An Aortic Aneurysm Is the Dilatation of a Portion Usually At a Weak Spot In the Aortic Wall.



Posted: Friday, February 27, 2009

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Aortic aneurysm

What is an aortic aneurysm?

An aortic aneurysm is the dilatation (widening or bulge) of a portion of the aorta, usually at a weak spot in the aortic wall. The aorta is the largest artery in the body. It carries all the blood that is pumped out of the heart and distributes it, via its many branches, to all the organs of the body. The aorta projects upwards from the heart in the chest and then arches downwards, travelling through the chest (the thoracic aorta) and into the abdomen (the abdominal aorta). The normal diameter of the abdominal aorta is about one inch.

What causes an aortic aneurysm and who is at risk?

Most aortic aneurysms occur in the abdominal aorta, the main cause being arteriosclerosis. This is a condition in which fatty deposits are laid down in the walls of arteries, which are less elastic and weaker as a result. Major risk factors for arteriosclerosis are smoking and high blood pressure, although it also probably runs in families.

Other causes of aortic aneurysm include:



There is another, more rare type of aneurysm called a 'dissecting aneurysm' which occurs mainly in the thoracic aorta. This is a very serious condition, in which the inner wall of the aorta develops a tear and then rips off inside the aorta due to the pressure of the blood flowing over it.

What are the common symptoms and complications of aortic aneurysm?

Many people can have an aortic aneurysm for years before any symptoms develop. When they do become evident, symptoms vary according to the type and location of the aneurysm. Symptoms of an abdominal aortic aneurysm include:



If an aortic aneurysm becomes very large, it can rupture (burst). This causes excruciating pain in the abdomen and back. There is severe internal bleeding which is often fatal. The symptoms of a thoracic aortic aneurysm often do not occur until the aneurysm is quite large. They are usually caused by pressure from the aorta on surrounding organs in the chest and include:

Other causes of aortic aneurysm include:



If a thoracic aortic aneurysm ruptures, it causes excruciating pain high in the back and often in the chest and arms. The pain may then go down into the abdomen and lower back. Massive blood loss can rapidly lead to death.

The symptoms of a dissecting aneurysm include:



How do doctors recognise aortic aneurysms?

Aortic aneurysms can be diagnosed from their symptoms when they occur but this is often too late. They are usually found on routine physical examination and chest and abdominal X-rays. On examination, your doctor may feel a pulsating mass in your abdomen which may be tender if an abdominal aortic aneurysm is large. If your doctor suspects an aneurysm, he or she will probably request that an ultrasound scan is carried out. Other scans such as computerised tomography (CT) and magnetic resonance imaging (MRI) may also be performed: these are very useful for determining the exact position in the chest of a thoracic aortic aneurysm.

Dissecting aneurysms are diagnosed initially from their symptoms and physical examination of the pulses in the arms and legs. Other tests include chest X-rays, ultrasound scans, CT (often using injected dyes that show the flow of blood) and MRI.

What is the treatment for aortic aneurysms?

Self-care action plan

There are several things you can do to reduce your chance of developing an aneurysm:



Surgery

The treatment of an aortic aneurysm depends on the symptoms that it causes. If it is asymptomatic, your doctor will advise you on the best course of treatment, as surgery carries a risk.

Symptomatic aneurysms require early or urgent treatment. The surgical procedure involves replacing the part of the aorta affected by the aneurysm with a synthetic graft & mdash; a tube made out of an elastic material with properties very similar to that of a normal healthy aorta. This very major operation is usually quite successful with a mortality of between five and two per cent. The risk of death from a ruptured abdominal aortic aneurysm is about 50 per cent, even during operation. However, there is no other treatment and an untreated ruptured abdominal aortic aneurysm is always fatal.

A thoracic aortic aneurysm is repaired using a synthetic graft usually if it is wider than three inches. Surgery on this type of aneurysm is more risky, with a death rate of up to 15 per cent. An untreated ruptured thoracic aortic aneurysm is also always fatal.

The treatment of a dissecting aneurysm initially involves lowering the blood pressure with drugs to reduce the force on the tear in the aorta. Then the surgeon must decide if it is safe to attempt to replace the dissected part of the aorta with a synthetic graft. The closer the dissection is to the heart, the more likely it is that surgery will be performed. The majority of people with an untreated dissecting aneurysm will die within a few weeks. However, if the operation is successful and the patient survives the first few weeks after the operation then the outlook is quite good so long as the blood pressure is carefully monitored and controlled.

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