A definition for an aortic aneurysm may be as follows: An aortic aneurysm is a bulge in the aorta of various types and locations that can burst and lead to fatal internal bleeding. The following topics include causes, classification, symptoms, and treatment.
Aortic aneurysm: causes and forms.
Aneurysms are bulges in the arterial vessels that occur at specific locations and predominantly affect the aorta. Basically, three different types can be distinguished from each other:
- Aneurysm verum
- Aneurysm dissecans
- Aneurysm spurium
Aneurysm verum
The “true” or “correct” aneurysm verum (verum = true in Latin) represents the most common of the three forms of aneurysm. It is characterized by an increasing bulge at a specific point in the vascular cord, thus resembling a rubber bubble on a water hose. Despite the bulging, the vessel wall as a whole remains intact. In most cases, aneurysm verum is caused by atherosclerosis of the aorta, which damages the vessel wall and promotes its bulging. Elevated blood pressure is an important risk factor both for the development of vascular calcification and for the increasing expansion of the aneurysm. Once an aneurysm has formed, the blood flow pulsating at high pressure causes it to expand further and further. In rarer cases, a congenital weakness of the vessel wall or a chronic syphilis or fungal infection may also be considered as triggers of an aneurysm verum.
Aneurysm dissecans
In aneurysm dissecans (dissecare = to cut into in Latin), which is found in about 25 percent of cases of aortic aneurysm, the inner lining of the vessel characteristically tears at a specific point in a longitudinal or transverse direction. The blood that is forced into the aorta at high pressure can subsequently burrow into the vessel wall and cause the aorta to sag. In contrast to aneurysm verum, congenital defects of the vessel wall predominate as the cause, and atherosclerosis tends to take a back seat to them.
Aneurysm spurium
Aneurysm spurium (spurius = Latin for spurious) occupies a special position in that it corresponds less to an aneurysm than to a small tear in the vessel through which blood can leak out. Clotted blood eventually surrounds the resulting vascular defect like a plug, preventing further bleeding in most cases. Aneurysm spurium occurs predominantly as a complication after surgery or puncture of arterial vessels.
Aortic aneurysm: symptoms and signs
Aneurysm verum of the aorta is found preferentially in the abdomen, where it can also be palpated as a pulsatile large nodule centrally below the costal arch, at least in slender patients. While this so-called abdominal aortic aneurysm leads predominantly to abdominal pain, flatulence, irregularities in bowel movements or sometimes also to an increased urge to urinate, in the case of the aneurysm verum in the thoracic region back pain is in the foreground. However, pressure from the pulsatile aortic aneurysm on surrounding structures can also cause hoarseness, shortness of breath, difficulty swallowing, and circulatory problems in the arms or head. A similar pattern of symptoms can also result from the less common aneurysm dissecans, which usually begins just above the aortic valve and can involve the entire aorta, extending into the abdomen. Aneurysm spurium rarely takes on dimensions as large as the other two types of aneurysms, but it can produce similar symptoms depending on its location.
Aortic aneurysm: progression
The decisive criterion for assessing the dangerousness of an aneurysm verum is the diameter of the bulge. This value can vary between 3 cm and, in extreme cases, up to 8 or 9 cm, with a critical diameter of 5 to 6 cm or more posing the risk of the outpouching bursting and causing life-threatening internal bleeding. In purely statistical terms, abdominal aortic aneurysms, for example, burst from a diameter of 5 to 6 cm in up to 40 percent of cases within 2 years. Aneurysms dissecans are even more dangerous than aneurysms verum because the already weakened and additionally torn vessel wall often cannot withstand the pressure of the blood flow for long.If the initial internal rupture of the aortic wall, which is accompanied by severe chest or abdominal pain, is survived, the repeated rupture of the damaged vessel wall, this time to the outside, often results in a fatal internal hemorrhage.
Aortic aneurysm: diagnosis and diagnosis.
Diagnosis of an aneurysm is made by either ultrasonography, computed tomography, or direct vascular imaging with x-ray contrast. In the latter procedure, the vascular tree with all irregularities, constrictions, and even bulges can be seen directly in the x-ray image.
