What is Aortic Aneurysm (Dilation) ?
Aorta is the biggest vein in human body. It transfers arterial blood from the heart to all organs which makes it “main blood line”. Considering height and weight of the person, it carries 3 to 6-7 lt. of blood in a minute. There is a certain pressure (80 - 140 mmHg) while transferring the blood depending on heart’s beat rate and structure. We call it tension. Aorta may enlarge silently in the body due to various reasons. It should be diagnosed early.
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Aorta is the main artery which pumps the blood after it gets out of the heart. Aorta’s size is 2,5 cm when it first gets out of the heart. There is no other vein that is bigger than aorta in the body. Aorta’s size may enlarge due to several reasons. We call it “Aneurysm” in medicine. If the aneurysm keeps getting bigger, there would be a risk of tear. The blood which flows inside of aorta starts to flow outward and if it comes to a level where this effects other organs we call it “rupture” (explosion) in medicine. Complication of expanding aorta is called “Dissection” (inwards tearing). Both are highly dangerous pathologies. They both need urgent intervention and they are life-threatening.
Aorta comes from left ventricular of the heart and it proceeds through thoracic and abdominal cavities. If there is aneurysm in thoracic cavity we call it “thoracic aneurysm”. If it occurs in abdominal cavity then, it is called “abdominal aneurysm”.
Aneurysms may occur in brain, heart, neck, spleen, back of knee and in other veins of the body. If a brain aneurysm ruptures it may cause prolapse.
Why aneurysm screening is important?
Every year approximately 15.000 people dies from rupture aneurysm. Rupture aneurysms are 10th cause of death between male patients over the age of 50. Most of rupture aneurysms may be prevented with early diagnosis and medical treatment. Aneurysm can be enlarged without no symptoms. That’s why it is important to make aneurysm scanning especially for risky patients.
As soon as it is diagnosed, aneurysms may be treated with the help of medicine or surgical interventions. Doctors give medicine for reducing heart beat and blood pressure after it is diagnosed which prevents the risk of rupture. If there is a large aortic aneurysm diagnosis, generally doctors replace unhealthy part of the aorta. These have generally good results.
What are the reasons of Aortic Aneurysm?
- Aortic Aneurysm may occur because of atherosclerosis (vessel stiffness or deterioration).As the atherosclerosis progresses, arterial walls become thick, damaged and they lose their regular inner surface. The damaged part of arterial may tighten or “aneurysm” may occur with the pressure of blood inside. Aneurysms are formed this way. Aneurysms may also occur due to constant high blood pressure in arterial.
- Aneurysms may also happen because of a trauma such as car accidents.
- Certain medical cases such as Marfan Syndrome may cause aneurysms. People with Marfan Syndrome are very tall, and their fingers are thin and tall. Their vascular structure tends to be thin.
- In rare cases, un-treated syphilis (sexually transmitted infections) may also cause aortic aneurysm.
Who are the risky group?
Frequency of AAA (Abdominal Aortic Aneurysm-the most frequent aneurysm) is 5-10 times higher in men comparing to women. The risk of AAA increases as people grow older and generally it is seen in people who are 60-80 years old. Peripheric aneurysms are also seen in 60-80 years old patients.
• Atherosclerosis (Arterial fat accumulation)
• Smoking (Smokers face 8 times greater risk of aneurysms)
• Excess weight and obesity
• Family history for aortic aneurysms, cardiac diseases or other diseases of arterial
• Certain diseases that weakens aortic walls (Marfan syndrome, untreated syphilis, tuberculosis)
• Traumas after car accidents
• Severe and permanent high blood pressure between ages 35-60 (pressure that is not get under control is dangerous)
• Stimulant drugs such as cocaine.
What are the symptoms?
Aneurysm symptoms depend on their type, localization and whether it is ruptured or not or it’s relation with other structures of the body. Aneurysms may appear in years and get bigger without causing no complaints.
They get bigger in years and they cause no complaints until aneurysm is ruptured. Sometimes a bulk with pulse is found inside abdominal region of the patients. In this case patients complain about back and abdominal pain near belly, stable and constant pain in abdomen and cold feet.We call Abdominal Aortic Aneurysm (AAA) when there is aneurysm in abdominal region. If AAA ruptures, the symptoms will be sudden and severe pain in lower abdomen and back, nausea, vomiting, sweating, dizziness and tachycardia. Internal bleeding arising out of ruptured AAA may cause a shock for the patient. Thoracic (Chest) Aneurysms are also tending to cause no complaints until they are ruptured. Complaints are generally; pain in the chest, back, neck and chin or coughing, hoarseness or shortness of breath.
In peripheric aneurysms complaints are generally bulk with pulse on the neck, arm, legs. Pain in arms, legs and symptoms such as cramps.
How can aneurysms be diagnosed?
Aneurysms may be detected during routine physical examinations. They can also be diagnosed through ultrasound, roentgen or computerized tomography which are made because of thoracic or abdominal pain. To diagnose a patient with aneurysm; ultrasound, CT, magnetic resonance or angiography methods are used.
When and how can aneurysm be treated?
Aortic Aneurysm’s treatment plan and method varies upon it’s location. We can summarize cases which needs treatment by splitting aneurysms as ascending and descending aorta:
- If ascending aorta’s size is 5,5 cm or more
- If ascending aorta’s size increased to 5mm during the last 6 months
- If ascending aorta’s size is 5 cm and there is unstable hypertension
- If descending aorta’s size is 6 cm or if there is 5mm enlargement during the last 6 months
- If there are another organ pressure
- If abdominal aorta’s size is 5,5 cm or if there is 5mm enlargement during the last 6 months
- If there is a bleeding suspicion in all aneurysm
If above situations are found in the patient, the patient should be treated with surgical or interventional methods such as EVAR, TEVAR. This last method is also known as “closed method”.