Generality
An aortic aneurysm is a permanent abnormal dilation of a short section of aorta.
Despite the lack of a correlated symptomatology, the presence of an aneurysm of the aorta represents a serious threat for the survival of the patient, since from a rupture of it it results an often fatal internal hemorrhage.
Various factors can contribute to the formation of an aortic aneurysm, including: aging, hypertension, atherosclerosis, cigarette smoking, causes of aortitis and genetic diseases of connective tissue.
For the diagnosis of an aortic aneurysm, the physical examination is useful, but often insufficient; this explains why radiological tests are needed, such as abdominal ultrasound, echocardiography, CT of the thoracic-abdominal compartment, etc.
With the aim of preventing any expansions and complications (eg, rupture or aortic dissection), the therapy of an aortic aneurysm varies according to the magnitude of the dilation.
Short review of the aorta
The aorta is the largest and most important artery in the human body.
Originating in the heart (to be precise from the left ventricle of the heart ), this fundamental arterial vessel is provided with numerous ramifications, through which it supplies every district of the human body with oxygenated blood, from the head to the lower limbs, passing through the limbs upper and trunk.
Analyzing it from the beginning, the aorta is didactically divided into two large consecutive sections: the thoracic aorta, occupying the anatomical portion of the thorax (up to the diaphragm), and the abdominal aorta, located in the anatomical portion of the abdomen (from below the diaphragm on).
What is an Aortic Aneurysm?
An aortic aneurysm, or aortic aneurysm, is a permanent abnormal dilation of a short segment of aorta.
Wanting to provide an even more precise and specialized definition, an aortic aneurysm is any non-physiological dilation of the aorta, which alters the vessel diameter by at least 1.5 centimeters more than normal.
Aortic aneurysms are conditions that give rise to many concerns not only among those who are a victim, but also among experts in the medical sector, as they are related to a high mortality rate and are difficult to treat.
The consequences
The aortic aneurysm represents a serious threat to survival, because:
- It makes the vascular wall of the dilated segment thinner and prone to breakage . A rupture of an aneurysm results in internal bleeding whose outcome is often lethal.
- It favors the formation of abnormal blood clots ( emboli ) or thrombus due to a profound alteration of the blood flow at the level of dilation. Conditions such as stroke or obstruction of the coronary arteries can result from this phenomenon.
What does it look like? The shapes
An aortic aneurysm may look like a saccular dilatation ( saccular or saccular aortic aneurysm ) or a fusiform dilation ( fusiform aortic aneurysm ).
Saccular aortic aneurysms are berry-like growths or balloons, which protrude from one side of the affected aorta segment; fusiform aortic aneurysms, on the other hand, are swellings that completely involve the affected aorta segment.
Statistics in hand, between the saccular form and the fusiform form of an aortic aneurysm, the most widespread is the second.
Typological classification of aortic aneurysm
Using the site of dilation along the aorta as a criterion of distinction, doctors recognize the existence of 3 types of aortic aneurysm:
- The aortic root aneurysm . This category includes all cases of an aortic aneurysm located at the level of the aortic root, ie the very first part of the ascending aorta, located immediately after the left ventricle of the heart.
- Thoracic aortic aneurysm . In this typology all the cases of aortic aneurysm located in any point of the thoracic aorta are represented (ascending aorta, aortic arch, descending aorta up to the diaphragm).
- The abdominal aortic aneurysm . All cases of aortic aneurysm located anywhere on the abdominal aorta fall into this category.
Note: involving the ascending aorta, the aortic root aneurysm is in fact a thoracic aortic aneurysm and as such should be included in the second of the above types; however, experts tend to consider it separately, due to the particularity of the aorta segment involved.
Epidemiology
According to world-wide statistical studies, the annual number of deaths from aneurysm of the aorta would have increased over the past 30 years; in fact, deaths rose from 100, 000 in 1990 to 152, 000 in the recent 2013.
An aortic aneurysm most frequently develop is elderly people over 65, men (2/3 of patients are male), smokers, people with hypertension and individuals with atherosclerosis problems.
Did you know that ...
The mortality rate in case of rupture of an abdominal aortic aneurysm is 70-90%.
Causes
Currently, doctors have not yet defined a precise cause for the aneurysm of the aorta; however, they are quite sure of the favoring action of factors such as:
- Aging .
The blood vessel wall is composed of elastin and collagen; the first ensures elasticity, while the second guarantees strength and resistance to stress.
With aging, the blood vessels lose both part of the elastin and the collagen, which makes them more rigid, more fragile and prone to permanent dilatations such as aneurysms.
- Atherosclerosis .
Atherosclerosis is the phenomenon of hardening of the arteries of medium and large caliber, which induces over time, on the inner wall of the arterial vessels just mentioned, the formation of atheromas, predominantly lipid aggregates capable of hindering blood circulation.
Atherosclerosis recognizes hypertension, hypercholesterolemia, high triglycerides, advanced age, smoking, diabetes mellitus and obesity as the main causes.
- Hypertension .
In medicine, the term "hypertension" indicates the condition in which the arterial pressure at rest is constantly higher than the values representing normality.
Possible causes of hypertension include overweight, obesity, physical inactivity, cigarette smoking, aging, stress, hypercholesterolemia and a certain family predisposition to high blood pressure.
- Cigarette smoke .
Cigarette smoking and smoking are generally a direct source of damage to the arteries, favor the formation of atheromas (atherosclerosis) and are responsible for an increase in blood pressure beyond normal levels (hypertension).
- The aortite, that is the vasculitis against the aorta .
In medicine, the term "vasculitis" means inflammation of the vascular walls; therefore, aortitis is the inflammation of the walls of the aorta.
The causes of aortitis include infections (eg: syphilis, tuberculosis and salmonella), autoimmune diseases (eg systemic lupus erythematosus, Takayasu arteritis and rheumatoid arthritis) and traumatic events affecting the aorta.
- Genetic diseases of connective tissue .
Among the genetic diseases in question, the most important are Marfan syndrome and Ehlers-Danlos syndrome, which are often associated with suffering from blood vessels (including the aorta).
It is important to point out that the aforementioned factors - in particular aging, atherosclerosis, hypertension and cigarette smoking - are much more dangerous when combined together; in practical terms, a subject who is both elderly and smoker is much more prone to developing an aortic aneurysm than a person of advanced age or only suffering from hypertension.
Risk factors
They are risk factors of aortic aneurysm:
- All the conditions mentioned above (advanced age, atherosclerosis, hypertension, etc.);
- Obesity;
- High triglycerides (or hypertriglyceridemia);
- Hypercholesterolemia;
- A sedentary lifestyle;
- Diabetes mellitus;
- A family history of an aortic aneurysm.
Symptoms and Complications
The aortic aneurysm is a subtle condition, as it has the tendency to remain asymptomatic as long as it does not reach considerable size or as long as its walls do not break.
Symptoms of a large aneurysm
The symptoms of a large aortic aneurysm vary depending on the site of dilation. In fact, if the dilation is at the level of the very first tract of ascending aorta (aneurysm of the aortic root) or in the thoracic compartment (thoracic aortic aneurysm), the characteristic symptomatic picture may include: hoarse voice, chest pain, breathing difficulties, cough and pain in the upper back ; if, on the other hand, the dilation is in the abdominal compartment (abdominal aortic aneurysm), the typical symptoms of the current problem may consist of: abdominal pain, pain in the middle-lower part of the back, sense of something pulsating at the level of the navel and pain in the lower limbs .
Deepening: why is a large aortic aneurysm symptomatic?
The symptoms related to the presence of a large aortic aneurysm are the result of the pressure exerted by the dilation, on the adjacent organs or nervous structures; to understand, taking as an example the symptom "husky voice" observable in the presence of a remarkable aortic root aneurysm, the aforementioned disorder depends on the compression of the recurrent laryngeal nerve, passing in the immediate vicinity of the ascending aorta.
Complications
Aortic aneurysms are known for at least 3 complications:
- The already mentioned breakage of their walls. More frequent when the dilation is noticeable, this serious event produces an internal hemorrhage that often has a lethal outcome;
- The aforementioned formation of abnormal blood clots (emboli) or thrombi. From such formations can result an episode of stroke or occlusion of the coronary arteries ( heart attack );
- The so-called aortic dissection . With aortic dissection, the doctors intend the abnormal separation of the layers that make up the wall of the aorta, followed by the formation of a false channel within which the blood can penetrate and which can easily break (thanks to a weakening of the aforementioned wall). ).
SYMPTOMS IN CASE OF BREAKAGE
The typical symptoms and signs resulting from the rupture of an aortic aneurysm are:
- Intense and persistent abdominal and lumbar pain;
- Pain between the lumbar area and the lower limbs;
- Intense sweating;
- Dizziness;
- Nausea and vomit;
- Hypotension (ie low blood pressure);
- Fast pulse;
- Loss of knowledge;
- Breathing difficulties.
When should I go to the doctor?
Especially for people at risk (so elderly, smokers, obese, subjects with hypertension, patients with Marfan syndrome, etc.), is a valid reason to contact a doctor or go to the nearest hospital for the apparently unjustified appearance of symptoms such as : pain in the abdomen, chest pain, hoarse voice, back pain, respiratory problems and strange pulsating sensation in the navel.
WHAT TO DO IN CASE OF BREAKAGE OF AN AORTIC ANEURISM?
Breaking an aortic aneurysm is a medical emergency, so it requires immediate care .
WHAT TO DO IF YOU HAVE NO SYMPTOMS?
According to the doctors, an apparently healthy individual should undergo a check-up to detect vascular problems such as aortic aneurysms when:
- He is over 65;
- He is a smoker and / or suffers from hypertension, atherosclerosis, diabetes, etc .;
- Suffers from Marfan syndrome or Ehlers-Danlos syndrome;
- He suffers from some autoimmune disease associated with aortitis;
- He suffered in the past from some infection associated with aortitis.
Diagnosis
A doctor could identify an aortic aneurysm by using the phonendoscope, during a classic physical examination ; however, this circumstance is quite unusual and in any case does not guarantee the certainty of the diagnosis; in fact, for a certain diagnosis of aneurysm of the aorta, more precise and specific tests are required such as radiological examinations.
Radiological examinations
Radiological examinations useful for the diagnosis of aortic aneurysm include: chest x-ray, echocardiogram, abdominal ultrasound, TAC in the thoraco-abdominal compartment and magnetic resonance in the thoracic-abdominal compartment .
In addition to providing the so-called diagnostic confirmation, these instrumental tests allow physicians to know the exact size and precise position of the aneurysm of the aorta present.
Therapy
The presence of an aortic aneurysm requires a therapy whose objectives are:
- Prevent further expansion of the expansion e
- Prevent the rupture of the dilation, the phenomenon of aortic dissection and the formation of blood emboli or thrombi.
The treatment options for achieving the aforementioned objectives are different and the choice of one rather than another is strictly dependent on the severity of the aortic aneurysm present. In fact, if the aneurysm of the aorta is small, doctors limit themselves to periodic monitoring of the dilation (the so-called "principle of surveillance") and to treatment by means of drugs and / or a healthy style of vision of any eventual condition of health capable of aggravating the whole situation (eg: smoking, hypertension, hypercholesterolemia, etc.); if instead the aortic aneurysm is large, they are forced to resort to surgery .
Periodic monitoring
Including tests such as echocardiography, CT or thoraco-abdominal magnetic resonance, abdominal ultrasound, etc., periodic monitoring of an aortic aneurysm allows for early identification of any changes (eg, expansions) of the latter.
Pharmacological therapy
Among the drugs that can be useful in case of an aortic aneurysm, beta blockers, angiotensin II receptor antagonists and statins deserve a mention; beta-blockers and angiotensin II receptors are medicines for the control of hypertension, while statins are medicines for the control of hypercholesterolemia.
Lifestyle
Those who suffer from an aortic aneurysm benefit from a lifestyle in which:
- Cigarette smoking is abolished;
- You regularly practice physical exercise;
- We eat in a balanced and healthy way (foods low in fat, foods low in refined sugars, foods poor in salt, etc.).
Surgery
There are two surgical approaches to treating a large aortic aneurysm: the traditional approach (or "open" surgery approach) and the endovascular approach (or endovascular surgery approach).
Through the traditional approach, the surgeon performs a sort of vascular transplant; in fact, the resection of the aorta tract is performed with the expansion and replacement of this tract with a graft of synthetic material.
By means of the endovascular approach, instead, the operating doctor carries out the implantation of a metal structure for the internal reinforcement of the aortic walls subject to expansion; in other words, it inserts a sort of metal prosthesis at the dilated aorta segment that acts as a reinforcement element for the weakened walls.
Between the two surgical approaches described above, the second is certainly less invasive than the first, but unfortunately it is not applicable to all carriers of an aortic aneurysm.
WHY WORK ONLY THE MOST SERIOUS CASES?
Surgery for the treatment of an aortic aneurysm is an extremely delicate procedure, during which the risk of death of the patient, due to an operative complication, is very high.
In light of this, doctors resort to surgery only when the risk of death due to the rupture of an aortic aneurysm is greater than the risk of death from an operative complication; in other words, they decide to operate only if the presence of the aortic aneurysm is more insidious than surgical practice.
Brief information on aortic aneurysm surgery:
- In the absence of connective tissue diseases or aortic dissection, the indication for surgery applies exclusively to cases of aortic aneurysm in which the diameter of the dilation is greater than 5 centimeters.
- In the presence of connective tissue diseases or aortic dissection, the aforementioned indication varies and also include aortic aneurysms with a diameter of less than 5 centimeters.
What is the treatment in case of rupture of an aortic aneurysm?
The rupture of an aortic aneurysm requires the immediate practice of a surgical procedure aimed at repairing the aorta and consequently blocking internal bleeding.
Prognosis
Suffering from an aortic aneurysm means being in serious danger of life, because the abnormal dilatation can rupture from one moment to the next and because an embolus can form that can trigger a stroke or a heart attack.
Prevention
Among the precautions useful for reducing the risk of aneurysm of the aorta, we note: not smoking and maintaining blood pressure and cholesterol levels normally.
