Abdominal and Thoracic Aortic Aneurysms


Description  

 

An aneurysm is a localized dilation or bulge in a blood vessel. Abdominal (AAA) and thoracic (TAA) aortic aneurysms occur when the aorta dilates more than 150% of its normal diameter at a particular point. The larger the bulge becomes, the greater the risk that the aorta will rupture, causing internal hemorrhage. Almost six in 100,000 people will develop an aortic aneurysm. Men are two to four times more likely to be affected than women and the average age at the time of diagnosis is 60-70 years of age.

Common Risk Factors

  • Smoking
  • Congenital abnormalities (heredity)
  • Infections
  • Atherosclerosis
  • High blood pressure/hypertension
  • High cholesterol

These risk factors can lead to a weakening of the blood vessel wall, allowing an aneurysm to develop. Additional risk factors may exist that can be tested by your physician.

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Symptoms

Many times physical exam results are normal and patients may experience no apparent symptoms. However, patients may experience the following symptoms:

  • Back, chest or abdominal pain
  • “Pulsing” sensation in the abdomen
  • Hoarseness
  • Wheezing
  • Difficulty swallowing
  • Hypotension (low blood pressure)
  • Tachycardia (fast heart beat)
  • Shock (if the aneurysm ruptures)

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Tests and Diagnosis:

Fortunately physicians today have many tools at their disposal to help accurately diagnose and treat abdominal and thoracic aneurysms (AAA and TAA.) The first and most important begins with a thorough history and physical. Tests include:

  • Blood work
  • Ultrasound
  • Contrast-enhanced CT scans
  • Magnetic resonance imaging (MRI)
  • Contrast angiography
  • Chest radiography
  • Transesophageal echocardiography
  • Ultra Sonography

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Treatment options

If an AAA or TAA is detected, it is typically treated surgically with a synthetic portion of blood vessel, a ”graft”, replacing the area where the aneurysm was. Small aneurysms may be monitored for a period of time to see if they enlarge.

Endovascular Aneurysm Repair
Endovascular aneurysm repair was developed in the 1990’s. In this procedure, your vascular surgeon inserts catheters into an artery in your groin and guides them to the aneurysm. Using continuous x-rays, your surgeon will watch the procedure on a video screen to assure proper placement of the stent-graft. Once in place, the stent-graft will allow blood to flow through normally  and prevent additional pressure on the aneurysm walls, thus preventing the aneurysm from rupturing. With this procedure, patients have a shorter hospital stay and recover much more quickly than with the open aneurysm repair. Post-operatively, it is important for patients to have regular check-ups to make sure that the stent-graft is in the proper position and that it is functioning correctly.  Your surgeon must evaluate your aneurysm, typically with a CT scan, to see if a stent-graft will fit “anatomically” and provide a lasting repair.

Open Aneurysm Repair
Open aneurysm repair requires your surgeon to make an incision in your chest or abdomen, where a synthetic graft is sewn into the aorta at the aneurysm site. The graft is a fabric tube that replaces the diseased aorta, allowing normal blood flow to be restored to the rest of the body and removing pressure on the aneurysm walls.  Open repair was first developed in the 1950’s and is a very durable and effective treatment.  It does, however, require a much larger incision and longer hospital stay and longer overall recovery time.   Your surgeon will need to take into account your overall medical condition to see if these factors can affect your outcome.

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FAQs

What is an aneurysm?
A weakening in the wall of a blood vessel that leads to significant dilation putting the patient at risk for rupture.

How do I know if I have an aneurysm?
Most aneurysms are silent but sometimes may cause back pain, chest pain and/or abdominal pain.  Family history is a very important risk factor.

What can be done to determine if I have aneurysm?
Simple non-invasive ultrasound for abdominal aneurysm.CT scan for thoracic aneurysm.

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Helpful Links

Please visit these websites for detailed information directed to patients and their families:

http://www.vascularweb.org/vascularhealth/pages/abdominalaorticaneurysm.aspx

http://www.vascularweb.org/vascularhealth/pages/thoracicaorticaneurysm.aspx

http://www.medicinenet.com/abdominal_aortic_aneurysm/article.htm

http://www.webmd.com/heart-disease/tc/aortic-aneurysm-treatment-overview

http://en.wikipedia.org/wiki/Abdominal_aortic_aneurysm

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