Brief overview
- Symptoms: Often asymptomatic, possibly pain in abdomen and back (abdominal aortic aneurysm), possibly cough, hoarseness, shortness of breath (thoracic aortic aneurysm), in case of rupture devastating pain, shock, unconsciousness
- Treatment: Depending on size and growth of the aneurysm, in case of risky size surgical intervention, stent or vascular prosthesis
- Examination and diagnosis: Often incidental finding, ultrasound examination, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), angio-computed tomography (angio-CT)
- Causes and risk factors: Risk increases with age, arteriosclerosis, high blood pressure, smoking, predisposition, rare hereditary diseases such as Marfan syndrome, Ehlers-Danlos syndrome, infections
- Prevention: measures that contribute to vascular health, healthy lifestyle, not smoking, treatment and control of hypertension, screening for certain groups of people to prevent threatening complications such as rupture
What is an aortic aneurysm?
In more than 90 percent of cases, the aortic aneurysm is located in the abdomen, especially below the outlet of the renal vessels (infrarenal aortic aneurysm).
Sometimes the vessel outpouching is also located in the thorax (thoracic aortic aneurysm). Even an aneurysm in the heart is possible. In about half of the cases, it is located in the ascending part of the main artery of the heart (ascending aorta), in 40 percent in the descending part (descending aorta) and in every tenth person affected in the so-called aortic arch.
Normally, the diameter of the aorta is 3.5 centimeters in the chest region and 3 centimeters in the abdominal region. In the case of an aortic aneurysm, the diameter sometimes measures twice that.
What are the symptoms of an aortic aneurysm?
Aortic aneurysm: symptoms in the abdominal region
An abdominal aortic aneurysm then leads, for example, to symptoms such as back pain radiating to the legs and digestive problems. In rare cases, the physician feels the aneurysm in the abdomen as a pulsating lump under the abdominal wall.
Aortic aneurysm: symptoms in the chest area
An aortic aneurysm in the chest (thoracic aortic aneurysm) also often causes no symptoms. However, when symptoms do occur, they sometimes include the following:
- Chest pain
- Cough
- Hoarseness
- Difficulty swallowing
- Shortness of breath
Ruptured aortic aneurysm
The larger the aortic aneurysm, the greater the risk of rupture. An abdominal aortic aneurysm greater than 5.5 centimeters in men and 5.0 centimeters in women is considered risky and in need of treatment.
How can an aortic aneurysm be treated?
Aortic aneurysm – surgery or wait and see?
The correct treatment of an aortic aneurysm depends primarily on its size. Smaller, asymptomatic aortic aneurysms are checked by the physician once a year, larger ones twice a year by ultrasound. It is important that the blood pressure remains in the lower normal range (120/80 mmHg). For this, the doctor may prescribe an antihypertensive medication.
It is also important to treat other risk factors for aortic aneurysm such as dyslipidemia or diabetes mellitus. It is also strongly advised to stop smoking.
Certain factors and behaviors increase pressure in the abdomen or chest. People with an aneurysm should avoid these. These include not lifting heavy things, for example. It is also helpful for those affected to learn how to breathe properly under pressure.
If an aortic aneurysm in the abdominal aorta reaches a diameter of 5.5 centimeters in men and 5.0 centimeters in women, doctors recommend surgery. The same is true for a thoracic aneurysm that reaches a diameter of 5.5 centimeters or more, as well as for a smaller aneurysm if the doctor observes that it is increasing in size by more than 10 millimeters per year.
Treatment for abdominal aortic aneurysm
There are basically two treatment methods for abdominal aortic aneurysm. Which one is used depends on the location of the aortic aneurysm and the condition of the vessel.
- Stent (endovascular procedure): The physician advances a small tube (stent) through the inguinal artery to the wall bulge – the stent stabilizes the vessel and bridges the aortic aneurysm.
- Surgery: During surgery, the surgeon removes the dilated portion of the artery wall through an abdominal incision and replaces it with a tubular or Y-shaped vascular prosthesis.
Treatment for thoracic aortic aneurysm
How can an aortic aneurysm be detected?
Doctors often discover an aortic aneurysm by chance during a routine examination. For example, physicians more often detect an abdominal aortic aneurysm during an ultrasound examination of the abdomen.
When listening with a stethoscope, the physician sometimes notices flow noises above the vessel outpouching. In slender people, a larger aneurysm of the abdominal aorta may be palpable with the hands through the abdominal wall.
Doctors also usually discover a thoracic aortic aneurysm by chance, most often during an X-ray of the lungs. The physician obtains a more exact picture by means of heart ultrasound. During this examination, parts of the aorta are also clearly visible.
Details about the size and danger of an aortic aneurysm are provided by computed tomography (CT) or magnetic resonance imaging (MRI) and possibly magnetic resonance angiography (MRA, imaging of the vessels).
Over-65 screening for abdominal aortic aneurysms
- Men aged 65 and over
- Women 65 years of age and older who are current smokers or have previously smoked
- Individuals of any age who have first-degree relatives with an aortic aneurysm
According to statistics, nine out of every hundred men between the ages of 65 and 75 are affected by an abdominal aortic aneurysm – and the number is growing. In fact, 22 percent of those over 85 are already affected. An aneurysm rarely ruptures, but if it does, the patient is at risk of bleeding to death.
Women are much less likely to develop an abdominal aortic aneurysm. Two percent of women between 65 and 75 and slightly more than six percent of those over 85 are affected. Therefore, the recommendation for screening does not generally apply to all women of this age. However, experts still advise that women at higher risk should also be screened.
What are the causes and risk factors of aortic aneurysm?
In more than 50 percent of cases, vascular calcification (atherosclerosis) is the cause of an aortic aneurysm. It also frequently develops in people with high blood pressure (hypertension). High blood pressure stresses the vessels and is also a risk factor for atherosclerosis.
Bacterial infections are also sometimes causally involved in the development of an aneurysm. The infection causes the vessel wall to become inflamed and eventually change to form the vessel bulge. This is called a mycotic aneurysm.
Aortic aneurysm: Rare causes
Very rare causes of aortic aneurysm include inflammation of the vessel wall, for example, in infections such as advanced syphilis or tuberculosis.
Another possible cause of an aortic aneurysm is a so-called type B dissection, which is a splitting of the individual layers of the vessel wall in the aorta. Doctors also refer to the split artery wall as aneurysm dissecans.
How can an aortic aneurysm be prevented?
Certain measures can be taken to prevent some risk factors for aortic aneurysm, such as atherosclerosis and high blood pressure.
These include:
- Healthy diet
- Sufficient exercise
- Healthy blood pressure, blood sugar and cholesterol levels (or treatment and control of these if needed)
- @ Not smoking
Attend regular checkups with your doctor, because most of the time the diagnosis is an incidental finding. Regular health checks increase the chance of detecting an aortic aneurysm early, before it develops to a life-threatening size.
