Cardiovascular system Aortic aneurysms
The aneurysm is a dilation located on the wall of a blood vessel. It can be formed in any artery in the body, such as the iliac, femoral, popliteal, and visceral ones, including the brain ones. However, they are more common to be developed in the aorta, the largest artery in the body. Can be developed in any portion of the aorta: thoracic and/or abdominal. The most common place for aortic dilation is in its abdominal portion, just below the renal arteries.
The aortic aneurysms is a serious disease, as, depending on the size, it can be ruptured, causing internal hemorrhage.
Most aneurysms are found occasionally, by exams usually requested by another reason. The aneurysm correction after its rupture is not always effective. A careful evaluation of the aneurysm type, location, and size is ideal, in order to be able to perform the correction before the rupture, in the indicated cases.
AORTIC ANEURYSMS USUALLY DO NOT CAUSE ANY SYMPTOM. THEY GROW SILENTLY, BEING HARD TO DETECT. MANY OF THEM BEGIN SMALL AND THUS REMAIN FOR YEARS. OTHERS GROW FASTER AND, CONSEQUENTLY MUST BE FOLLOWED WITH PERIODICAL EXAMS. LARGER ANEURYSMS USUALLY TEND TO GROW MORE AND, THE LARGER THE ANEURYSM SIZE, THE LARGER THE RUPTURE CHANCE WILL BE. IT IS LIKE A BALLOON (THE CHANCE OF EXPLOSION IS HIGHER AS THE BALLOON IS BEING INFLATED).
When the aneurysm is large or is rapidly growing, the patient may feel:
– Pulsation feeling in the abdomen;
– Pain in thorax or abdomen (depending on the location);
– Pain on the back.
Large aneurysms can also cause compression symptoms.
In the exam, the physician can palpate the abdominal aneurysm, but small and medium aneurysms are hard to be palpated, mainly if the patient is obese. Every patient with aneurysm and one of these signs must contact his/her physician soon.
The main and most feared complication is the rupture. The larger the aneurysm, the larger will be the rupture chance. Once the aneurysm is ruptured, there is internal hemorrhage. The rupture symptoms are:
– Intense and sudden abdominal pain with radiation to the back
– Dizziness associated to low pressure
Aneurysms often also present blood clots inside themselves. These clots can be dislocated, causing ischemia (reduction in circulation). Such ischemia can occur in a brain territory in cases of aneurysms of thoracic aorta and in the legs and toes in cases of aneurysms of thoracic and/or abdominal aorta. This latter complication is rarer.
As for the treatment, the objective is preventing the rupture. Not all aneurysm must be surgically treated. The treatment depends on size, location, and growth rate, and on the patient’s general health.
As in any medical procedure, the risk/benefit relationship must be well-evaluated. Aneurysms of abdominal aorta smaller than 4 cm of diameter and with no symptoms can be usually closely accompanied with an echography or tomography at every 6 months. A 3.0-cm aneurysm of abdominal aorta in an 80-years-old patient can be accompany very well with serial exams, while an abdominal aneurysm of 6.0 cm of diameter in a 50-years-old patient must be corrected.
In case of observation, it is important to treat the high pressure, to not perform a great physical effort implying in a pressure increase inside the abdomen, and to not smoke.
If there is no contraindication, the use of a medication called betablocker can be recommended, aiming to delay the aneurysm growth.
Large aneurysms of thoracic or abdominal aorta that are growing or showing symptoms must be treated, and there are two main treatment forms: conventional surgery and endovascular surgery.
* More information on this subject can be found in the session Aortic Aneurysms.