aortic aneurysm


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Aortic Aneurysm

 

Definition

An aneurysm is an abnormal bulging or swelling of a portion of a blood vessel. The aorta, which can develop these abnormal bulges, is the large blood vessel that carries oxygen-rich blood away from the heart to the rest of the body.

Description

The aorta carries oxygen-rich blood to the body, and is therefore called an artery. Because the aorta is an artery, its walls are made of up three layers; a thin inner layer, a muscular middle layer (that gives the vessel its flexibility under pressure from the filling blood), and a fiber-like outer layer that gives the vessel strength to not burst when the heart pumps blood to the body.
Aortic aneurysms occur when a weakness develops in part of the wall of the aorta; three basic types are usually found. If all three layers of the vessel are affected and weakness develops along an extended area of the vessel, the weakened area will appear as a large, bulging region of blood vessel; this is called a fusiform aneurysm. If weakness develops between the inner and outer layers of the aortic wall, a bulge results as blood from the interior of the vessel is pushed around the damaged region in the wall and collects between these layers. This is called a dissecting aneurysm because one layer is "dissected" or separated from another. If damage occurs to only the middle (muscular) layer of the vessel, a sack-like bulge can form; therefore, this is a saccular aneurysm.

Causes and symptoms

Aortic aneurysms occur in different portions of the aorta, which begins in the chest (at the heart) and travels downward through the abdomen. Aneurysms found in the region of the aorta within the chest are called thoracic aortic aneurysms. Aneurysms that occur in the part of the aorta within the abdomen are called abdominal aortic aneurysms.
Thoracic aortic aneurysms do not usually produce any noticeable symptoms. However, as the aneurysm becomes larger, chest, shoulder, neck, lower back, or abdominal pain can result. Abdominal aortic aneurysms occur more often in men, and these aneurysms can cause pain in the lower back, hips, and abdomen. A painful abdominal aortic aneurysm usually means that the aneurysm could burst very soon.
Most abdominal aortic aneurysms are caused by atherosclerosis, a condition caused when fat (mostly cholesterol) carried in the blood builds up in the inner wall of the aorta. As more and more fat attaches to the aortic wall, the wall itself becomes abnormally weak and often results in an aneurysm or bulge.
Aortic aneurysms occur when a weakness develops in a part of the wall of the aorta. The aorta is the large blood vessel that carries oxygen-rich blood away from the heart to the rest of the body.
Aortic aneurysms occur when a weakness develops in a part of the wall of the aorta. The aorta is the large blood vessel that carries oxygen-rich blood away from the heart to the rest of the body.
(Illustration by Electronic Illustrators Group.)
Aortic aneurysms are also caused by a breakdown of the muscular middle layer of the artery wall, by high blood pressure, by direct injury to the chest, and although rare, by bacteria that can infect the aorta.

Diagnosis

Silent, stable aneurysms are often detected when a person has an x ray as part of a routine examination or for other medical reasons. Otherwise, when chest, abdominal, or back pain is severe, aortic aneurysm is suspected and x-ray (radiographic) studies can confirm or rule out that condition.

Key terms

Atherosclerosis — The accumulation of fat on the inner wall of an artery. This fat is largely made up of cholesterol being carried in the blood.
Dacron — A synthetic polyester fiber used to surgically repair damaged sections of blood vessel walls.

Treatment

Aortic aneurysms are potentially life-threatening conditions. Small aneurysms should be monitored for their rate of growth and large aneurysms require consideration for a surgical repair. The most common method of surgical repair is to cut out the bulging section of artery wall and sew a Dacron fiber material into its place in the vessel wall.

Prognosis

Only 1-2% of people die from having surgical repair of an aortic aneurysm. However, if the aneurysm is untreated and eventually ruptures, less than half of the people with ruptured aneurysms will survive. The challenge for the physician is to decide when or if to do the preventive surgery.

Prevention

Aneuryms can develop in people with atherosclerosis. High blood pressure can also lead to this condition. Although no definite prevention exists, lifestyle and dietary changes that help lower blood pressure and the amount of fat in the blood stream may slow the development of aneurysms.

Resources

Periodicals

van der Vleit, J. Adam, and Albert P. M. Boll. "Abdominal Aortic Aneurysm." The Lancet 349 (March 22, 1997): 863.

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.
National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

a·or·tic an·eu·rysm

diffuse or circumscribed dilation of a portion of the aorta (for example, abdominal aortic aneurysm, aortic arch aneurysm).
See also: dissecting aneurysm.

aortic aneurysm

A fusiform swelling of the aorta, which is linked to atherosclerosis, most (±75%) of which occur in the abdominal aorta.
 
Clinical findings
Most aortic aneurysms are asymptomatic and found incidentally during physical examination (PE); if pain is present, it is gnawing, relieved by positional changes and often pulsating in character.
 
Diagnosis
PE, CT, US, MRI, digital subtraction angiography, aortic angiography.
 
Natural history
AAs enlarge with time; 15% to 20% rupture in 1 year if < 6 cm in diameter; 50% rupture if ≥ 6 cm.
 
Management
Elective replacement of AA with synthetic vascular graft if > 4 cm and patient is stable; for large AAs, Creech’s intrasaccular approach, which places the graft inside of the aneurysm, is associated with the least morbidity.

aortic aneurysm

Cardiology A fusiform swelling of the aorta, which is linked to ASHD, ±75% of which occur in the abdominal aorta Clinical Most are asymptomatic and emerge as an incidental finding during physical examination–PE; if pain is present, it is gnawing, relieved by positional changes, and often pulsating in character Diagnosis PE, CT, US, MRI, digital subtraction angiography, aortic angiography Natural history AAs enlarge with time; 15% to 20% rupture in 1 yr if < 6 cm in diameter; 50% rupture if ≥ 6 cm Management Elective replacement of AA with synthetic vascular graft if > 4 cm and Pt is stable; for large AAs, Creech's intrasaccular approach, which places the graft inside of the aneurysm is associated with the least morbidity. See Aortic dissection.

a·or·tic an·eur·ysm

(AA) (ā-ōr'tik an'yūr-izm)
Diffuse or circumscribed dilation of a portion of the aorta.
See also: dissecting aneurysm
Synonym(s): antimycotic.
Enlarge picture
AORTIC ANEURYSMS

aortic aneurysm

An aneurysm affecting any part of the aorta from the aortic valve to the iliac arteries. The dilated artery is usually asymptomatic, detected as an incidental finding during imaging. See: illustration
See also: aneurysm

aortic aneurysm

A dangerous sac-like widening (dilation) of the wall of the AORTA. Aortic aneurysm was once most commonly caused by SYPHILIS but is now usually the result of degradation of the extracellular matrix proteins elastin and collagen by matrix metalloproteinases 2, 8 and 9 and by oxidative stress, chronic inflammation and genetic influences.

a·or·tic an·eur·ysm

(ā-ōr'tik an'yūr-izm)
Diffuse or circumscribed dilation of a portion of the aorta (e.g., abdominal aortic aneurysm, aortic arch aneurysm).

Patient discussion about aortic aneurysm

Q. Is there a good screening test for aortic abdominal aneurysm? A friend of mine was diagnosed with an aortic abdominal aneurysm. I am afraid i might have this condition too. is there any screening test that is good for me?

A. Today there are "mobile" testing centers that charge to use ultrasound technology to detect such things as AAA. I would highly recommend it only because it can act as a preventative measure. I am 50 years old and just suffered a ruptured AAA that very nearly killed me. I was the fortunate one. This very possibly could have detected it before it actually ruptured. You may want to check in your local areas for these mobile testing centers.

More discussions about aortic aneurysm
References in periodicals archive ?
Solberg, "Incisional hernia after surgery for abdominal aortic aneurysm," Tidsskr Nor Laegeforen, vol.
Another major challenge in this case was the ascending aortic aneurysm. Aortic root dilation occurs in up to 3% of patients with severe AS [7].
Classically, aortic aneurysm is thought of as a condition for the old.
Fuster, "Thoracic aortic aneurysm and dissection," Journal of the American College of Cardiology, vol.
Segura, "Infected abdominal aortic aneurysm: In situ replacement with cryopreserved arterial homograft," Journal of Cardiovascular Surgery, vol.
Constantly increasing secretion of GM-CSF may trigger aortic aneurysm [79].
The sensitivity and specificity of ultrasonography for abdominal aortic aneurysm were >90% for all attributes, with minor differences usually resulting from measurement variation rather than failure to distinguish between large aneurysms and normal aortas.
"At our center, we routinely recommend patients with thoracic aortic aneurysm visit a clinical geneticist and have all first-degree relatives screened if there is a suggestion of a family history," says Dr.
Thoracoabdominal aortic aneurysm repair is associated with a significant risk of postoperative mortality and morbidity and with a high risk of postoperative paraplegia, renal failure, stroke, pulmonary complications and myocardial infarction (10, 20, 25).
Inflammatory abdominal aortic aneurysm and bilateral complete ureteral obstruction: treatment by endovascular graft and bilateral ureteric stenting.
Among those who had quit smoking for three to eight years (recent quitters) still had an approximately 2.6 to 3.5 fold increased risk for both clinical and asymptomatic abdominal aortic aneurysm in the next 15 years compared to never smokers.