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Aortic Aneurysm

(AAA; Abdominal Aortic Aneurysm; Aneurysm, Abdominal Aortic; Thoracic Aortic Aneurysm; Aneurysm, Thoracic Aortic)

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, iliac artery, and femoral artery.
Abdominal Aortic Aneurysm
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

Factors that increase your chance of getting an aortic aneurysm include:

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:

Diagnosis

The doctor will ask 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.
Your doctor may need pictures of your heart. This can be done with:

Treatment

Treatment includes surgery or stenting.

Surgery

Surgery to repair an aortic aneurysm is called aneurysmectomy . It involves removing the portion of the aorta that contains the aneurysm and replacing it with a mesh graft.
With aneurysms of the thoracic aorta, the aortic valve may also be affected and need to be replaced or repaired. If the aneurysm involves important branches of the aorta, these vessels may either be repaired or bypassed.
When deciding whether to operate, the doctor will consider:
  • Your age
  • Your general health
  • Your symptoms
  • The size of your aneurysm
  • Associated disease such as kidney failure or stroke
  • If the aneurysm has ruptured or not
  • If you've had a recent heart attack

Stenting

Depending on where the aneurysm is located and how complex it is, stenting may be done. A stent-graft is a polyester tube covered by a tubular metal web. The stent-graft is inserted into the aorta. With the stent-graft in place, blood flows through the stent-graft instead of into the aneurysm, eliminating the chance of rupture.

Prevention

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

RESOURCES

American Heart Association http://www.heart.org

The National Heart, Lung and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.ca

References

Abdominal aortic aneurysm (AAA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 18, 2013. Accessed May 8, 2013.

Braunwald E. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, PA: WB Saunders Company; 2001.

Sabiston DC, Townsend CM. Sabiston Textbook of Surgery. 16th ed. Philadelphia, PA: WB Saunders Company; 2001.

Screening for abdominal aortic aneurysm: recommendation statement. US Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/uspstf05/aaascr/aaars.htm. Published February 2005. Accessed May 8, 2013.

Thoracic aortic aneurysm (AAA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 16, 2013. Accessed May 8, 2013.

7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Thompson SG, Ashton HA, Gao L, Scott RA, Multicentre Aneurysm Screening Study Group. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ. 2009;338:b2307.

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