Question 1 of 10

    Aortic Aneurysm (Aneurysms Aortic)

    AneurysmAorta[1]

    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.

    urogenital
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  • cardiovascular
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  • musculoskeletal
    Back Pain
    • Still, you might have: Back pain A deep pain on the side of your abdomen A throbbing sensation near your navel If the aneurysm ruptures, you might feel sick to your stomach, or suddenly develop an intense pain in your back or abdomen.[webmd.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.[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.[vascularweb.org]
    • 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]
    • There are many causes of mild abdominal and back pain.[patient.info]
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  • gastrointestinal
    Abdominal Mass
    • 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]
    • He or she may also find: An abdominal mass A stiff or rigid abdomen A pulsating sensation in the abdomen Following your exam, your doctor may order additional tests and procedures to help confirm the aneurysm and determine the size of your aorta.[upmc.com]
    • Rupture of an abdominal aortic aneurysm can be catastrophic, even lethal, and is associated with abdominal distension, a pulsating abdominal mass, and shock due to massive blood loss.[medicinenet.com]
    • The classic syndrome is characterized by hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass.[aafp.org]
    • The presence of a pulsatile abdominal mass is virtually diagnostic but is found in fewer than half of all cases.[emedicine.medscape.com]
    Dysphagia
    • 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]
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  • respiratoric
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  • neurologic
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  • Entire body system
    Relapsing Polychondritis
    • Arteritis: Inflammation of blood vessels as occurs in Takayasu disease , giant cell arteritis , and relapsing polychondritis can contribute to aneurysm.[medicinenet.com]
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  • 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.

    Laboratory

    Serum
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  • Microbiology
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  • 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. 

    Complications

    Aortic Aneurysm
    • Abdominal aortic aneurysm [ edit ] Abdominal aortic aneurysms (3,4 cm) Abdominal aortic aneurysms (AAAs) are more common than their thoracic counterpart.[en.wikipedia.org]
    • Learn more about abdominal aortic aneurysm symptoms and testing From our Health Library at UPMC.com : Aortic Aneurysm Symptoms Exams and Tests for Aortic Aneurysm Abdominal Aortic Aneurysm Screening Aortic Aneurysm FAQ UPMC Patient Education Materials[upmc.com]
    Hypovolemic Shock
    • […] steroids Good [ 8 ] Previous AAA patient Aorta and subclavian Details not known [ 7 ] 56-year-old Japanese man presented with shock Ruptured left gastric Aneurysm was diagnosed post mortem Died of hemorrhagic shock [ 3 ] A hospitalized developed sudden hypovolemic[casesjournal.biomedcentral.com]
    Thoracic Aortic Aneurysm
    Aortitis
    • Mural calcification is seen both in atherosclerotic disease as well as various causes of aortitis (see causes of ascending aorta calcification ).[radiopaedia.org]
    • […] arteritis - a disease that causes inflammation of the temporal arteries and other arteries in the head and neck, causing the arteries to narrow, reducing blood flow in the affected areas; may cause persistent headaches and vision loss trauma infectious aortitis[uhealthsystem.com]
    • Conclusion Whenever a young patient presents with an isolated aneurysm, dissection or aortitis screening for connective tissue disease should be performed.[casesjournal.biomedcentral.com]
    • […] are several risk factors associated with aortic dissection, such as: High blood pressure Connective tissue disorders, such as Marfan disease, Ehlers-Danlos syndrome, and Turner syndrome Cystic medial disease (a degenerative disease of the aortic wall) Aortitis[massgeneral.org]
    • In those without Marfan syndrome or acute aortitis, thoracic aortic aneurysms tend to grow quite slowly, so annual imaging is sufficient for surveillance.[circ.ahajournals.org]
    Relapsing Polychondritis
    • Arteritis: Inflammation of blood vessels as occurs in Takayasu disease , giant cell arteritis , and relapsing polychondritis can contribute to aneurysm.[medicinenet.com]
    Ehlers Danlos Syndrome
    • Common causes include hypertension, atherosclerosis, infection, trauma, and hereditary or acquired connective tissue disorders (eg, Marfan syndrome, Ehlers-Danlos syndrome).[merckmanuals.com]
    • […] at risk for AAA if you: Have high cholesterol Have high blood pressure Smoke Have a family history of AAA Are older than 60 Are of male gender — AAA is four to five times more likely to occur in men Have genetic disorders (such as Marfan syndrome , Ehlers-Danlos[heart.uvahealth.com]
    • However, several risk factors associated with aortic dissection include, but are not limited to, the following: hypertension (high blood pressure) connective tissue disorders, such as Marfan’s disease, Ehlers-Danlos syndrome, and Turner’s syndrome cystic[uhealthsystem.com]
    • 1 : true aneurysm atherosclerotic aneurysms (most common) inflammatory/ aortitis rheumatoid arthritis (RA) ankylosing spondylitis Takayasu arteritis giant cell arteritis (GCA) syphilis connective tissue disease cystic medial necrosis Marfan disease Ehlers-Danlos[radiopaedia.org]
    • They noted that patients with congenital disorders associated with defects in the connective tissue protein collagen, such as Marfan syndrome or vascular Ehlers-Danlos syndrome , have been shown to have a higher than normal risk for aneurysm-related dilation[medpagetoday.com]
    Marfan Syndrome
    • […] aortic diameter less than 5.0 to 5.5 cm in patients without Marfan syndrome Descending and thoracoabdominal atherosclerotic aortic aneurysm diameter less than 6 cm, or Type B aortic dissection complicated by impaired blood flow, rupture, or rapid expansion[mountsinai.org]
    • Some common causes are: Hardening of the arteries ( atherosclerosis ) Genetic disorders, most commonly Marfan syndrome Family history Learn more about the causes of thoracic aortic aneurysms .[stanfordhealthcare.org]
    • Common causes include hypertension, atherosclerosis, infection, trauma, and hereditary or acquired connective tissue disorders (eg, Marfan syndrome, Ehlers-Danlos syndrome).[merckmanuals.com]
    • Aortic disease in Marfan’s syndrome.[circ.ahajournals.org]

    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.

    Other symptoms

    Tobacco Use
    • The cause of aortic aneurysms is not completely understood, although known risk factors include: Tobacco use Hypertension Obesity Hardening of the arteries (atherosclerosis) A connective tissue disease, such as Marfan syndrome Untreated infections such[cedars-sinai.edu]
    • […] weekday, and this is likely due to several factors including a delay in prompt surgical intervention. [5] Risk factors [ edit ] Coronary artery disease Hypertension Loeys-Dietz Syndrome Hypercholesterolemia Hyperhomocysteinemia Elevated C-reactive protein Tobacco[en.wikipedia.org]
    Doxycycline
    • Drug: Doxycycline 100 mg po bid Other Names: doxycycline hyclate Vibramycin Oracea Adoxa Atridox and others Placebo Comparator: Placebo 100 mg capsules, twice a day, for a period of two years.[clinicaltrials.gov]
    • There have been proposals to introduce ultrasound scans as a screening tool for those most at risk: men over the age of 65. [7] [8] The tetracycline antibiotic doxycycline is currently being investigated for use as a potential drug in the prevention of[en.wikipedia.org]
    • […] benefit. 27 , 28 Statins are likely to be used for overall cardiovascular risk reduction and do improve all-cause mortality in patients after AAA repair. 28 Additionally, roxithromycin (a macrolide antibiotic not available in the United States) and doxycycline[aafp.org]
    Tetracycline
    • . are currently or have been recently treated (previous six months) with tetracycline derivatives. they are currently taking anti-seizure medicines metabolized by pathways influenced by doxycycline (e.g., carbamazepine, phenytoin, and barbiturates). stage[clinicaltrials.gov]
    • There have been proposals to introduce ultrasound scans as a screening tool for those most at risk: men over the age of 65. [7] [8] The tetracycline antibiotic doxycycline is currently being investigated for use as a potential drug in the prevention of[en.wikipedia.org]
    Fluoroquinolone
    • "As fluoroquinolones may induce degradation of collagen causing tendinopathy, this raises the concern that fluoroquinolones may cause or aggravate aortic aneurysm and dissection by a similar mechanism."[medpagetoday.com]
    • Fluoroquinolones and Aortic Injury "Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms.[en.wikipedia.org]
    Spinal Cord Injury
    • […] systematic review noted that further research regarding the effectiveness of CFSD for preventing a spinal cord injury is required. [16] Endovascular [ edit ] Endovascular treatment of aortic aneurysms is a minimally invasive alternative to open surgery[en.wikipedia.org]
    Atorvastatin
    • Anacetrapib reduces progression of atherosclerosis, mainly by reducing non-HDL-cholesterol, improves lesion stability and adds to the beneficial effects of atorvastatin [10] Elevating the amount of HDL cholesterol in the abdominal area of the aortic artery[en.wikipedia.org]

    Self-assessment

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    References

    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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    1. AneurysmAorta, CC BY-SA 3.0

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