Aortic Aneurysm

Victor Politi, M.D., FACPMedical Director, SVCMC, School of Allied Health Professions, Physician Assistant Program

The Aorta

The aorta is the largest human artery

It is the primary artery that carries blood from the heart to the head and extremities

During an average lifetime it transports 200 million liters of blood and withstands the force of up to 3 billion heartbeats

The Aorta

The aorta is one inch in diameter

It divides at the hip into the two iliac arteries that supply blood to the legs

The arteries that feed all of the body’s organs branch off from the aorta

The Aorta

The aorta emerges from the heart and runs the length of the torso

thoracic aorta - as it leaves the heart, ascends, arches, and descends through the chest until it reaches the diaphragm

abdominal aorta - after passing the diaphragm - continues down abdomen- ends where it splits at two iliac arteries

Where do they develop

Can develop anywhere along the aorta In the chest - called thoracic aneurysm

More than 3/4 of aortic aneurysms occur in the abdomen - most often below the renal arteries About 2/3 of abdominal aneurysms extend

from the aorta into one or both of the iliac arteries

What is an aortic aneurysm

An aneurysm can be caused by pressure on a weakened section of the arterial wall

or by dissection - a split in the three layers of tissue comprising the aortic wall - blood seeps between them, the wall stretches, increasing the risk of rupture

Three common types of aortic aneurysms

Saccular involves only the muscular middle layer of aorta with a

localized out-pocketing (balloon-like swelling)

Fusiform most common form, spindle shaped, widens all around

circumference of aorta (balloon-like swelling)

Dissecting longitudinal, blood-filled split in the lining of the artery,

usually in the aortic arch near the heart

Incidence

On average 15,000 Americans die suddenly each year from rupture of an aortic aneurysm

It is the 9th leading cause of death from men over age 55

Incidence

Increases with age > 60 at greater risk

Males more common than females (5:1)

5% of men over age 60 develop an abdominal aortic aneurysm

Incidence

Most common cause - arteriosclerosis (80% of cases)

post physical trauma to aortaOther Risk factors

connective tissue disease, arteritis, congenital malformation, Marfan syndrome, atherosclerotic risk factors (smoking, HTN, hyperlipidemia, diabetes)family hx of aneurysm

Symptoms

Aneurysms can be small or grow to the size of a grapefruit

Most are symptomless, especially when small

Symptoms tend to increase as aneurysms enlarge and press on nerves, organs, or other blood vessels

Symptoms occur in only 25% of patients

Symptoms

Most common symptom is a throbbing, or pulsation in the abdomen

May cause lower back pain

Symptoms

In thoracic aneurysm symptoms may include: pain in the shoulders, lower back, neck

or abdomen a dry cough hoarseness from pressure of aneurysm

on nerves controlling vocal cords many of these are frequently misdiagnosed!

Symptoms

Other symptoms throbbing lump in abdominal area severe backache leg pain/coldness in leg (due to embolus

from clot formed in abdominal aneurysm)

severe abdominal pain (rupture)

Diagnosis

Abdominal palpitation may reveal abnormally wide pulsation of

the abdominal aorta characteristically felt on both sides of the

aorta which is midline Even large aneurysms can be difficult to

detect on exam in overweight people Aneurysms that are rapidly enlarging and

on the verge of rupture are often tender

Diagnosis

Abdominal aortic aneurysm x-ray (shows calcium deposits in 90% of

cases) CT Scan w/contrast MRI abdominal Ultrasound -(98% accuracy in

size measurement) abdominal aortography

Aortic Aneurysm

The aorta (short arrow) looks like a white "candy-cane" in the middle of this image. The aneurysm (long arrow) is the thin line running through the candy cane.

Diagnosis

thoracic aortic aneurysm chest x-ray TEE MRI CT scan

Complications -

1/2 of all persons with untreated abdominal aortic aneurysms die of rupture within 5 years

Abdominal aortic aneurysms - 13th leading cause of death - overall - in the US

Complications

Rupture highly lethal - causes profuse bleeding, leads

to shock- death uncommon < 5cm wide More common > 6cm wide

Peripheral embolization of clot within the aneurysm

Infection of aneurysmSpontaneous blockage of the aorta

Treatment

Symptomatic aneurysms require early or urgent treatment

Surgical treatment involves replacing the part of the aorta affected by the aneurysm with a synthetic graft

- risk of death from rupture 50%- even during surgery

Surgery only treatment

Treatment

Treatment of dissecting aneurysm lowering of BP to reduce force on the

tear-prior to surgery if left untreated- most people die within

a few weeks

Treatment

Repair can be done surgically or by installation of a stent graft Surgical repair

recommended for all aneurysms over 6cm wide

usually recommended for aneurysms 4-6cm in good surgical risk cases

Stent graft - minimally invasive -may be option in some cases

Questions??