Aortic Aneurysm Frequently Asked Questions (FAQ)
Aneurysms of the aorta are a complicated disease. As a result, it is difficult for patients and their families to understand their diagnosis. In addition, new treatment options are becoming available and it is challenging to find clear information about these procedures.
Here is a list of frequently asked questions and answers which are meant to be a valuable resource regarding aortic aneurysms and surgical and endovascular aortic stent treatment options.
1. What are the symptoms of an aortic aneurysm?
Most aortic aneuryms are asymptomatic, meaning that there are no associated symptoms. Most aneuryms are detected either through routine screening tests or found incidentally on imaging studies such as a chest X-ray or CT scan, also called a CAT scan, performed for another reason. Many peoples' lives have been saved with the use of screening studies performed in high-risk patients.
Thoracic aortic aneurysms, also called TAA, occur in the chest. When these aneurysms do cause symptoms, it is frequently associated with pain in the middle of the chest or mid-back. The chest pain is often described as sharp and intermittent in the center of the chest behind the breastbone or sternum. The back pain is sharp and also intermittent and located in the center of the back right between the shoulder blades. The pain is usually not associated with activity and can occur at rest. Pain is a warning sign of advanced disease and should be evaluated immediately because this could be a sign of impending rupture. Other symptoms of aortic aneurysms in the chest are shortness of breath or a pressure on the chest.
Abdominal aortic aneurysms, also called AAA, (tripple A) occur in the stomach region or abdomen. Most AAA are not associated with any symptoms, but when they do cause symptoms, it is frequently involves a dull pain in the mid-back. Other symptoms are flank pain, side pain, lower abdominal pain or a dull pain sensation within the stomach region. As with aortic aneurysms in the chest, when aneuysms of the abdominal aorta do cause symptoms, it is a severe warning sign that should require urgent evaluation by an aortic specialist.
2. What causes an aortic aneurysm?
What causes aneurysms? There are several known risk factors for developing an aortic aneurysm.
These risk factors include:
1) High blood pressure, also called hypertension.
2) A family history of aneurysms.
3) Smoking (even if not currently smoking, a history of past use of tobacco products is significant).
4) Diagnosis of a conncective tissue disorder, such as Marfan's Syndrome.
5) A history of trauma.
6) Age greater than 60 years old.
7) Elevated cholesterol, also called hypercholesterolemia.
Even if a patient does not have any of these risk factors, they could develop an aneurysm. Any patient that has one or more of the above risk factors should be screened for an aortic aneurysm. There is still a great deal of research needed to be done regarding the etiology and causes of aortic aneurysms since there are many patients who develop an aortic aneurysm without any of the above risk factors.
3. How is an aortic aneurysm diagnosed?
Many aortic aneurysms are diagnosed with imaging procedures such as a chest X-ray, CAT scan or abdominal duplex ultrasound. Aortic aneurysms in the chest, or thoracic aortic aneurysms (TAA), can only be diagnosed with imaging procedures. Since the aneurysms in the chest are located deep inside the rib cage, or chest wall, it is impossible to detect with physical examination. Therefore, an imaging test is needed. A chest X-ray can sometimes show an abnormal contour of the aorta, called mediastinal silloutte, but for an accurate diagnosis, a CAT scan is needed. With a CAT scan, the location and size of the aneurysm in the chest can be specifically identified. For aortic root aneurysms, which are located next to the heart, a cardiac ultrasound can sometimes detect the enlargement.
For abdominal aortic aneurysms (AAA), which are located in the stomach region, physical examination by an experienced physician can sometimes feel an enlarged pulsation mass in the abdomen. However, because the abdominal cavity lacks the bony protection, like the rib cage, an abdominal duplex ultrasound can accurately diagnose an aneurysm. For best resolution and detail about the location and size of the abdominal aneurysm, a CAT scan is needed.
4. Do aortic aneurysms ever go away?
Unfortunately, once someone has been diagnosed with an aortic aneurysm, it does not disappear, shrink or go away. The bulge and widening of the aorta are permanent and remains a chronic medical concern that needs lifelong monitoring and surveillance by a qualified medical profession. Not all aneurysms will continue to expand, although it is impossible to identify in which patients the aneurysms may expand, and therefore needs continued follow-up.
5. Are there any medications that I can take which will treat my aortic aneuysm?
There are no specific available medications targeted directly at curing aortic aneurysm disease. However, blood pressure medications have been shown to decrease the arterial stress on the aneurysm tissue and help slow the progression of the aneurysm sac. Oftentimes, these blood pressure medications are prescribed for people who haven't been diagnosed with hypertension (high blood pressure) and work to decrease the wall stress of the aneurysm. Cholesterol fighting medications, called statins, have been shown to help stabilize the aneurysm sac. In patients with connective tissue disorders, such as Marfan's Syndrome, a low dose of a particular blood pressure medication has been shown to slow progression of aortic aneurysms. Finally, stopping smoking is an important intervention which can help minimize the growth of the aortic aneurysm. Please note that stopping smoking does not necessarily reverse the damage which has occured with prior use of tobacco products.