Aortic aneurysms often involve more than one area
An aneurysm is a blood vessel that has enlarged beyond its normal size. Aortic aneurysms usually occur in four distinct areas: the aortic root/ascending aorta, the aortic arch, the descending thoracic aorta and the abdominal aorta. Frequently, the disease involves more than one contiguous area.
Usually no symptoms of aortic aneurysm
In the great majority of cases, aortic aneurysms are asymptomatic, meaning they are discovered incidentally by scans of the chest or abdomen, without the presence of symptoms.
In certain cases, aneurysms may be symptomatic. As an aneurysm enlarges, it sometimes compresses adjacent structures and organs. For example:
- Pressure on the nerves of the larynx (voice box) may cause hoarseness.
- Pressure on the esophagus (food pipe) may cause difficulty swallowing.
- An enlarged abdominal aortic aneurysm may cause lower back pain and a pulsating feeling in the navel.
- An enlarged descending aortic aneurysm may cause upper back pain.
As aortic aneurysms enlarge, they have a tendency to either dissect (form a partial tear in the aortic wall) or rupture (form a full tear in the wall). If an aneurysm tears, it usually causes severe pain corresponding to the area of the aneurysm. In some cases, aneurysms do not tear but instead expand rapidly, which frequently causes a dull, persistent pain. In both circumstances, prompt or emergency surgery is needed.
The greatest danger is that an aortic aneurysm may rupture and cause severe, life-threatening bleeding.
In individuals whose aortic aneurysms are asymptomatic, the decision to recommend surgery (open or endovascular) is based on a balance between two opposing risks—the risk of rupture and the risk of operation. If the risk of rupture outweighs the risk of operation, surgery is usually recommended.
The assessment of these risks requires a thorough understanding of the factors involved in aneurysmal rupture and significant surgical experience to accurately estimate the risk of every individual operation. Certain factors, such as age and presence of heart, lung or kidney disease, may impact not only the surgical risk, but also the risk of rupture.
Diagnosing aortic aneurysms
The diagnosis of aortic aneurysms is established with the use of specialized imaging tests such as computed tomographic (CT) scan or magnetic resonance imaging (MRI) and often with echocardiograms (ECC/EKG).
At Lankenau Heart Institute we utilize these diagnostic tools to obtain detailed information on the location and size of the aorta and aortic aneurysms.
- 256-slice computed tomography (CT) scan – This test provides clear images of the aorta. Using iodinated contrast material and relying on a machine that can convert X-rays passed through the body into electrical imaging signals, the CT scan results in a set of cross-sectional images (slices) of the aorta.
- Transthoracic and/or transesophageal echocardiography – This test uses high-pitched sound waves to generate images of the heart and various segments of the aorta. Moving images are created as the sound waves bounce off the different parts of the heart and aorta. These clips can then be scrutinized frame-by-frame to retrieve important diagnostic information.
- Magnetic resonance angiography (MRA) – This test uses the combination of a magnetic field and pulses of radio waves to provide pictures of blood vessels inside the body, including the aorta. Injectable, non-iodinated contrast material is sometimes used during MRA to make blood vessels show more clearly.