An aneurysm is a bulge in the artery wall. Weakened by atherosclerosis (hardening of the arteries), smoking, hypertension, or other causes, the vessel walls balloon outward with the pressure of the blood flow inside. If an aneurysm bursts, it can cause heavy, life-threatening internal bleeding. This condition may also lead to blood clots (possibly leading to a heart attack or stroke) and leakage of blood.
Aneurysms can form in arteries throughout the body, but most occur in the aorta. Starting in the heart and continuing through the chest and abdomen to the legs, the aorta is the body's largest blood vessel. If the aneurysm occurs in the lower section of the aorta, it is known as an abdominal aortic aneurysm; if it occurs in the portion of the aorta in your chest, it is called a thoracic aortic aneurysm.
Aneurysms may expand slowly or quickly, or they may stay the same size for many years. They often develop without any warning signs. Sometimes, however, people experience symptoms from an aneurysm that can include:
- A pulsing sensation in the abdomen
- Stomach pain or tenderness
- Back pain
A burst aneurysm is a medical emergency. Signs of a ruptured aneurysm include:
- Sudden, intense pain in the abdomen
- Low blood pressure
- Fast pulse
In most cases, an aortic aneurysm is detect during a routine exam or while testing for another condition, such as during an X-ray or ultrasound. If an aneurysm is suspected, your doctor will perform an echocardiogram or aortic ultrasound in order to confirm this diagnosis. Patients at risk for this condition, including smokers and those over the age of 60, should be screened regularly for an aortic aneurysm through imaging tests or genetic testing.
If an aneurysm is discovered, it will be monitored closely. Many remain small and never rupture. Large, fast-growing, leaking or painful aneurysms may require surgery. Surgery is performed immediately on aneurysms that threaten imminent rupture or that have already ruptured, although the procedure is less successful once the vessel has burst.
Treatment for an aortic aneurysm depends on the size and severity of the condition, as well as the patient's overall health. Medications are often prescribed as an initial treatment to help lower blood pressure, relax blood vessels and reduce the risk of rupture. Beta blockers and calcium channel blockers are most commonly prescribed for an aortic aneurysm.
Aortic Endovascular Stent Grafting
In an endovascular stent-grafting procedure, a small metal cylinder called a stent is implanted in the artery to provide a strong new vessel wall. During the procedure, a thin tube called a catheter is guided up the aorta to the site of the aneurysm. A balloon on the end of the catheter helps fit the stent into place. Then the catheter is removed. The aneurysm generally shrinks around the stent as time passes.
Open Aneurysm Repair
Open aneurysm repair involves making an incision in the abdomen, removing the section of the artery with the aneurysm, and replacing the excised segment with a graft made of a synthetic tube.
Recent minimally invasive laparoscopic techniques allow surgeons to make very small incisions in the groin to access the femoral artery. A thin tube with a camera is inserted into the artery and threaded up to the aneurysm so the surgeon can "see" inside the patient's body without the need for traditional open surgery. Your doctor will determine which treatment option is best for you based on a thorough evaluation of your condition.
Although there is no surefire way to prevent an aortic aneurysm from developing, there are certain steps patients can follow to reduce their risk. It is important to:
- Keep blood pressure under control
- Avoid or quit smoking
- Exercise regularly
- Lower cholesterol and fat