An aneurysm develops when a diseased blood vessel dilates or “balloons”
outward. Arterial aneurysms can be found in many locations throughout
the body but typically involve the abdominal aorta below the kidneys.
Risk factors for developing an aortic aneurysm include hypertension, smoking,
high cholesterol, emphysema, genetic factors and male gender. An abdominal
aortic aneurysm can develop in anyone, but it is most frequently seen
in males over 60 with one or more risk factors. Aneurysms usually develop
slowly over many years and often have no symptoms. They are frequently
discovered during a work-up for vague abdominal or back pain. The larger
the aneurysm, the more likely it is to rupture. If an aneurysm expands
rapidly, tears open, or blood leaks along the wall of the vessel, symptoms
may develop suddenly. Small aneurysms without symptoms can be followed
with periodic ultrasound evaluation to detect changes in aneurysm size.
Surgery is generally recommended for larger aneurysms and those that rapidly
increase in size. The goal is to perform surgery before complications
or symptoms develop.
Another condition affecting the aorta is called a "dissection".
This problem occurs when there is a split in the layers of tissue that
comprise the aortic wall. Blood can then “dissect” between
the layers and cause bleeding or obstruction of blood flow to vital organs.
Men are four times more likely than women to develop an abdominal aortic
aneurysm; it's the ninth leading cause of death in men over age 55.
The most common risk factors for an aortic aneurysm or dissection include:
Age - Aneurysms usually affect patients who are 50 to 80 years of age
Atherosclerosis (aka hardening of the arteries) – The large majority
of aortic aneurysms are associated with this condition
High blood pressure - Increased pressure inside the arteries can create
stress on weakened areas within the wall of the aorta
Injuries and hereditary disorders - This includes Marfan's syndrome,
a connective-tissue disorder that is occasionally associated with sudden
death due to aortic dissection
Smoking – Smoking at any time in your life increases your risk for
developing an aneurysm and other manifestations of atherosclerosis
Most aneurysms, especially small ones, have no symptoms. In fact, less
than one quarter of aneurysms present obvious symptoms until the time
that it ruptures. Vague symptoms can occur as the aneurysm begins to enlarge
and press on nerves, organs or other blood vessels.
For an aortic aneurysm, common symptoms generally include:
Throbbing or pulsation in the abdomen
Abdominal pain - if severe, this could mean the aneurysm has ruptured
Back or flank pain – if severe, this could mean the aneurysm has ruptured
An aneurysm that occurs in the chest (called a "thoracic aneurysm")
may have the following symptoms:
- Pain between the shoulder blades, lower back, neck or abdomen
- A dry persistent cough
- Hoarse voice (due to pressure from the aneurysm on the nerve that stimulates
the vocal cords)
- Symptoms of a thoracic aneurysm or acute aortic dissection are frequently
Screening and Diagnosis
Even if an aneurysm does not cause symptoms, it may be detected during
a routine physical examination. An abdominal aortic aneurysm can sometimes
be felt in the abdomen and thoracic aneurysms can often be seen on a routine
chest X-ray. Ultrasound of the abdomen is a highly accurate screening
tool that can be used to make the initial diagnosis. More sophisticated
imaging technology, such as computed tomography (a "CT scan")
or magnetic resonance imaging (an "MRI") is then used to further
evaluate a newly found aneurysm.
Highly trained and experienced physicians within the St. Joseph Hospital
Vascular Institute are able to offer the latest treatments for thoracic
and abdominal aortic aneurysms as well as acute (sudden onset) and chronic
(long duration) aortic dissections. In short, acute aortic dissection
may require immediate surgery, but in some situations aggressive blood
pressure control with IV/oral medication is also appropriate for certain
types of aortic dissections. Chronic aortic dissections are generally
followed with periodic imaging, and repaired if complicating circumstances
arise despite good blood pressure control. Large or rapidly growing thoracic
aneurysms usually require surgical repair. Without surgery, the risk of
life-threatening aneurysm rupture increases with time and with aneurysm size.
There are two types of surgery offered at the St. Joseph Hospital Vascular
Institute to repair an aneurysm:
Traditional surgery - Involves an incision in the chest or abdomen through which the aneurysm
is opened and replaced with artificial graft material. This method of
aneurysm repair offers proven and durable results with a low incidence
of long-term complications. However, recovery from this relatively invasive
procedure usually requires more time than less-invasive alternatives.
The vascular specialists in the Vascular Institute can also perform an
open abdominal aortic aneurysm repair using a less-invasive approach in
which the skin incision is made in either the right or left flank area.
This surgical approach offers better exposure of the abdominal aorta and
its arterial branches, as well as results in a shorter hospital stay and
a quicker recovery than the traditional open repair.
Endovascular surgery - Involves two relatively small incisions at each groin to expose the
common femoral arteries. A stent graft is then inserted through the femoral
arteries and appropriately positioned using catheter/guidewire and video
techniques. Once the stent graft is deployed within the aneurysm, it effectively
diverts blood flow away from the aneurysm sac. Thus, pressure within the
bulging aneurysm sac is reduced and the risk of aneurysm rupture is greatly
diminished. This type of minimally invasive surgery has a relatively short
recovery time and in general causes less physiologic trauma to the body.
However, there is increased risk of blood vessel trauma using this technique
and long-term periodic imaging is required because there is a small chance
that the stent graft may move (i.e. migrate) or that blood flow may enter
the aneurysm sac from the ends of the stent graft or from back-bleeding
arteries, causing it to once again become pressurized and potentially rupture.