Aortic Aneurysm

Risk Factors A risk factor is something that increases your chance of getting a disease or condition.Risk factors for an aortic aneurysm include the following: High blood pressureSmoking Arteriosclerosis, atherosclerosis Inherited connective tissue defects ( Marfan syndrome , Ehlers-Danlos syndrome ) Polyarteritis nodosaBacterial endocarditisSyphilisAge: 60 or older History of heart attackObesityFamily members with aneurysms, particularly male children of an effected motherInfectious aortitisGreat vessel arteritis (Takayasus disease)Injury to the aorta, from either a motor vehicle accident or a stab wound The US Preventive Services Task Force recommends that men aged 65-75 who have ever smoked be screened once for abdominal aortic aneurysm with ultrasound . This is a painless procedure that gives a picture of the abdomen using sound waves. Early detection of abdominal aortic aneurysm in this group has been shown to reduce mortality from this condition. SymptomsMany aneurysms do not have symptoms and are detected during a routine physical exam or during x-ray evaluation for another disorder.

Symptoms may occur when the aneurysm grows or disrupts the wall of the aorta. Symptoms depend on the size and location of the aneurysm and may include: Pain in the abdomen or in the lower backBoring, gnawing, constant pain occurring over hours or daysSudden onset of severe stabbing painUnusual sensation of pulsing in the abdomenCough, shortness of breath (thoracic aortic aneurysm)Sudden blood pressure drop, fainting (upon rupture of aneurysm)HoarsenessDifficulty swallowingCoughing up bloodWeight lossBowel obstructionChest pain DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam. Pain is the symptom that will most likely cause you to go to the doctor. Most aortic aneurysms are discovered during a routine physical exam. Tests may include: Abdominal or chest x-ray Abdominal or chest ultrasound CT scan of the abdomen or chesta type of x-ray that uses a computer to make images of the inside of the body MRI scan of the abdomen or chesta test that uses magnetic waves to make images of the inside of the body Transesophageal echocardiography (ECHO)the use of ultrasound to study the heart and its vessels; a transducer, which records the information, is swallowed by the patient Aortography the use of x-rays and injection of a contrast dye to make images of the heart and the aorta Cardiac catheterization a tube-like instrument is inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply TreatmentTreatment includes surgery or stenting.

Surgery Surgery to repair an aortic aneurysm is called aneurysmectomy . It involves removing the portion of the aorta that contains the aneurysm and replacing it with a mesh graft. With aneurysms of the thoracic aorta, the aortic valve may also be affected and need to be replaced or repaired. If the aneurysm involves important branches of the aorta, these vessels may either be repaired or bypassed. When deciding whether to operate, the doctor will consider: Your ageYour general healthYour symptomsThe size of your aneurysm Associated disease ( kidney failure, stroke , etc.) If the aneurysm has ruptured or not If you've had a recent heart attack StentingDepending on where the aneurysm is located and how complex it is, stenting may be done. A stent-graft is a polyester tube covered by a tubular metal web. The stent-graft is inserted through a small incision in the upper thigh into the aorta. Using x-ray, it is guided through the aorta to the site of the aneurysm. With the stent-graft in place, blood flows through the stent-graft instead of into the aneurysm, eliminating the chance of rupture. Prevention There are no guidelines for preventing an aneurysm because the cause is not known. However, you can reduce some of your risk factors by following these recommendations:

Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.Don't smoke. If you smoke, quit.Maintain a healthful weight.Begin a safe exercise program as recommended by your doctor.Seek treatment for high blood pressure, syphilis, and other infections.If you have Marfan syndrome, see your doctor regularly for monitoring and CT scans. RESOURCES: American Heart Associationhttp://www.americanheart.org The National Heart, Lung and Blood Institutehttp://www.nhlbi.nih.gov/health/ CANADIAN RESOURCES: Canadian Cardiovascular Societyhttp://www.ccs.ca/home/index_e.aspx Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca References: American Heart Association website. Available at: http://www.americanheart.org . Cecil Textbook of Medicine . 21st ed. WB Saunders Company; 2000. Heart Disease: A Textbook of Cardiovascular Medicine . 6th ed. WB Saunders Company; 2001. Sabiston Textbook of Surgery .16th ed. WB Saunders Company; 2001. US Preventive Services Task Force. Screening for Abdominal Aortic Aneurysm: Recommendation Statement. AHRQ Publication No. 05-0569-A, February 2005. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm . Accessed on January 15, 2006.

Last reviewed February 2008 by Michael J. Fucci, DOPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.