Aortic aneurysms: what you need to know

Have you ever heard of an aortic aneurysm? It might sound complicated, but understanding it is crucial for maintaining good health, especially as we age. Miss Nandratarath Ganshanar explains everything you need to know about this condition, from its causes to the treatments available. To see more details, watch the video below.

What is an aortic aneurysm?

An aortic aneurysm is essentially a bulge in the wall of the aorta, the main artery that carries blood from the heart to the rest of the body. Normally, the aorta is about one and a half to two centimetres in diameter. However, if it stretches to more than three centimetres, it is classified as an aortic aneurysm. While this may not sound like much, the gradual enlargement of the aorta can lead to severe health risks if not monitored and managed properly.

How do aortic aneurysms grow?

Most aortic aneurysms expand slowly, typically at a rate of one to two millimetres per year. However, when the diameter of the aorta surpasses five and a half centimetres, the risk of it bursting, or rupturing, significantly increases. A rupture can cause life-threatening internal bleeding, so it’s critical to repair the aneurysm before it reaches this size.

Types of aortic aneurysms

Aneurysms can develop in any blood vessel, but they most commonly occur in the aorta. Here are the two main types:

• Abdominal Aortic Aneurysms (AAA): These are the most common, affecting three out of every four people with aortic aneurysms. They occur in the part of the aorta that passes through the abdomen, below the arteries that supply the kidneys. AAA is particularly prevalent among men over 65, with about 1.5% of this population being affected.
• Thoracic Aortic Aneurysms (TAA): These are less common and occur in the chest area. Despite being rarer, they are just as dangerous as AAA if they rupture.

What causes aortic aneurysms?

Aortic aneurysms are caused by a weakening of the aortic wall. Several risk factors can contribute to this weakening, including:

• Smoking: One of the leading risk factors.
• High blood pressure: Puts extra stress on the aortic wall.
• High cholesterol: Can lead to plaque build-up and a weakening of the aorta.

These are modifiable risk factors, meaning lifestyle changes can help reduce the risk. There is also a genetic component; some people inherit a tendency to develop aneurysms, often due to genetic conditions like Marfan syndrome or Ehlers-Danlos syndrome. These individuals might develop aneurysms at a younger age, even in their 40s or 50s.

Symptoms to watch out for

Aortic aneurysms are often called “silent killers” because they usually do not cause symptoms until they are quite large or rupture. However, there are some signs to be aware of:

• Abdominal pulsation: Feeling a pulse in the abdomen when pressing on the belly.
• Back pain: Some people with very large aneurysms might experience back pain.

If an aneurysm bursts, the symptoms are severe and sudden:

• Severe abdominal and back pain: This comes on quickly and intensely.
• Collapse: Due to sudden blood loss, fainting or collapsing can occur.

A ruptured aneurysm is a medical emergency. If you or someone you know experiences these symptoms, it’s critical to call 000 or seek immediate medical attention.

Diagnosing aortic aneurysms

Diagnosing an aortic aneurysm typically involves a physical examination. If a doctor suspects an aneurysm, they may order a duplex ultrasound scan to get a closer look at the size and shape of the aorta. Many aneurysms are also discovered incidentally during CT scans for other medical issues.

Treatment options

When an aneurysm is larger than five and a half centimetres, treatment usually involves surgery. There are two main types of surgical repairs:

• Open surgery: This involves making an incision in the abdomen, opening the aorta, and stitching a tube graft into place to divert blood flow away from the aneurysm.
• Endovascular surgery: This is a less invasive option, using a catheter to insert a stent graft into the aorta. The stent graft is then expanded inside the vessel, like opening an umbrella, to redirect blood flow.

Each method has its own suitability criteria. Open surgery requires the patient to be fit enough to withstand a major operation, while endovascular surgery depends on the aorta’s size and shape.

Understanding aortic aneurysms, their risks, and the available treatments can be lifesaving. If you are concerned about your risk factors or symptoms, seek medical advice. Early diagnosis and appropriate treatment are key to preventing severe complications.

Miss Nung Rudarakanchana is a highly regarded vascular surgeon based in London, UK, specialising in the treatment of vascular conditions, with a particular focus on varicose veins. With a patient-centric approach, Miss Rudarakanchana utilises advanced, minimally invasive techniques to provide personalised care and achieve effective outcomes.