Abdominal and Thoracic Aortic Aneurysms

An aneurysm is a severe and life-threatening condition and often does not show symptoms. It is the abnormal bulging or enlargement in the wall of an artery. It happens when part of a blood vessel wall weakens, making it widen. Most aneurysms occur in the aorta, the main artery that carries blood away from the heart to the abdomen, pelvis and legs. An aortic aneurysm is usually discovered during health screenings or tests, so stay on top of your health by regularly visiting a doctor for assessment.

What Is Aortic Aneurysm?

An aortic aneurysm is the bulging and ballooning in the aorta, the large artery that carries blood from the heart through the torso and chest. Most deaths from aortic aneurysms are caused by:

• Rupture – aneurysm bursting and causing internal bleeding
• Dissection – the arterial wall layers split, and blood leaks in between

Narrowing, clots or blockages in a blood vessel caused by an aneurysm can lead to poor blood circulation, resulting in health complications such as stroke, organ damage or even death. Some types of aneurysms include:

• Abdominal aortic aneurysm (AAA) - Affects the aorta that supplies blood to the abdomen, pelvis and legs
• Thoracic aortic aneurysm (TAA) - Affects the part of the aorta that passes from the chest to the diaphragm
• Cerebral aneurysm – Affects a blood vessel in the brain

What Causes Aneurysms in the Aorta?

The exact cause of thoracic and abdominal aortic aneurysms remains unknown, but the following factors may increase your risk of developing this medical condition:

• Smoking – Directly damages the arterial walls, making them more susceptible to abnormal enlargement. It also increases your risk of hypertension.
• Atherosclerosis – Occurs when plaque builds up inside the blood vessels, limiting the supply of oxygen-rich blood to the organs and the rest of the body.
• Hypertension – High blood pressure can weaken the aortic walls and may cause an aneurysm to form.
• Chronic obstructive pulmonary disease (COPD) – A group of diseases causing airflow blockage and breathing-related conditions.
• High cholesterol levels
• A family history of aneurysm
• Cardiovascular disease

What Is the Difference Between Thoracic and Abdominal Aortic Aneurysm?

TAA occurs in the parts of the aorta that runs through the thoracic cavity in the chest area, including the section of the aorta that extends from the heart’s upper chambers (atria) to the diaphragm. On the other hand, AAA occurs in the portion of the aorta that passes through the abdomen. Both aneurysms may not cause noticeable symptoms until they rupture, leak or become larger. When symptoms do occur, they can include chest pain for TAA and abdominal pain for AAA.

Some symptoms of TAA may include:

• Deep and throbbing chest pain
• Trouble or pain swallowing
• Neck swelling
• Hoarseness
• High-pitched breathing
• Clammy skin
• Vomiting and nausea
• Rapid heart rate

Abdominal aortic aneurysm symptoms may include:

• Stomach pain that does not go away
• Sweaty or clammy skin
• Shock or fainting
• Dizziness
• Increased heart rate
• Nausea and vomiting
• Pain spreading from your abdomen or back to the pelvis, buttocks, groin or legs
• A throbbing and deep pain in the stomach

Always consult a doctor if you experience any symptoms listed here for proper diagnosis and evaluation.

How Is an Aortic Aneurysm Diagnosed?

Since aneurysms do not usually cause symptoms, unruptured aneurysms are often diagnosed during tests or exams for other health conditions. Your physician may perform the following initial physical examination to look for a possibility of aortic aneurysm:

• Feel your stomach area
• Listen to your heart for abnormal sounds
• Check whether the blood pressure in your limbs is weaker than normal
• Look for symptoms of other medical conditions that may be increasing your risk for aneurysm

The following tests may be conducted if your doctor suspects you may have an aortic aneurysm:

• Abdominal ultrasound
• Chest X-ray
• Magnetic resonance imaging (MRI)
• Abdominal computerized tomography (CT) to confirm the aneurysm size
• CT angiogram (CTA) to help with surgical planning

Treatment for Aortic Aneurysm

Treatments depend on the aneurysm’s size and exact location. A ruptured aneurysm requires immediate surgery. A small aneurysm that is not causing any symptoms may not need surgery. Instead, your physician may recommend closely monitoring your condition through ultrasound tests every six months.

Surgery is usually done when the aneurysm is medium-sized (bigger than 5 centimeters across) or growing quickly to prevent complications from developing. The outcome is often good if the surgery is done before the aneurysm ruptures. Surgery involves placing a graft in the aneurysm site to stabilize the weakened aortic walls. Putting a graft can also redirect blood flow through the graft instead of the aneurysm. The types of surgical approaches to treat aneurysm are:

• Open surgical repair – Involves making a large cut in the stomach or chest area, depending on where the aneurysm is located. The aneurysm is removed, and a graft is sewn into place. Recovery from this surgery is usually longer than a minimally invasive procedure.
• Endovascular aneurysm repair (EVAR) - A procedure less invasive than open surgical repair and is usually done more often for AAA than TAA. In this procedure, your doctor makes a small cut (usually in the groin). A stent graft will be inserted here and guided through the blood vessels until it reaches the affected part of the aorta, where the stent will be expanded so it attaches to the aortic walls. Recovery time from EVAR is usually faster than open repair surgery.

How To Reduce the Risk of Developing Aortic Aneurysm?

No specific lifestyle changes or therapy can prevent the aneurysm from developing, but maintaining good health overall can help. Get screened if aneurysms run in your family. Quitting smoking can also help reduce your risk, as a history of smoking accounts for about 75% of all AAAs cases. Approach your doctor for smoking cessation programs that may work for you.

Your doctor might prescribe medicines if you have a condition that raises your risk for an aneurysm, like high blood pressure, cholesterol or diabetes. These heart-healthy habits include:

• Eating a balanced diet
• Exercising
• Maintaining a healthy weight
• Quitting smoking
• Cutting down on alcohol consumption
• Reducing stress