a symptomless aortic aneurysm whose diameter is less than about four centimeters, regular medical observation may initially be sufficient; depending on the individual case, such monitoring is performed once or twice a year, for example, with the aid of ultrasound. To ensure that blood pressure remains constant and does not rise, the administration of beta-blockers may also be useful in individual cases of aortic aneurysm. According to experts, an aortic aneurysm should be treated if it exceeds a diameter of about five centimeters. The appropriate treatment depends, among other things, on the location of the aortic aneurysm and the patient’s constitution. One way of counteracting an aortic aneurysm is, for example, to insert a so-called stent, i.e. a narrow tube that provides support for the aortic aneurysm from the inside. Alternatively, an aortic aneurysm can be removed during surgery and replaced with a vascular prosthesis.
Outlook and prognosis
An aortic aneurysm is often discovered by chance during a routine physical exam. If the physician determines that the aneurysm requires surgery, that surgery carries an associated risk. If the aneurysm is injured during the operation, life-threatening bleeding can occur in rare cases, with a fatal outcome in the worst case. A successful aneurysm operation, on the other hand, offers those affected the possibility of a largely normal life without medical restrictions.If an aneurysm remains undetected and rupture occurs, it is a medical emergency with a rather unfavorable prognosis. Even with immediate medical intervention, many patients die of circulatory failure due to severe blood loss. If such an aortic aneurysm ruptures internally and this is not detected at all, rapid death of the affected person is very likely. The prognosis in such a case is accordingly extremely unfavorable. However, if the situation in which the aortic aneurysm bursts permits rapid surgery, there is now also a realistic prospect of surviving the rupture. When considering the prognosis of an aortic aneurysm, prevention also plays an important role. Since aneurysms are often hereditary, special examinations for early detection offer the chance of detecting the aneurysm and removing it in a planned operation. In this case, there is a more favorable chance of recovery.
Prevention
To prevent an aortic aneurysm, regular preventive examinations are initially advisable. This can limit the risk that an aortic aneurysm has already grown to a diameter that can be life-threatening when it is discovered. To prevent an aortic aneurysm or its enlargement, it may also be useful to combat appropriate risk factors or prevent them from developing; risk factors that can promote an aortic aneurysm include, for example, atherosclerosis and high blood pressure, as well as poor diet and lack of exercise.
Follow-up
The options for follow-up care prove relatively difficult in most cases of aortic aneurysm. First and foremost, the disease itself must be treated in order to prevent further complications and not reduce the life expectancy of the affected person. If the aortic aneurysm is not detected and treated at an early stage, the worst-case scenario could be the death of the affected person or a significantly reduced life expectancy. Therefore, early diagnosis with timely treatment has a very positive effect on the further course of the disease. Since the aortic aneurysm is usually treated with the help of medication, the affected person must in any case ensure that the medication is taken regularly. Possible interactions with other medications must be taken into account, and a physician can also be consulted. In some cases, however, surgical intervention is also necessary to completely treat the aortic aneurysm. After such a procedure, affected individuals should rest and take it easy on the body. Strenuous activities or stressful activities should be avoided. A healthy lifestyle with a balanced diet also has a positive effect on the course of the disease.
What you can do yourself
If an aortic aneurysm bursts, a life-threatening situation occurs within a very short time. Only immediate intensive medical therapy offers the possibility of survival. In this respect, there is no possibility of self-help in an acute emergency caused by a rupture of the aneurysm. The only concrete thing you can do in this case is to call the emergency number immediately. Therefore, in the field of self-help in everyday life in the case of an aortic aneurysm, self-observation and early detection are of great importance. For example, it is known that aneurysms occur more frequently in some families. Thus, a hereditary component can be assumed. Anyone who knows that cases of aneurysms have occurred in their own family should definitely have themselves examined. If discovered at an early stage, it is possible to wait under close monitoring or to operate promptly. Once an aneurysm has been discovered, it is important that those affected are aware of this risk in their daily lives. They must not only be aware of the necessary checks. They must also make sure to consult a doctor quickly in the event of unclear symptoms such as palpitations, any form of circulatory problems or diffuse pain in the abdomen, and to address the problem of the aneurysm on their own initiative. All persons in the immediate vicinity should also be informed so that they can react immediately in an emergency.
