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Aortic Aneurysms:
Symptoms, Causes, Diagnosis & Treatment

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1.What is an Aortic Aneurysm?

An aortic aneurysm is the swelling of the aorta's wall. Aorta is a major blood vessel that is responsible for the blood circulation from your heart to the rest of your body. In the case of aortic aneurysm, there is no specific location where the swelling may occur, it may occur anywhere in the aorta. The bulge can be round or the shape of a tube. Aneurysm usually happens when the blood vessel becomes weak. The weak spot in the vessel expands due to the constant blood flow. In the beginning, the swelling is small but eventually, it may become bigger with the increase in pressure. An aortic aneurysm is considered dangerous.

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2.Aortic Aneurysms symptoms and causes

There are two types of aneurysm; abdominal aortic aneurysm and thoracic aortic aneurysm. The symptoms and causes of each are discussed below.

Abdominal aortic aneurysm symptoms might not be observed immediately and sometimes there are no symptoms at all. Some types of abdominal aortic aneurysm are hard to identify and some stay small always while others become bigger with time. Some abdominal aortic aneurysms become large pretty quickly. When an abdominal aortic aneurysm is increasing in size, there are certain symptoms. You may have back pain, abdominal pain, especially on the sides. You may feel a pulse around your belly button area.

Causes of abdominal aortic aneurysm are as follows:

  • Atherosclerosis is one of the major causes. In atherosclerosis, there is a build-up of fat in the blood vessel.
  • A rare cause of an abdominal aortic aneurysm is a fungal infection. A bacterial infection may cause an abdominal aortic aneurysm too.
  • Any diseases that cause blood vessels to inflate or bulge may contribute to an abdominal aortic aneurysm.
  • An injury or trauma may cause an abdominal aortic aneurysm. For example, if you were involved in an accident then you are at a higher risk to have an abdominal aortic aneurysm.
  • An increase in blood pressure may cause damage to the aorta. So, high blood pressure is one of the causes of an abdominal aortic aneurysm.

Thoracic aortic aneurysm symptoms are as follows:

Unlike abdominal aortic aneurysm, symptoms of Thoracic aortic aneurysm are hard to recognize. However, there are some signs and symptoms that indicate a thoracic aortic aneurysm. You might be constantly coughing all the time. You might feel like your voice becomes hoarse. You might feel like you are out of breath more often even when you are not doing anything. Pain in the back and chest are some of the other common symptoms of thoracic aortic aneurysm.

Causes of thoracic aortic aneurysm are as follows:

  • Certain medical conditions such as conditions that cause inflammation may lead to thoracic aortic aneurysm.
  • Atherosclerosis is a contributing factor that may cause thoracic aortic aneurysm and it is more common in the elderly.
  • An injury caused due to an accident may lead to thoracic aortic aneurysm, although this is a rare occurrence.
  • People who have bicuspid aortic valves are more prone to thoracic aortic aneurysm. Anyone with aortic valve problems are more likely to have a thoracic aortic aneurysm.
  • Certain genetic conditions can lead to the development of a thoracic aortic aneurysm. Some examples include Marfan syndrome, Loeys-Dietz syndrome, and Ehlers-Danlos.
  • If there is an infection that was left untreated or inadequately treated, it may lead to thoracic aortic aneurysm.

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3.Types of Aortic Aneurysm

Abdominal aortic aneurysm:

Types of aortic aneurysm

An abdominal aortic aneurysm occurs in the part of the aorta that is near the abdomen. Certain factors make you more prone to having an abdominal aortic aneurysm. If you are 65 years old or more, then you are more likely to have an abdominal aortic aneurysm. If you smoke regularly then there is a higher chance of abdominal aortic aneurysm. Males are more likely to have an abdominal aortic aneurysm and so are people of fair complexion. If you have a family history of abdominal aortic aneurysm, then your chances of having an abdominal aortic aneurysm are high.

Thoracic aortic aneurysm

Thoracic aortic aneurysm

A thoracic aortic aneurysm occurs in the section of the aorta that is near the chest. There are various risk factors of thoracic aortic aneurysm. The chances are high if you have a family history of someone with a thoracic aortic aneurysm. If you have high blood pressure, then you are more likely to have the problem. If you have certain disorders, then you are at a higher risk. If you consume tobacco and you are 65 years old or more, then you are highly likely to have a thoracic aortic aneurysm. If you have atherosclerosis, then you are more likely to have a thoracic aortic aneurysm. People with a bicuspid aortic valve are at a higher risk too.

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4.How to prevent Aortic Aneurysms?

At present, there are no medications that help to prevent aortic aneurysms. However, there are some ways in which you can prevent them. The following are some of the prevention strategies.

  • If you smoke, then consider quitting smoking because it is a risk factor of aortic aneurysms. You should avoid being exposed to passive smoking.
  • You should focus on switching to a balanced diet that is low in cholesterol. Eating a low-fat diet will help improve the strength of your blood vessels.
  • You should make sure to keep your blood pressure under control. Your doctor can help you by prescribing medications if necessary.
  • You should get regular exercise. It is recommended that you do about an hour and a half of aerobic exercise per week.
  • You should get yourself screened when you turn 55 years old or more. This will ensure that any aortic aneurysm is detected on time.

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5.Aortic Aneurysm Diagnosis and Aortic Aneurysms Treatment

Aortic aneurysm diagnosis and treatment

Abdominal aortic aneurysm diagnosis

An abdominal aortic aneurysm can be diagnosed when you have your routine medical tests. Else, if you are having your abdomen or your heart examined, then your doctor can find out if you have an abdominal aortic aneurysm or not. Your doctor will first take a look at your medical history to see whether you are at risk. Your family history will be analyzed to see how likely you are to have an abdominal aortic aneurysm. Then, your doctor will conduct a physical exam. By this point, your doctor will get an idea about whether you have an abdominal aortic aneurysm or not. If s/he thinks that you might have it, s/he will perform other tests such as MRI, abdominal ultrasound and CT scan.

Treatment of abdominal aortic aneurysm

The treatment that your doctor provides you depends on two factors. It depends on how prominent the aortic aneurysm is and the rate at which it is growing. The aim of treating aortic aneurysm is to ensure that the aortic aneurysm does not rupture. Two treatment options are available; medical monitoring and surgery.

Medical monitoring is the treatment option that is best for you when your abdominal aortic aneurysm is not that prominent. Moreover, it might be chosen when there are no symptoms of an abdominal aortic aneurysm. You will have to visit your doctor regularly to ensure that the abdominal aortic aneurysm is not growing as there are chances that it can. Your doctor might choose to treat your other conditions that increase the risk factor of abdominal aortic aneurysm. For instance, if you have high blood pressure, then your doctor might give you medications and other treatment options to ensure the risk is kept low.

One of the treatment options is abdominal aortic aneurysm repair. This is used when the aortic aneurysm is anywhere between 4.8 centimeters to 5.6 centimeters. But, this method can be used when the aortic aneurysm is larger. If the abdominal aortic aneurysm is growing fast, then repair may be necessary. In addition to this, if you are showing certain symptoms, then your doctor might advise you to go for surgery. For instance, symptoms such as stomach ache might require you to consider surgery. If you have an aneurysm that is tender or if you have a leaking aneurysm, then you might require surgery too.

There are two types of repair options. The option that is best for you depends on what conditions you are currently suffering from, your overall health, your age, and the specifics of the aneurysm. Open abdominal surgery is the first option. In this surgery type, the aorta part that has been damaged is first removed. Then a synthetic tube is used to replace the damaged aorta part with the graft. It can take a few months for you to recover completely when you have open abdominal surgery. Another repair option is endovascular repair.

Endovascular repair is another abdominal aortic aneurysm surgery option that your doctor might suggest. In this type of repair, a synthetic graft is used. It is placed where the aneurysm is. It is first expanded and then placed on the site of the aneurysm. A catheter is used and a graft is attached at one end. Your doctor then threads it through an artery in your leg. The endovascular repair prevents the aneurysm from rupturing. This type of repair is a less invasive procedure. Once the procedure is complete, you will be required to go for imaging tests. These tests are to see that the repair is not leaking and is as it should be.

Thoracic aortic aneurysms diagnosis

Just like an abdominal aortic aneurysm, thoracic aortic aneurysm can be found during your routine medical tests. If your doctor thinks that you might have developed a thoracic aortic aneurysm, then he might recommend you to get some tests done, such as echocardiogram, CT scan, chest X-ray, and an MRI scan.

Thoracic aortic aneurysm treatment options

There are three treatment options available for thoracic aortic aneurysm; medical monitoring, medications, and surgery.

In medical monitoring, your thoracic aortic aneurysm is going to be monitored. This option is used when the thoracic aortic aneurysm is small. Your doctor might prescribe certain medications for you. Besides, if you are suffering from other conditions that can potentially cause more damage, then your doctor might recommend treatment options accordingly. Your doctor will ask you for your medical history, family history, and will perform imaging tests. The imaging tests include magnetic resonance angiography (MRA), echocardiogram, and CT scan. These can be done after a few months following diagnosis.

There are various medications that your doctor might prescribe depending on your current health issues and what might increase the complications. For instance, artery blockages and high blood pressure can increase the risk of complications arising from a thoracic aortic aneurysm. Hence, your doctor might prescribe medicines accordingly. Statins might be prescribed by your doctor if you have a high cholesterol level. Statins are medications that help decrease artery blockages and hence reduces the risk of complications. Some examples of statins include simvastatin and atorvastatin.

Beta-blockers are often prescribed to people who have high blood pressure. Beta-blockers work by decreasing your heart rate. Some examples of beta-blockers are bisoprolol and metoprolol. Another medication option is angiotensin II receptor blockers. These are used if beta-blockers are unable to keep your blood pressure under control. If for some reason you cannot take beta-blockers, then these can be prescribed. Examples of angiotensin II receptor blockers include olmesartan and losartan. These can be recommended to people who have certain conditions such as Marfan syndrome.

Your doctor may advise you to go for a surgery for a thoracic aortic aneurysm if it is up 5 centimeters or bigger. If you have a connective tissue disease or if you have a family history of aortic dissection, then your doctor is likely to recommend surgery. Moreover, if you have a bicuspid aortic valve, then your doctor will most probably recommend surgery. If your doctor thinks that you have a higher chance of having an aortic dissection, then s/he will recommend surgery. Various types of surgeries can be recommended to you depending on the specific details of the thoracic aortic aneurysm.

Open chest surgery is the most common type of thoracic aortic aneurysm surgery and it is somewhat like the open abdomen surgery discussed previously. In this, the damaged aorta part is removed and then a graft is sewn in its place. You might require an aortic root replacement surgery if you have conditions such as Marfan syndrome. An aortic root replacement surgery is performed when an aorta’s part needs treatment that is near the place where the aorta and heart connect. Your doctor will remove a part of the aorta along with the aortic valve. A graft is used to replace the aorta part that has been removed. Instead of an aortic valve, a biological valve will be placed.

Another surgery option is endovascular surgery and it is similar to the one discussed in the abdominal aortic aneurysm section. Other surgical options are available too. The surgeries that your doctor will recommend depend on the problem that is causing your aneurysm to develop. For example, if the heart valves are causing the thoracic aortic aneurysm to develop, then he will perform surgery that will help to repair the valves. This can be done by repairing the valves or replacing the valves to ensure that your thoracic aortic aneurysm is treated.

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6.Outlook and Prognosis

People tend to think that since an aortic aneurysm is a serious condition, it isn’t possible to completely heal from it. However, that is not true at all. It is highly possible that you can recover completely after immediate diagnosis and appropriate treatment. Most people have a favorable outlook after proper treatment is given promptly to them. As long as you get the treatment that you require before further complications occur, you are safe and may heal completely from any type of aortic aneurysm. Hence, it all depends on the medical care that you get once you know you have an aortic aneurysm.

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7.Road to Recovery and Aftercare

Recovery can take time but it is possible to completely heal after an aortic aneurysm. However, since it usually occurs in elderly people, the recovery may seem slow. But with proper aftercare and precautions, it is possible to lead a happy and healthy life. Recovery depends on the type of treatment you have received and how well you cope after the treatment. You should make a note of what your doctor tells you about aftercare because it can vary from patient to patient. You will most likely be required to have specialized tests done to ensure that you are healthy and fine. Your doctor will give you the specifics of how to best take care of yourself after treatment.

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8.Aortic Aneurysm FAQs: All your concerns addressed

Q.   What are the complications associated with aortic aneurysms?

  1. There are various complications of aortic aneurysms. An aortic dissection is a major complication. Another complication is a ruptured aneurysm which can be life-threatening. The risk depends on the size of the aneurysm and how fast it is growing. There is a higher chance of blood clots developing in the case of aortic aneurysm. It may lead to blood flow blockage. This can happen anywhere in your body.

Q.   What are the symptoms of thoracic aortic aneurysm rupture?

  1. When the thoracic aortic aneurysm has ruptured, there are several symptoms that you might experience. You may experience partial paralysis of a body part. You might experience sudden weakness along one side of your body. You might experience signs of stroke such as the inability to speak properly. You might have trouble breathing. You might start to feel dizzy. Another symptom is difficulty in swallowing. You might have sharp pain in your chest or back area. You might have low blood pressure.

Q.   Is there anything I can do to ensure that the aneurysm does not rupture?

  1. Your doctor will let you know about it but there are some things that you can do too. Once you are diagnosed with aortic aneurysm you should avoid any type of physical activity. You should avoid lifting anything heavy too. These ensure that your blood pressure does not increase to dangerous levels. This helps to ensure that the aneurysm does not rupture. If you wish to exercise then you should speak to your doctor about it so you know which types of exercises are safe for you to do. Usually, moderate exercise is fine but still, you should consult your doctor about it.
    Prevention techniques can help too. Eating a diet that is low on cholesterol level and low in fat is something that can help. You should focus on keeping your blood vessels healthy. If you consume tobacco, then reducing and eventually quitting it is the best precaution you can take. One of the factors that increase your blood pressure is stress. You should ensure that you can manage your stress levels. If there is something that causes your stress levels to go high, then your doctor might prescribe medications or techniques to enable you to manage your stress.

Q.   What are the symptoms of abdominal aortic aneurysm rupture? And is treatment possible?

  1. You may feel a tearing sensation that is pretty intense in your back area or your abdomen area. Another symptom is dangerously low blood pressure. A fast pulse is another indicator that the abdominal aortic aneurysm has ruptured. Surgeons can repair an aortic aneurysm that has ruptured through aortic aneurysm surgery. However, you should know that the risk is high and so are the chances of you having various complications.

Q.   What is an aortic dissection?

  1. People tend to confuse aortic dissection with an aortic aneurysm but the two of them are different. Aortic dissection is when the aorta’s wall tears. This leads to bleeding inside the wall of the aorta. In certain situations, the bleeding may spread outside the aorta which is known as rupture. This is an emergency regardless of where it occurs as it requires surgery. But even after surgery, there is a high chance of having several complications. The key is to treat aortic aneurysm before it leads to aortic dissection.

Q.   How should I prepare for my appointment?

  1. If you think that you might have an aortic aneurysm, then you should ask your doctor if you need to do anything in advance. For example, if you think that you are highly likely to have an aortic aneurysm, then your doctor might recommend you to undergo some tests. You might be required to fast for a certain period before the test which is why you should be prepared in advance by checking with your doctor. This will help ensure that you are screened in advance. The earlier the aortic aneurysm is diagnosed, the faster the treatment can begin and the better the outlook.
    You should write down all the symptoms that you experience so your doctor knows about them. Anything that seems off should be written down. You should write about any medications that you take; prescribed and over-the-counter as well. You should have information ready about your family’s medical history and whether they had the problem of aortic aneurysm. You should let your doctor know about your habits such as smoking. You should openly speak to your doctor about how much exercise you do and the type of diet that you eat daily. Telling your doctor about your lifestyle is a good option too.
    Don’t forget to write down the questions you want to ask your doctor and anything else that you think might be of value. For instance, if diet changes need to be made then ask your doctor about it. You should never hesitate to ask any questions to your doctor regardless of how silly they may sound to you. Instead of assuming, it is better to have the advice of your doctor. If you wish, then you can take a loved one with you so that they can accompany you to the doctor’s appointment.

Q.   Can you survive an abdominal aortic aneurysm?

  1. Abdominal aortic aneurysm, in most cases, is asymptomatic. However, it becomes evident when it grows in size and people develop a pain or a pulsating feeling in their abdomen. Some people may also complain of persistent back pain. Usually, AAA or abdominal aortic aneurysm doesn’t pose a serious threat to health. But if a large aneurysm ruptures, it can lead to massive internal bleeding, which can be fatal. On an average, eight out of ten people with a rupture either die before they reach the hospital or don’t survive surgery. The most common symptom that a ruptured aortic aneurysm produces is a sudden and severe pain in the abdomen.

Q.   Who is at risk for an aortic aneurysm?

  1. Certain factors that put individuals at a risk for aneurysm include
    • Atherosclerosis – a build-up of fatty deposits in the arteries leading to blockage in the blood flow
    • Smoking – Smoking can increase your chances of developing an aneurysm by eight times.
    • Being overweight or obesity
    • A family history of aortic aneurysm, heart disease or other diseases of the arteries
    • There are many diseases that can weaken the wall of the aorta like Marfan syndrome, untreated syphilis, and tuberculosis.
    • Trauma that could have been caused from a blow to the chest in a car accident
    • People between the ages of 35 and 60 and with a severe and persistent high blood pressure are at a higher risk for a cerebral aneurysm.
    • Use of stimulant drugs, such as cocaine

Q.   Will I need surgery to treat an unruptured aneurysm?

  1. If the aneurysm hasn’t ruptured, the doctor will decide if it should be treated now or monitor it carefully. Certain aneurysms are more likely to bleed or rupture. In such cases, your healthcare team will determine the course of treatment for the aneurysm. The two most effective treatment methods for aneurysm today are microsurgical clipping and endovascular clipping.

    In microsurgical clipping technique, a metal or titanium clip is used to prevent the blood from flowing into an aneurysm. On the other hand, the endovascular coiling approach involves placing a stent, tube or coils inside a blood vessel to divert blood away from an aneurysm.

Q.   What does it mean when an aneurysm bleeds?

  1. An aneurysm is like a balloon that has developed in the wall of a blood vessel. As it grows in size, the walls stretch until it eventually ruptures and spills the blood on the surrounding tissues. If the aneurysm has formed in a blood vessel leading to the brain, the blood after the rupture can spread out on the brain’s surface, which is called subarachnoid haemorrhage.

Q.  How big does an aneurysm get before it bursts?

  1. Usually, aortic aneurysm increases in size slowly. Over time, the wall stretches and bulges out like a balloon. If it doesn’t grow much, people can live with it for years. However, the risk of rupture can increase with the increase in the size of the aneurysm. In one-third of cases, where the aortic aneurysm grew larger than two inches in width, ruptured within five years. The risk of death after the rupture of an aneurysm is about 90%.

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