Aortic Aneurysms Treatment in Delhi, India

A balloon-like bulge in the aorta is termed an aortic aneurysm. The aorta is the main artery of the heart that carries blood from the heart to the rest of the body through its network of branch arteries and capillaries.

Aortic aneurysms can dissect or rupture while in the blood vessel. Dissection is the splitting of the arterial wall layers due to pressure from the pumping blood, leading to a leak between them. Rupture is the bursting of the aneurysm, causing bleeding in the surrounding cavity body. Dissections and ruptures are the most common causes of death due to aortic aneurysms.

Symptoms of Ruptured Aortic Aneurysm

Aneurysms develop slowly over many years, often being asymptomatic. However, the onset of symptoms may become rapid if the aneurysm progresses quickly or if tears open or leak within the wall.

The symptoms of a ruptured aortic aneurysm are:

• Sudden, severe, persistent or constant pain in the abdomen or back that may radiate to the lower part of the body
• Fainting
• Cold and clammy skin
• Dizziness
• Nausea and vomiting
• Rapid heart rate
• Shock

Types of Aortic Aneurysms

Three types of aortic aneurysms have been identified:

1. Thoracic aortic aneurysm
2. Abdominal aortic aneurysm
3. Aneurysms thoracoabdominal

Causes of Aortic Aneurysms

The precise cause of an aneurysm is not known. However, it is stated that it may occur due to weak walls of the artery ( inherited or age-related disorders) and high blood pressure. Factors that help increase the risk of developing an aneurysm may be:

• Smoking
• Hypertension
• Male predilection
• Heredity

An abdominal aortic aneurysm is commonly seen in males over the age of 60 and shows positive signs for one or more of the above-stated risk factors. The larger the aneurysm, the more likely it will burst open or tear. This can be life-threatening.

Aortic Aneurysms Diagnosis

The doctor first examines the abdomen and checks the pulse in the legs. The doctor may look for:

• A lump in the abdomen
• Pulsation in the abdomen
• Stiff abdomen

The doctor may advise the following tests:

• Ultrasound of the abdomen
• Computed tomography (CT)Aortogram: The advanced 3D CT technology provides doctors with accurate assessments of any aortic pathology; exact measurements of the aortic aneurysm coronary arteries can also be seen
• Magnetic resonance imaging (MRI): In recent years, MRIs have proven to be helpful in evaluating aortic pathology owing to the ability of MRI to assess the anatomy in more detail
• Transesophageal echocardiography (TEE): This procedure is most helpful in diagnosing dissection in the aorta with high-sensitivity
• Conventional angiography (aortography): Not used frequently nowadays

Aortic Aneurysms Treatment

There are two main lines of treatments for aortic aneurysms -

a. Medicines

Medications control blood pressure and lower the risk of an aortic aneurysm

b. Surgical Intervention

Surgery repairs or replaces the affected section of the aorta.

If the size of the aneurysm is small and the patient is asymptomatic:

• Surgery is not required
• The doctor would assess the size of the aneurysm with ultrasound tests once every six months

Often, surgery is recommended if the aneurysm is of larger diameter or progressive 5 centimetres) across or proliferating rapidly. Surgery must be scheduled before complications start to develop.

There are two types of intervention:

• Open repair surgery - It involves a large incision on the abdomen, and the abnormal vessel is replaced with an artificial graft
• Endovascular stent grafting -This is a procedure that can be done without making a large incision on the abdomen for a speedy recovery. This is a safer choice of surgery for the aged population. The endovascular repair can fix a leaking or bleeding aneurysm

Complications of Aortic Aneurysms

When not addressed, the following complications may occur:

Rupture

The principal and the most feared complication of an aortic aneurysm is rupture. A ruptured aneurysm often leads to massive internal bleeding. Symptoms of a rupture usually begin with sudden severe pain in the chest or back, followed rapidly by palpitations, severe weakness, light-headedness, shock, and loss of consciousness.

Cardiovascular collapse is usually so rapid that mortality is excessively high, even if an attempt is made to repair the rupture surgically. If an aortic aneurysm is to be repaired successfully, the surgery should be ideally done electively well before the rupture

Aortic Dissection

A tear in the aorta lining is called an aortic dissection. It can occur in a weak aortic wall area. The blood flowing through the artery can enter the tear, forcibly separating the aortic wall layers. When such a dissection occurs, the victim will complain of severe, sudden, tearing, or ripping pain in the back or chest.

The vessel damage and internal bleeding from a dissection can cause loss of consciousness, stroke, neurological impairment, organ failure, and even death. Aortic dissection can occur even in the absence of an aortic aneurysm, but an aneurysm makes dissection more likely

Aortic Regurgitation

Another complication resulting from an aortic aneurysm is aortic regurgitation - a leaking aortic valve. This complication can occur due to an ascending aorta aneurysm dissecting just above the aortic valve.

Severe dilation of the aorta can lead to distortion of the aortic valve, resulting in a malfunctioning valve. Affected people often present with dyspnea, chest pain, palpitations, cardiac arrhythmias, and heart failure

Blood Clots

Sometimes, a blood clot may form within the dilated part of the aorta, disrupting the normal blood flow and forming areas of relative stagnation. A blood clot in the aorta can break off and migrate to any organ in the body, often producing severe damage

Risk Factors of Aortic Aneurysms

• Age: Aortic aneurysms most commonly occur in people above the age of 60 years
• Tobacco use: It is a significant risk factor for developing an aortic aneurysm
• High blood pressure: An increased blood pressure may damage the body's blood vessels, causing an aneurysm
• The build-up of plaques in the vessels: Fat and other substances tend to build up at the lining of the blood vessels. These plaques damage the lining and increase the risk of aneurysms, a common phenomenon in the elderly
• Family history. People with a family history of aortic aneurysms are at a higher risk of developing one. This may occur at a younger age with a higher risk of rupture
• Marfan syndrome and related conditions. People with Marfan syndrome, Loeys-Dietz syndrome or vascular Ehlers-Danlos syndrome are at a higher risk of developing an aortic aneurysm and aortic dissection or rupture
• Bicuspid aortic valve: People with an aortic valve with two cusps instead of three may eventually develop an aortic aneurysm

Certain medical conditions carry higher risk factors for aortic aneurysms. These are:

• Chronic obstructive pulmonary disease (COPD)
• Cardiovascular conditions (atherosclerosis, coronary heart disease, and peripheral artery disease)
• Unhealthy blood cholesterol level
• High blood pressure is the major cause of thoracic aortic aneurysms and a risk factor for abdominal aortic aneurysms
• Bacterial infections
• Kidney conditions such as renal failure, chronic kidney disease, and polycystic kidney disease
• Obesity
• Pheochromocytoma, a tumour of the adrenal gland that can lead to high blood pressure
• Trauma, such as car accidents or falls, is a risk factor for thoracic aortic aneurysms
• Vasculitis

Prognosis of Aortic Aneurysms

The prognosis of a treated aortic aneurysm is often satisfactory. However, it is considered a medical emergency when an aortic aneurysm tears or ruptures. The survival chances of a ruptured aneurysm are only about 1 in 5 people.

Review