Aortic Aneurysm

Aortic Aneurysm More than 6000 deaths in the US are attributed to aortic aneurysm both thoracic and abdominal. Almost 15000 to 25000 patients are diagnosed with the condition each year, making it a leading cause of mortality in seniors. The ailment is caused due to the distention of a part of the aortic artery, a major blood vessel that carries blood from the heart. The dilation or aneurysm causes a swelling which is prone to hemorrhage. Overview Aortic aneurysm is classified based on the position of the dilation • Aortic root aneurysm: This refers to a distention of the sinus of the Vulsalva or the root of the aorta. • Thoracic aortic aneurysm: In this condition, the swelling is on the thoracic aorta; the ailment is further classified as descending, ascending or aortic arch aneurysm based on the location of the dilation on the thoracic aorta • Abdominal aortic aneurysms: This is the most common form of the condition; in this case, the dilation is observed on the abdominal aorta • Thoracoabdominal aneurysm: In this form of the condition the thoracic as well as the abdominal aorta are affected. Symptoms Intact instances of aortic aneurysm are generally asymptomatic with overt signs of a malady only experienced upon rupture. Distention of the abdominal aorta are usually accidentally discovered when the patient undergoes a test or surgical procedure for some other medical reasons. The most common symptoms of large aneurysms that may rupture include • Chest pains and tightness • Back pains In fact, any irregular sensation in the thoracic region (upper chest) or the back can be a result of aortic aneurysm. Intense chest pain, described by most as ripping or tearing, is usually felt in case of aortic dissection/rupture. Other symptoms of the extremely serious condition include palpitation, profuse perspiration, dizziness due to loss of blood, shock and rapid breathing. Depending on the size the aortic aneurysm and the growth rate of the swelling, patients may also experience • A pulsating bulge in the abdomen or a strong rippling pulse in the abdominal area • Feeling of fullness even after modest consumption of food • Vomiting • Nausea Because the aneurysm causes the aorta to widen into a bulge, thrombi (blood clots) formation is a real risk. A piece of this clot may get dislodged from the walls of the aorta and travel through the circulatory system causing the disruption or the complete blockage of blood flow to an organ. In more serious cases, this may lead to a stroke or even a heart attack depending on the area of the body to which the blood flow has been stopped. Other vital organs like the lungs, kidneys or liver may also stop functioning properly. In the initial stages or in less severe cases, the emboli may lead to tingling, weakness, numbing, pallor and coldness in one of the limbs along with localized pain and loss of sensation. If the aortic aneurysm ruptures, massive internal bleeding will occur and if immediate surgery is not performed, the loss of blood may lead to death. The symptoms of such a condition include: • Light headedness • Extreme weakness • Confusion • Profuse sweating • Shortness of breath • Rapid heart rate • Numbness or tingling sensation • Dangerously low blood pressure • Fainting Aortic hemorrhage is a very serious condition and you must seek medical assistance immediately. Patients who are afflicted by the aneurysm of the aortic arch may develop a hoarse voice due to the stretching of the recurrent laryngeal nerve which winds around the arch of the aorta. Causes The precise cause of aortic aneurysm is unknown; however, several contributing factors can impact the growth of the swelling. These include: Marfan syndrome: This is a genetic condition which causes the weakening of the connective tissue in the body including the aortic walls, which makes them more susceptible to aneurysms. Other connective tissue disorders: Other ailments that impact the connective tissue like Ehlers-Danlos syndrome may also play a contributing role in the development of the condition. Heart valve problems: Individuals who have problems with the aortic valve are at a higher risk of developing aortic aneurysm. Particularly, people who have a bicuspid aortic valve have a greater susceptibility to the condition. Trauma: Those who have been through accidents that led to trauma in the chest region or a tear in the wall of the aorta are also likely to have aortic aneurysm in the future. Atherosclerosis: This ailment refers to the hardening of the arteries and eventual calcification which leads to damage and clogs that may lead to aneurysms. Atherosclerosis is one of the leading causes of cardiac issues and heart attack. High blood pressure: Unchecked high blood pressure puts undue stress on the arterial walls which may cause them to bulge Diabetes: The disorder is known to cause premature accelerated atherosclerosis. Treatment Depending on the size of the aortic aneurysm and its growth rate, drugs, regular monitoring or surgery may be recommended as a remedial measure. Monitoring and drugs If the aortic aneurysm is small (around 1.2 cm or smaller), your doctor will recommend medical monitoring which will help to track the growth of the swelling and any underlying conditions that may aggravate the ailment. Usually, doctors will ask patients to undergo regular imaging tests to check the size of the aneurysm. Most patients with an aneurysm have to undergo an echocardiogram every 6 months along with other tests. Some of the drugs that may be prescribed to check the growth of the aneurysm or to address any prevalent medical conditions that may be contributing to the growth of the swelling include: • Beta Blockers: These drugs lower the blood pressure by slowing the heart rate. The “olol” family of drugs including atenolol, bisoprolol and metoprolol are all beta blockers • Angiotensin II receptor blockers: This is another form of medication that controls blood pressure. It is usually prescribed when beta blockers prove less than effective; it is also recommended for people who suffer from Marfan syndrome. Some of the drugs in the category include valsartan, Diovan, losartan and olmesartan. • Statins: These help to lower blood cholesterol level which in turn helps to prevent blockages and reduces aortic aneurysm complications. Examples of statins include simvastatin, atorvastatin, lovastatin and others. Surgical intervention to treat aortic aneurysm Although aortic ruptures can be repaired through surgical interventions, the prognosis is generally bleak for patients who go through an episode of aortic hemorrhage with less than 50% surviving the surgery. Even if the procedure is successful, the loss of blood may lead to other acute or chronic conditions like renal failure, leg ischemia, dead bowel and others. Surgery is generally recommended for people who have an aortic aneurysm that is 2.2 inches or larger. In individual who have a history of Marfan syndrome or any other connective tissue ailment or a family history of aortic dissection, surgical intervention may be recommended sooner. Depending on the patient’s specific condition and the location of the aneurysm on the aorta, the surgical procedures required will include: • Open Chest Surgery: This procedure entails the removal of the affected part of the aorta and replacement with a synthetic tube graft. This is an open chest surgery and patients need several months to recover after the procedure. • Endovascular Surgery: In this type of surgery a synthetic graft is inserted into aorta by threading it up from an artery in the leg. The graft is then fastened with the help of small pins or hooks. The woven tube used for grafting lends support to the weakened section of the aorta. • Other surgical procedures: Depending on the contributing factors that have led to the condition or its aggravation additional surgeries may have to be performed. With prompt diagnosis and the proper course of treatment, it is possible to make a full recovery from aortic aneurysm.