Definition

An aortic aneurysm is an abnormal dilation (aneurysm) of a section of the aortic blood vessel. This dilation causes a bulging part of the blood vessel, similar to a sac or balloon. If ruptured; this sac can disrupt blood vessel flow and cause serious complications.

Blood in the body flows into blood vessels. Humans have three types of blood vessels: arteries (carrying oxygen-rich blood), veins (carrying carbon dioxide-rich blood), and capillaries (blood vessels that bridge arteries and veins). The aorta is the main and largest artery in the body. It is directly connected to the heart and serves as the first conduit for oxygen-rich blood before transporting it to the rest of the body.

The aorta extends from the chest cavity to the kidneys. The aorta in the chest cavity is known as the thoracic the aorta, and the aorta in the abdomen is the abdominal aorta. Aneurysms can occur along these aortic blood vessels. Aortic aneurysms are classified according to these divisions:

• If it occurs in the thoracic aorta, the aneurysm is referred to as a thoracic aortic aneurysm
• If it occurs in the abdominal aorta, the aneurysm is referred to as an abdominal aortic aneurysm (AAA)

These two are the most common types of aneurysms; however, aneurysms can occur in other blood vessels, including the popliteal artery (in the knee), renal artery (kidney), and others.

According to CDC data in the United States, aortic aneurysms caused 9904 deaths in 2019.  About 59% of these cases were in men,, and 75% of patients had a history of smoking. This prompted the United States to impose screening requirements for all males aged 65 to 75 with a history of smoking, even if they had no symptoms.

Causes

The aorta, the largest blood vessel that must withstand high-pressure, has a thick and durable wall lining. However, wall can weaken as a result of certain conditions, such as chronic high blood pressure or genetic disorders. If a section of the aortic wall weakens, high-pressure blood flow pushes against it, causing it to dilate. If the dilation continues, a sac could form. This condition is referred to as an aneurysm.

Things that can disrupt the structure of the aortic wall include:

• Atherosclerosis. Fat can adhere to the walls of blood vessels, resulting in stiffness. This condition is known as atherosclerosis
• High blood pressure. Chronic high blood pressure (over a long time) can weaken the blood vessel walls
• Certain medical conditions such as Marfan's syndrome, where there are connective tissue disorders throughout the body
• Inflammation of the blood vessels due to infection or other medical conditions,
• Blood vessel injury from an accident

Risk Factor

The following factors can increase the risk of developing an aortic aneurysm:

• Tobacco use. Smoking is a major risk factor for aortic aneurysms. Smoking can weaken the blood vessel walls, increasing the risk of aneurysm formation and rupture
• Age. People who are 65 years of age or older
• Family history. A family history of aortic aneurysm increases the risk of developing an aortic aneurysm in the future
• A history of high blood pressure and high cholesterol can disturb the structure of the blood vessel wall and increase the risk of aneurysms

Symptoms

Aortic aneurysms typically cause no symptoms and develop slowly which makes it difficult to detect. Some aneurysms never tear, rupture, or cause symptoms. However, if the aneurysm begins to enlarge, some symptoms may appear, depending on its location.

Symptoms of a thoracic aortic aneurysm include:

• Chest pain
• Back pain
• Hoarseness of voice
• Cough
• Persistent shortness of breath

Symptoms of an abdominal aortic aneurysm (AAA) include:

• Persistent pain in the abdominal area
• Back pain
• Visible heartbeat movement in the abdominal region

Diagnosis

To diagnose an aneurysm, your doctor will conduct a physical examination as well as radiology tests.

• During a physical examination, the doctor will examine your abdomen for movements that match your heartbeat, listen to your heart sounds, check the pulse on your hands and feet, and look for symptoms that match other medical conditions, such as Marfan Syndrome
• Radiology examinations include:
• Ultrasound. Ultrasound can help the doctor see the blood flow in the abdomen and detect the presence of AAA. This procedure is harmless and painless
• Echocardiogram. An echocardiogram can help the doctor determine if the thoracic aorta has an aneurysm. This procedure can see and measure the structure and function of the heart and aorta in real-time
• CT Scan or MRI. CT scans or MRIs, are radiologic examinations that can provide a more detailed picture of an aneurysm than ultrasounds or echocardiograms. This examination is used to guide the doctor when performing treatment or monitoring the condition of the aneurysm after treatment

Management

The goal of aneurysm treatment is to prevent dilation and to treat the aneurysm before it ruptures or dissects. Depending on the size of the aneurysm and the rate of enlargement, treatment may range from observation to surgery.

• Observation. If the aneurysm is small and at low risk of rupture, the doctor will recommend regular check-ups to monitor its condition. The doctor will advise you to change your lifestyle and stop smoking
• Medications. Medications do not help to restore the structure of the blood vessel to its original state but they do keep the aneurysm from expanding. These include high blood pressure medications (beta blockers, ACE-I, etc.) and cholesterol-lowering medications (statins). If your doctor has prescribed these medications, take them regularly. Do not buy any medications without first consulting your doctor
• Surgery. Surgery is typically the treatment of choice for aneurysms that are large with a at high risk of rupture and cause symptoms. There are two types of surgeries that can be performed:
• Endovascular surgery. This procedure involves inserting a catheter into the aorta. The catheter contains a metal mesh support to help strengthen the aortic wall. This technique typically results in faster healing than open chest or open abdominal surgery
• Open chest and open abdominal surgery. These two techniques use the same principles but for different aneurysms. Open chest surgery is is used to treat thoracic aortic aneurysms, whereas open abdominal surgery is is used to treat abdominal aortic aneurysms. The doctor removes the weak weak blood vessel wall and replaces it with a new, stronger layer (graft),. Healing from this procedure takes longer

Complications

complications of aortic aneurysm include:

• Dissecting aneurysm
  A dissecting aneurysm occurs when the wall of a dilated blood vessel or aneurysm tears. Because the entire lining of the blood vessel is not torn during dissection, blood flows and fills the layers of the wall without exiting the vessel completely. While seemingly harmless, dissection can disrupt overall blood flow and potentially lead to shock or even death
• Aneurysm rupture
  An aneurysm rupture occurs when the blood vessel wall completely tears, allowing blood to escape from the vessel and into another body cavity.  This condition is very dangerous and is an emergency
• Blood clot
  A pouch in a blood vessel can disrupt blood flow and retain blood within it. restriction of blood flow (stasis) can result in small blood clots. If these small blood clots break off, they could cause blockages in other blood vessels

Prevention

To prevent aortic aneurysm or further deterioration, you can follow the steps below:

• Quit smoking. Avoid using tobacco in any form, including as a passive smoker. If you need help quitting smoking, consult with your doctor
• Eat a healthy and balanced diet. Such as vegetables and fruits in your diet, and avoid foods high in cholesterol and saturated fat
• Keep your blood pressure and cholesterol normal. If your doctor prescribes medications to control your high blood pressure and cholesterol, take them regularly, even if there are no symptoms
• Do 150 minutes of physical activity per week. If you are not an active exerciser, you can start this habit slowly until you reach the goal of 150 minutes

When to See a Doctor?

You should get yourself checked if you have a family history of aneurysms, are over the age of 65, or have other medical conditions like Marfan Syndrome. Aneurysms typically do not cause symptoms until they tear or rupture, making early detection critical, especially if you have risk factors.

Visit the emergency room immediately if you experience symptoms of a ruptured aneurysm, including:

• Sharp, sudden, tearing-like pain in the chest that radiates downward
• Pain that radiates to the chest, shoulders, neck, and arms
• Difficulty breathing

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