An aortic aneurysm is a weak spot in the wall of the aorta, the primary artery that carries blood from the heart to the head and extremities. Saccular and fusiform aneurysms are balloonlike swellings of the arterial wall that can occur in the portion of the aorta within the chest or just below the kidney in the abdomen. A dissecting aneurysm is a longitudinal, blood-filled split in the lining of the artery, usually occurring in the aortic arch near the heart. As blood is pumped through the aorta, the weak spot in the elastic arterial wall bulges outward.
The risk is that an aneurysm will eventually rupture, with great bleeding internally and complete collapse of circulation. Sudden severe pain, shock, and loss of consciousness usually occur within seconds, and death is imminent in more than 50 percent of cases, even with emergency surgery. Thus, the goal is to detect and treat an aortic aneurysm before it ruptures. Aortic aneurysms generally affect people over 60 and are more common among men.
What Causes Aortic Aneurysm?
- Approximately 95 percent of aortic aneurysms are caused by atherosclerosis (hardening and narrowing of the arteries) due to the buildup of fatty plaque in the arterial walls. Atherosclerosis damages the walls of the arteries, causing them to thicken and lose their normal inner lining. Damaged areas of the artery can can stretch from arterial blood flow, resulting in an aneurysm.
- Infections such as untreated syphilis (a sexually transmitted infection; STD) rarely can cause aortic aneurysm.
- The muscular middle layer of the artery may be congenitally weak and thus prone to a dissecting aneurysm.
- High blood pressure (hypertension) intensifies the force of blood on the walls of the arteries and contributes to the development of dissecting aneurysms.
- Syphilis may cause a saccular or fusiform aneurysm near the heart (now rare).
- The arterial wall may be weakened as a result of trauma or complication of other diseases, possibly leading to saccular or fusiform aneurysms.
Symptoms of Aortic Aneurysm
- In the majority of cases there are no warning symptoms. More likely, an aortic aneurysm is detected with an x-ray or during a routine physical examination.
- Aortic aneurysm may cause a pulsing feeling (similar to a heartbeat) in the abdomen.
- Rarely, material shed from the aneurysm can cause foot pain, discoloration or sores on the toes or feet
- Hoarseness, difficulty in swallowing, or persistent cough may indicate a saccular or fusiform aneurysm in the chest area.
- A throbbing lump in the abdominal area, which may indicate that the aneurysm is about to burst. Severe backache, leg pain or a feeling of coldness in the leg (due to an embolus from a clot formed in an abdominal aneurysm), or severe abdominal pain (due to the rupture of an abdominal aneurysm) may indicate a saccular or fusiform aneurysm in the abdominal area.
- Severe chest pain that may be mistaken for a heart attack may signal a dissecting aneurysm.
- A torn or leaking aortic aneurysm may cause vomiting, abnormal stiffness in the abdominal muscles, swelling or bulging in one area of the abdomen and clammy skin.
- Eat a diet low in cholesterol and saturated fats to reduce the risk of atherosclerosis.
- Take steps to prevent, detect, and treat high blood pressure.
- To reduce the risk of the aneurysm bursting or tearing quit smoking and work with your doctor to control blood pressure and cholesterol levels.
Diagnosis of Aortic Aneurysm
- Physical examination of your abdomen by the doctor may reveal a pulsating aneurysm.
- X-rays, CT (computed tomography) or MRI (magnetic resonance imaging) scans, or ultrasound imaging may confirm the presence of an aneurysm.
- Angiography (an injection of an opaque dye into an artery to produce a clear x-ray image of the aorta) may be performed.
How to Treat Aortic Aneurysm
- Have regular physical exams to detect an aortic aneurysm before it has a chance to rupture. Your doctor may recommend x-rays and angiography to determine the size and location of an aneurysm if one is suspected.
- If an aneurysm is detected, your doctor may recommend watching and waiting (especially if it is small), since aneurysms tend to grow very slowly.
- Your doctor may prescribe a beta-blocking medication. Beta-blockers decrease blood pressure and the force of the heart’s contraction, thus reducing pressure against the walls of the aorta.
- Periodic ultrasound examinations are used to follow the expansion of an aneurysm over time.
- Certain aneurysms require immediate treatment, often involving surgical removal of the affected portion of the artery and replacement with a synthetic arterial graft. Surgery may also be required if an aneurysm is causing pain, is larger than six centimeters, or is rapidly expanding.
When to Call a Doctor
- Call a doctor if you experience symptoms of an aortic aneurysm.
- See your doctor regularly if you suffer from high blood pressure or high cholesterol, each a major risk factor for the different types of aneurysm.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media