Aortic Aneurysm Victor Politi, M.D., FACP Medical Director, SVCMC, School of Allied Health Professions, Physician Assistant Program

The Aorta zThe aorta is the largest human artery zIt is the primary artery that carries blood from the heart to the head and extremities zDuring an average lifetime it transports 200 million liters of blood and withstands the force of up to 3 billion heartbeats

The Aorta zThe aorta is one inch in diameter zIt divides at the hip into the two iliac arteries that supply blood to the legs zThe arteries that feed all of the body’s organs branch off from the aorta

The Aorta zThe aorta emerges from the heart and runs the length of the torso ythoracic aorta - as it leaves the heart, ascends, arches, and descends through the chest until it reaches the diaphragm yabdominal aorta - after passing the diaphragm - continues down abdomen- ends where it splits at two iliac arteries

Where do they develop zCan develop anywhere along the aorta yIn the chest - called thoracic aneurysm zMore than 3/4 of aortic aneurysms occur in the abdomen - most often below the renal arteries yAbout 2/3 of abdominal aneurysms extend from the aorta into one or both of the iliac arteries

What is an aortic aneurysm zAn aneurysm can be caused by pressure on a weakened section of the arterial wall zor by dissection - a split in the three layers of tissue comprising the aortic wall - blood seeps between them, the wall stretches, increasing the risk of rupture

Three common types of aortic aneurysms zSaccular yinvolves only the muscular middle layer of aorta with a localized out-pocketing (balloon-like swelling) zFusiform ymost common form, spindle shaped, widens all around circumference of aorta (balloon-like swelling) zDissecting ylongitudinal, blood-filled split in the lining of the artery, usually in the aortic arch near the heart

Incidence zOn average 15,000 Americans die suddenly each year from rupture of an aortic aneurysm zIt is the 9th leading cause of death from men over age 55

Incidence zIncreases with age > 60 at greater risk zMales more common than females (5:1) y5% of men over age 60 develop an abdominal aortic aneurysm

Incidence zMost common cause - arteriosclerosis (80% of cases) zpost physical trauma to aorta zOther Risk factors yconnective tissue disease, arteritis, congenital malformation, Marfan syndrome, atherosclerotic risk factors (smoking, HTN, hyperlipidemia, diabetes)family hx of aneurysm

Symptoms zAneurysms can be small or grow to the size of a grapefruit zMost are symptomless, especially when small zSymptoms tend to increase as aneurysms enlarge and press on nerves, organs, or other blood vessels zSymptoms occur in only 25% of patients

Symptoms zMost common symptom is a throbbing, or pulsation in the abdomen zMay cause lower back pain

Symptoms zIn thoracic aneurysm symptoms may include: ypain in the shoulders, lower back, neck or abdomen ya dry cough yhoarseness from pressure of aneurysm on nerves controlling vocal cords xmany of these are frequently misdiagnosed!

Symptoms zOther symptoms ythrobbing lump in abdominal area ysevere backache yleg pain/coldness in leg (due to embolus from clot formed in abdominal aneurysm) ysevere abdominal pain (rupture)

Diagnosis zAbdominal palpitation ymay reveal abnormally wide pulsation of the abdominal aorta ycharacteristically felt on both sides of the aorta which is midline yEven large aneurysms can be difficult to detect on exam in overweight people yAneurysms that are rapidly enlarging and on the verge of rupture are often tender

Diagnosis zAbdominal aortic aneurysm yx-ray (shows calcium deposits in 90% of cases) yCT Scan w/contrast yMRI yabdominal Ultrasound -(98% accuracy in size measurement) yabdominal aortography

Aortic Aneurysm zThe aorta (short arrow) looks like a white "candy-cane" in the middle of this image. The aneurysm (long arrow) is the thin line running through the candy cane.

Diagnosis zthoracic aortic aneurysm ychest x-ray yTEE yMRI yCT scan

Complications - z1/2 of all persons with untreated abdominal aortic aneurysms die of rupture within 5 years zAbdominal aortic aneurysms - 13th leading cause of death - overall - in the US

Complications zRupture yhighly lethal - causes profuse bleeding, leads to shock- death yuncommon < 5cm wide yMore common > 6cm wide zPeripheral embolization of clot within the aneurysm zInfection of aneurysm zSpontaneous blockage of the aorta

Treatment zSymptomatic aneurysms require early or urgent treatment zSurgical treatment involves replacing the part of the aorta affected by the aneurysm with a synthetic graft z - risk of death from rupture 50%- even during surgery zSurgery only treatment

Treatment zTreatment of dissecting aneurysm ylowering of BP to reduce force on the tear- prior to surgery yif left untreated- most people die within a few weeks

Treatment zRepair can be done surgically or by installation of a stent graft ySurgical repair xrecommended for all aneurysms over 6cm wide xusually recommended for aneurysms 4-6cm in good surgical risk cases yStent graft - minimally invasive -may be option in some cases

Questions??