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Aortic Aneurysm

Aneurysms Aortic

Aortic aneurysms are a relatively common condition and potentially life-threatening.


Presentation

There are rarely any noticeable signs or symptoms associated with an aortic aneurysm [7]. Any symptoms that do occur only do so once the vessel walls are already enlarged. These symptoms are usually abdominal or back pain. As the nerve roots may become compressed, a person can experience leg pain and numbness. A hoarse voice is usually a common sign of an aortic aneurysm in the arch of the aorta because the laryngeal nerve is involved when the aortic aneurysm is located in this area.

If a patient is experiencing any of the vague symptoms and there is a history of aneurysms in the family, it mandatory to examine for an aortic aneurysm as early detection and treatment will lead to a better prognosis.

If an aortic aneurysm goes unnoticed and untreated it can increase in size at a variable rate. As the aneurysm grows in size, the likelihood of blood clots breaking off and causing embolism increases. This, however, does remain rare.

Usually, aneurysms are found during a patient’s normal physical examination. In order to confirm a diagnosis, a medical professional will use imaging which will confirm the presence of an aortic aneurysm and figure out the severity of the condition.

Walking with a Cane
  • Of the 90 participants (93%) surviving 90 days, six (7%) were paraplegic and six (7%) had paraparesis, four of whom were able to walk with assistance (cane, walker, brace).[doi.org]
Cough
  • Symptoms of aortic aneurysm may be related to the location, size and growth rate of the aneurysm and can include: Pain in the chest, neck, and/or back Swelling of the head, neck, and arms Coughing, wheezing, or shortness of breath Coughing up blood Symptoms[marfan.org]
  • […] of breath Fainting Hoarseness Difficulty swallowing Coughing up blood Weight loss Chest pain Diagnosis & Treatment Diagnosis The doctor will ask about your symptoms and medical history.[semc.org]
  • Depending on the size, location and progression rate of dilatation/dissection, patients may be asymptomatic or may present dyspnea, cough, jaw, neck, chest or back pain, head, neck or upper limb edema, difficulty swallowing, voice hoarseness, pale skin[orpha.net]
  • , shortness of breath Fainting Hoarseness Difficulty swallowing Coughing up blood Weight loss Chest pain Treatment Treatment includes surgery or stenting.[cancercarewny.com]
  • Symptoms of a thoracic aortic aneurysm (affecting upper part of aorta in chest): Pain in the jaw, neck, upper back or chest Coughing, hoarseness or difficulty breathing Learn more about thoracic aortic aneurysm Symptoms of an abdominal aortic aneurysm[my.clevelandclinic.org]
Abdominal Pain
  • A patient presenting with severe back pain, vague abdominal pain, weight loss and decline in general health, was diagnosed with a contained-rupture of a suprarenal mycotic aortic aneurysm, as a complication of spondylodiscitis.[ncbi.nlm.nih.gov]
  • Prednisolone cyclophosphamide Good [ 11 ] 67-year old man presented with abdominal pain and shock Superior pancreatico-duodenal artery Open repair of ruptured artery Died from multi-organ failure [ 4 ] 50-year old woman presented with abdominal pain and[casesjournal.biomedcentral.com]
  • Abdominal pain may radiate into the low back due to the aorta’s proximity to the spine. Pain may also spread to the groin, pelvis, or legs. Tenderness, pulsing sensation in the abdomen.[spine-health.com]
  • Non-abdominal causes of abdominal pain Failing to consider extra-abdominal causes in the patient presenting with abdominal pain is a frequent pitfall. Several life-threatening illnesses can present with abdominal pain only.[doi.org]
  • KEYWORDS: Abdominal aortic aneurysm; Abdominal pain; Appendicitis; Elderly; Mesenteric ischemia[ncbi.nlm.nih.gov]
Abdominal Mass
  • masses noted that imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches.[emedicine.com]
  • Treatment Rupture of an abdominal aneurysm is a catastrophic event and is associated with pain, abdominal distension, a pulsating abdominal mass and shock due to massive blood loss.[azcentral.com]
  • ACR Appropriateness Criteria for pulsatile abdominal mass, suspected abdominal aortic aneurysm. Available at: . Updated 2016. Last reviewed February 2018 by EBSCO Medical Review Board Michael J.[cancercarewny.com]
  • A patient who presents with a ruptured AAA will usually not have the classic triad of hypotension, back pain, and a pulsatile abdominal mass. Wrong diagnoses such as gastrointestinal bleed, nephrolithiasis, and diverticulitis are often made.[acep.org]
  • Large aneurysms may present as a pulsatile abdominal mass.[radiopaedia.org]
Nausea
  • The larger an aneurysm grows, the more likely it will burst or rupture, causing intense abdominal or back pain, dizziness, nausea or shortness of breath.[radiologyinfo.org]
  • If the AAA starts to leak or ruptures, you may have any of the following: Sudden pain in your abdomen, groin, back, legs, or buttocks Nausea and vomiting A lump or swelling in your abdomen Stiff abdominal muscles Numbness or tingling in your legs Pale[drugs.com]
  • […] pressure that interferes with the function of vital organs like the brain and kidneys and is marked by: Clammy, sweaty skin Light-headedness Rapid heart rate Ruptured abdominal aneurysms can cause: Sudden, severe pain in your lower abdomen and back Nausea[medstarheartinstitute.org]
  • When an aneurysm ruptures, you experience pain, dizziness, nausea, vomiting, clammy skin, rapid heart rate, shock or plunging blood pressure. This is a medical emergency.[heart.memorialhermann.org]
Hematemesis
  • That might happen if the aneurysm erodes into the trachea nearby or hematemesis, that's vomiting up blood. That might occur if the aneurysm erodes into the esophagus also nearby, so we don't want these things to happen to us.[khanacademy.org]
  • Dysphagia is due to compression on the esophagus and esophageal rupture can cause significant hematemesis. Emboli may involve distally to renal, visceral, or lower extremities. Aneurysm rupture presents with severe pain, hypotension, and shock.[clinicaladvisor.com]
Dysphagia
  • Dysphagia is due to compression on the esophagus and esophageal rupture can cause significant hematemesis. Emboli may involve distally to renal, visceral, or lower extremities. Aneurysm rupture presents with severe pain, hypotension, and shock.[clinicaladvisor.com]
  • When thoracic aortic aneurysms are large, patients may suffer a local mass effect, such as compression of the trachea or mainstem bronchus (causing cough, dyspnea, wheezing, or recurrent pneumonitis), compression of the esophagus (causing dysphagia),[circ.ahajournals.org]
Oral Bleeding
  • KEYWORDS: chronic disseminated intravascular coagulation; oral bleeding; thoracoabdominal aortic aneurysm; tooth extraction[ncbi.nlm.nih.gov]
Chest Pain
  • Chest Pain Accreditation On June 16, 2005, Good Samaritan was given official Chest Pain Center designation by the Society of Chest Pain Centers and recognized for offering state-of-the-art heart care to its patients.[chihealthgoodsamaritan.org]
  • We report the case of a previously healthy adolescent who presented with chest pain and fever and who developed a mycotic aneurysm of the aorta after contracting community-acquired, methicillin-resistant Staphylococcus aureus .[ncbi.nlm.nih.gov]
  • Symptoms of a thoracic aortic aneurysm (affecting upper part of aorta in chest): Pain in the jaw, neck, upper back or chest Coughing, hoarseness or difficulty breathing Learn more about thoracic aortic aneurysm Symptoms of an abdominal aortic aneurysm[my.clevelandclinic.org]
  • pain and/or upper back pain, sometimes described as “ripping” or “tearing” Pain that feels like it is moving from one place to another Unusually pale skin Faint pulse Numbness or tingling Paralysis In some instances, there may be no pain but a sense[marfan.org]
Back Pain
  • A patient presenting with severe back pain, vague abdominal pain, weight loss and decline in general health, was diagnosed with a contained-rupture of a suprarenal mycotic aortic aneurysm, as a complication of spondylodiscitis.[ncbi.nlm.nih.gov]
  • See Getting an Accurate Back Pain Diagnosis If an abdominal aortic aneurysm is suspected, the diagnosis will be confirmed using an imaging test.[spine-health.com]
  • A kidney punch test will help qualify if low back pain is of renal/ureter origin because shock waves from the "punch" will be felt into the groin area. Therefore, a urological referral may be necessary.[dynamicchiropractic.com]
  • SUDDEN, SEVERE ABDOMINAL OR BACK PAIN If you have a family history of AAA and feel sudden, severe pain in your abdomen or back, seek immediate care. These symptoms may signal that you have developed an AAA, possibly one in process of rupturing.[vascularweb.org]
Claustrophobia
  • Claustrophobia and a patient's inability to remain motionless are likely to yield a nondiagnostic study. MRI is not as available as CT and US. Angiography is also a safe procedure.[emedicine.com]
Paresthesia
  • A 58-year-old Japanese man with an unremarkable medical history presented with a 3-day history of mild weakness in both legs, and experienced paraplegia and paresthesia a day before admission.[ncbi.nlm.nih.gov]
  • Aortic dissections usually cause severe, sudden chest or back pain, and may also result in unusually pale skin (pallor), a very faint pulse, numbness or tingling (paresthesias) in one or more limbs, or paralysis.[ghr.nlm.nih.gov]

Workup

The best way to diagnose an abdominal aortic aneurysm is through an abdominal aortic ultrasound [8]. This is usually done after there is a suspicion of an aneurysm after a normal physical examination occurs and a family history is examined. If a thoracic aortic aneurysm is suspected, a chest X-ray should be done. The early detection of an aortic aneurysm is important as treatment for the condition can prevent ruptures from occurring. Early detection and treatment will also lower the chances of related mortality.

Pleural Adhesions
  • Nevertheless, open repair of thoracoabdominal aortic aneurysms is still relevant in complex cases, including combined chronic aortic dissection, congenital aortic abnormalities such as aberrant right subclavian artery, and dense pleural adhesions after[ncbi.nlm.nih.gov]

Treatment

Once an aortic aneurysm is diagnosed, there are a number of treatment options available [9]:

  • Risk factor reduction and control (eg. cessation of smoking, blood pressure control)
  • Stent grafting
  • Surgery to place a synthetic arterial graft in the affected area

Prognosis

In general, the prognosis for an aortic aneurysm of any kind is positive [6]. Once an aneurysm is properly treated, the chances of death related to one are as low as 10 percent. In the cases where surgery is required mortality increases, but only to around 30 percent. 

Etiology

The exact etiology of an aortic aneurysm is usually not known. There are various lifestyle factors that are associated with aneurysms [3]. A family history of aneurysm can also increase the chances of one occurring. Other risk factors that can be associated with aneurysms are:

Epidemiology

In the United States, the likelihood of an abdominal aortic aneurysm occurring can range from as small as three in 100,000 up to 117 in the same amount of people [4]. On an international scale there is a chance of abdominal aortic aneurysm ranging from 4.8 to 13 occurrences in 100,000 people annually. The incidence of thoracic aortic aneurysms is estimated to be 6:100,000 person-years.

While an aneurysm can occur at any point in a person’s life, the possibility increases once a person passes the age of 50 for males and after the age of 60 for women. The likelihood of an aneurysm peaks around the age of 80 for everyone.

Sex distribution
Age distribution

Pathophysiology

It is unclear if there are any inciting factors that cause aortic aneurysms but, it is obvious that there has to be a defect in collagen and elastin, probably the most important structural proteins, in order for an aortic aneurysm to develop [5]. This process and degeneration of the media cause weakening of the vessel wall and dilation. Heredity and hemodynamic factors also seems to play an important role in the occurrence of aortic aneurysms.

Prevention

Lifestyle changes can lower a person’s chance of suffering from an aortic aneurysm. A low-cholesterol diet void of saturated fats can reduce atherosclerosis, therefore lowering the risk of aortic aneurysms [10]. High blood pressure should also be controlled, if present, or prevented if it’s likely to occur.

If there is a family history of aortic aneurysms, a person should be aware of their health and remain on the lookout for the usual signs and symptoms of the condition. By being aware of their own health an aortic aneurysm can be diagnosed early and the chances of a positive prognosis icreased. If a person is considered to be high risk, periodic screenings should be done.

Summary

When the aorta becomes dilated to more than 1.5 times its average size, the condition is defined as an aortic aneurysm [1]. There are different etiologies for this disorder, but an aortic aneurysm results in dilatation in all layers of the vessel wall no matter the cause. A person suffering from this ailment can experience pain which is usually a precursor to a rupture. This aortic rupture will cause internal bleeding and should be treated immediately. In individuals who do not receive timely treatment, it can cause shock or even death.

There are four different aortic aneurysms that are designated by location [2]:

  • Aortic root aneurysm – located in Valsalva sinus.
  • Thoracic aortic aneurysm – located within the chest and broken up into ascending, aortic arch and descending aneurysms.
  • Abdominal aortic aneurysm (AAA) – the most common aneurysm located in the aortal segment of the abdominal cavity.
  • Thoracoabdominal aortic aneurysm – located in the thoracic and abdominal aorta. 

Patient Information

An aortic aneurysm is defined as a bulge in the aortic walls. The aorta is the largest artery in the body which goes down into the chest and the abdominal region. The aorta then splits into two blood vessels, one for each leg. The bulge occurs due to weaknesses within the walls.

This ailment should be taken seriously as it can lead to a rupture of the vessel which will cause internal bleeding when left untreated. If a rupture does occur, it must be remedied quickly since the internal bleeding can lead to shock or death.

When an aortic aneurysm is caught early it can be treated through medications like beta blockers. More severe cases may need surgery to properly remedy the aneurysm.

References

Article

  1. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 1991 13 (3): 452–8.
  2. Saratzis A, Bown MJ.The genetic basis for aortic aneurysmal disease. Heart. 2014 Jun;100(12):916-22.
  3. Nazari S, Salvi S, Visconti E, et al. Descending aorta substitution with expandable ends prosthesis. Case report. J Cardiovasc Surg (Torino) 1999 40 (3): 417–20.
  4. Cinà C, Abouzahr L, Arena G, Laganà A, Devereaux P, Farrokhyar F. Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery: a systematic review and meta-analysis. Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 2004 40 (1): 36–44.
  5. Gopaldas RR, Huh J, Dao TK, et al. Superior nationwide outcomes of endovascular versus open repair for isolated descending thoracic aortic aneurysm in 11,669 patients. J. Thorac. Cardiovasc. Surg. 2010 140 (5): 1001–10.
  6. Crawford ES, Cohen ES. Aortic aneurysm: a multifocal disease. Presidential address. Arch Surg 1982; 117:1393.
  7. Pressler V, McNamara JJ. Aneurysm of the thoracic aorta. Review of 260 cases. J Thorac Cardiovasc Surg 1985; 89:50.
  8. Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982; 92:1103.
  9. Itani Y, Watanabe S, Masuda Y, et al. Measurement of aortic diameters and detection of asymptomatic aortic aneurysms in a mass screening program using a mobile helical computed tomography unit. Heart Vessels 2002; 16:42.
  10. Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation 2005; 111:816.

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Last updated: 2019-07-11 21:50