Definition

The aorta is the body's largest artery. It carries blood from the heart and delivers it to the rest of the body. The aorta travels through the chest and the abdomen. An aortic aneurysm is a weak, bulging area in the wall of the aorta. The bulging develops from a weakness or defect in the aortic wall. It tends to get bigger with time.

The greatest danger is that an aneurysm will rupture. This will cause heavy, uncontrollable bleeding. Aortic aneurysms can also occur with aortic dissection. Dissection is a small tear in the aortic wall. Blood from the aneurysm can leak through this tear and spread between the layers of the aortic wall. This leads to eventual rupture of the vessel.

Aneurysms can develop anywhere. They are most common in the aorta (thoracic and abdominal), iliac artery, and femoral artery.

Abdominal Aortic Aneurysm

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Causes

Atherosclerosis is frequently associated with aneurysm. However, it is not thought that this disease alone causes the growth of an aneurysm. It is believed that other factors, such as high blood pressure or connective tissue disorders, must be present for an aneurysm to form.

Risk Factors

Aortic aneurysms are more common in adults over 60 years of age. Other factors that may increase your chances of an aortic aneurysm:

• High blood pressure
• Smoking
• Arteriosclerosis, atherosclerosis
• Inherited connective tissue defects such as Marfan syndrome or Ehlers-Danlos syndrome
• Polyarteritis nodosa
• Bacterial endocarditis
• Syphilis
• History of heart attack
• Obesity
• Family members with aneurysms, particularly male children of an affected mother
• Infectious aortitis
• Great vessel arteritis, also known as Takayasu disease
• Injury to the aorta, from either a motor vehicle accident or a stab wound

Symptoms

Many aneurysms do not have symptoms. They are detected during a routine physical exam or during x-ray evaluation for another disorder.

Symptoms may occur when the aneurysm grows or disrupts the wall of the aorta. Symptoms depend on the size and location of the aneurysm and may include:

• Pain in the abdomen or in the lower back
• Boring, gnawing, or constant pain occurring over hours or days
• Sudden onset of severe stabbing pain
• Unusual sensation of pulsing in the abdomen
• Cough, shortness of breath
• Fainting
• Hoarseness
• Difficulty swallowing
• Coughing up blood
• Weight loss
• Chest pain

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Pain is the symptom that will most likely cause you to go to the doctor. Most aortic aneurysms are discovered during a routine physical exam.

Images of your heart may be needed. This can be done with:

• Abdominal ultrasound
• CTA scan
• MRA scan
• Abdominal CT scan
• Aortography
• Transesophageal echocardiography
• Cardiac catheterization

Treatment

Treatment includes surgery or stenting.

Prevention

There are no current guidelines for preventing an aneurysm because the cause is not known. However, you can reduce some of your risk factors:

• Eat a healthful diet that is low in saturated fat and rich in whole grains, fruits, and vegetables.
• If you smoke, talk to your doctor about ways to quit.
  • The US Preventive Services Task Force recommends that men aged 65-75 who have ever smoked be screened once for abdominal aortic aneurysm with ultrasound. This is a painless procedure that gives a picture of the abdomen using sound waves. Early detection of abdominal aortic aneurysm in this group has been shown to reduce mortality from this condition.
• Maintain a healthy weight.
• Begin a safe exercise program with the advice of your doctor.
• Seek treatment for high blood pressure, syphilis, and other infections.
• If you have Marfan syndrome, see your doctor regularly for monitoring and CT scans.