An aortic aneurysm is a balloon-like bubble formed in an enfeebled and vulnerable section of the wall of the aorta, which is the principal artery exiting the heart. This kind of aneurysms can burst or split, causing potentially fatal internal haemorrhaging, or obstruct blood flow from the heart to different organs.

Aortic aneurisms have 2 locations:

Thoracic aortic aneurysm (TAA): Happens in the chest
Abdominal aortic aneurysm (AAA): Happens in the abdomen, below the diaphragm

The incidence of AAA is more frequent than that of TAA, perhaps because the wall of the thoracic aorta is thicker and stouter than the wall of the abdominal aorta.

Common risk factors for aortic aneurysms include:

Smoking
Being over 65 years of age
Male
Family history of aortic aneurysms
Hypertension
Substance abuse
Congenital heart valve defect called bicuspid aortic valve

Aortic Anuerysm

Common symptoms of a ruptured aortic aneurysm:

Giddiness or feeling light-headed
Accelerated heart rate
Sudden sharp pain in the chest, abdomen or back

Common symptoms of an unruptured aortic aneurysm:

Shortness of breath
Feeling of heaviness after a small meal
Pain in the neck, chest, back or abdomen
Difficulty swallowing
Swollen arms, neck or facial region

How are aortic aneurysms diagnosed?

Very often, such bulges don’t manifest in any telltale signs and are often chanced upon during routine screening. When there are symptoms, doctors can suggest imaging tests like:

CT scan
CT or MRI angiography
Ultrasound

How are aortic aneurysms treated?

Once it ruptures, an aortic aneurysm requires emergency surgery to repair it, or else it can prove fatal. However, if it is diagnosed before bursting and the bulge is still relatively small, doctors might opt to wait and watch, prescribing periodic reviews with tests like CT scan or echocardiogram to monitor the size of the bubble.

Meanwhile, to keep cholesterol count and blood pressure level under control, the medical team can put the patient on medications like beta-blockers, statins, ACE inhibitors and angiotensin 2 receptor blockers. The patient will be advised to quit smoking and refrain from doing vigorous exercises.

When there’s a danger of rupture, surgery is a better option and is usually recommended if the aneurysm is larger than 5cm or growing rapidly. The damaged section of the aorta is either replaced or strengthened.

Types of aneurysm surgery:

Open repair: In this procedure, the portion of the aorta which carries the bubble, is severed out and a graft or an artificial tube is stitched in its place. This surgery is usually performed when the aneurysm is in the chest and the patient generally recovers in a month or so.
Aortic root surgery: This type of open surgery is carried out to treat a swollen portion of the aorta to preempt a rupture. When an aortic aneurysm is located close to the aortic root, it could be linked to Marfan syndrome or other such conditions. In such cases, the diseased section of the aorta is removed, sometimes even the aortic valve. While a graft is used to replace the removed part of the aorta, the aortic valve is substituted with a mechanical or biological valve. When the valve can be retained, the procedure is termed ‘valve-sparing aortic root repair’.

Endovascular repair or EVAR: EVAR is a less invasive technique which involves strengthening the aorta with a mesh-like structure. A catheter is threaded through the blood vessel from the wrist or groin to reach the aneurysm location. A stent graft is then inserted by the doctor which swells and sticks to the inner wall of the aorta to prop it up. EVAR is more commonly used in abdominal aortic aneurysms and the patient normally recovers quite fast, albeit regular reviews are required to make sure the stent hasn’t moved or leaked.

How can aortic aneurysms be prevented?

Hypertension, elevated cholesterol levels and smoking are the major triggers which heighten the risk of aortic aneurysms. So, doctors advise a healthy lifestyle involving:

A heart-healthy diet
Regular exercise
Watching your weight
Quitting smoking/tobacco use