Aortic Aneurysm

Aortic aneurysm refers to a bulge or extension from a weak part of the wall of aorta, the largest artery in the body. Pressure within the blood vessel pushes the weak walls and creates a bulge. Aortic aneurysms are of two kinds

• Thoracic aortic aneurysms – these aneurysms are found in the part of aorta that pass through the chest cavity.
• Abdominal aortic aneurysms – these aneurysms are the most common form of aortic aneurysm. In this type, the bulge is seen in the part of aorta that pass through low and middle abdomen.

Aneurysms in aorta may be tube-like or saccular in structure. When the pressure increases the weak wall of the blood vessel may tear, resulting in aortic dissection. It also increases the risk of blood vessel rupture causing bleeding.

Aortic Aneurysms may remain asymptomatic until they grow very big or rupture. The two most common symptoms of aneurysm are chest pain and back pain. The pain may be in the form of an unusual sensation or pressure in the upper part of chest or back. Chest pain is caused by aortic dissection also. The pain is described as a ripping one, and is often accompanied by sweating, rapid heart rate, increased breathing, dizziness and shock. Abdominal aneurysm is characterized by nausea, feeling of fullness, and a pulsating bulge in the abdomen. 

As the aorta bulges outwards, blood clots form inside the blood vessel. These clots often break off and travel through the blood to other parts of the body. A clot lodged in the blood vessel reduces the blood flow through the artery, resulting in symptoms. The symptoms depend on the affected organ or part of the body. Broken clots may result in stroke or heart attack. It may also affect the functioning of other organs like lungs and kidneys.

Ruptured blood vessel results in bleeding that causes symptoms like

• Nausea and vomiting
• Confusion
• Weakness
• Lightheadedness
• Sweating
• Loss of consciousness
• Numbness or tingling
• Rapid heartbeat
• Shortness of breath

Although these symptoms are not specific to aortic aneurysms, they represent a medical emergency and require immediate attention. If left untreated, it will result in a drastic drop in blood pressure resulting in circulatory shock.

Weakness in the wall of the aorta causes bulges or aortic aneurysms. In some cases it may be present at the time of birth, while in some others it develops due to injury or diseases. The most common causes of aortic aneurysms are
Atherosclerosis – deposition of fatty substance on the lining of wall of blood vessel weakens aorta, leading to aneurysms. This is the most common cause of aortic aneurysms.

• Hypertension—increased pressure inside the blood vessel puts stress on the wall, which weakens it and leads to bulging.
• Diabetes – diabetes accelerates atherosclerosis which is a common cause of aortic bulging
• Cystic medial necrosis – this condition characterized by degeneration of the wall of the blood vessel is associated with certain inherited diseases like Marfan syndrome and Ehlers-Danlos syndrome.
• Mycotic aneurysm – this is caused by bacterial infection that weakens the wall of the blood vessel.
• Inflammatory aneurysm – conditions like as psoriasis and rheumatoid arthritis leads to inflammation of the blood vessels that weakens the wall of aorta.
• Injury – injuries also damage the wall of aorta, weakening the wall and leading to bulging.

In some cases, the actual cause of aneurysm is not known. The major risk factors for aortic bulging include:

• Age above 55 years
• Gender
• Hypertension
• Smoking
• Certain inherited diseases
• Family history
• Atherosclerosis

Aortic aneurysms may remain asymptomatic and are frequently diagnosed incidentally, while screening for other conditions. When aortic aneurysms are suspected, the following tests and procedures help in confirmatory diagnosis.

• Ultrasound and echocardiography – these imaging techniques help to visualize the inner structures and also to locate and assess the size of aneurysm.
• CT scan – In this procedure a dye is injected into the blood which makes the arteries visible in scan. This procedure produces a more detailed picture of the inner structures and helps to assess the size and shape of the aneurysm.
• MRI – this technique also helps to detect and assess the size of aortic bulge.
• Angiography – this method is used to visualize the inner parts of aorta. It helps to show the location and size of the aneurysm.

Treatment depends on the location and size of aortic aneurysm, and the overall health of the patient. The first level of treatment for any aneurysm is the prevention of vessel rupture. For small aneurysms watch and wait strategy works. Regular checkups to monitor the growth of the bulging is important.

Other medical conditions that worsen symptoms of aneurysms need to be managed to prevent complications. Large, rapidly growing aneurysms may require immediate attention.

If the abdominal aortic aneurysm is less than 2 inches, and is developing very slowly, the risk of rupture is less. In this case, close monitoring of the bulge is recommended. If the aneurysm grows bigger than 2.5 inches, surgery. Emergency repair is suggested for inflammatory abdominal aortic aneurysm. Those that are growing rapidly have a high risk of rupture and surgery is recommended.

Medications are given to control hypertension and high levels of cholesterol, both of which increase the risk of complications. Beta blockers, angiotensin II receptor blockers, and statins are the commonly recommended medications.

Surgery is recommended when the thoracic aneurysm range from 1.9 to 2.4 inches or larger. Surgical treatment is also suggested if the person has bicuspid aortic valve, or a family history of aneurysm. In open chest surgery, the aneurysm is removed and replaced with a graft.

In endovascular surgery, the graft is placed at the site of aneurysm using a catheter inserted through the artery. The graft has a metal mesh support that reinforces the weak walls of the blood vessel. Ruptured thoracic aortic aneurysms is repaired by an emergency surgery.

Controlling the risk factors is the best preventive measure for aortic aneurysms. Healthy diet and regular exercise helps to avoid atherosclerosis, one of the risk factors of aneurysm. Risk of aneurysm can be reduced by

• Quitting smoking
• Managing hypertension and high cholesterol levels
• Maintaining a healthy weight
• Having a well-balanced diet

Regular checkups are a must if there is a family history of aneurysms.

Several alternative and homeopathic remedies exist for Aortic aneurysm.

In homeopathy, veratrum viride is used to control pulse rate. Other medications used include gallicum acidum, ergotinum, baryta muriatica, aconite, digitalis, gelsemium, and Laurocerasus. Garlic is suggested for controlling hypertension and to reduce the risk of heart diseases.

Lifestyle modifications are necessary in order to cope with Aortic aneurysm.

One should avoid stressful situations and strenuous physical activity, both of which increases the pressure on aneurysms. Taking healthy steps like quitting smoking, managing blood pressure, and reducing cholesterol in diet help to reduce the risk of developing aneurysms.

Talking to an expert and being a part of the support group helps to cope with the condition.

The main complication of aortic aneurysm is the rupture of blood vessel. This may lead to sudden, shooting pain in the chest, low blood pressure, loss of consciousness, difficulty in breathing, trouble swallowing, and paralysis of one side of the body.

Risk of blood clots also increases with aortic aneurysms.