Aneurysmal Disease

What is aneurysmal disease?

Aneurysmal disease (also known as aneurysmal arterial disease) is a slow, progressive process during which arteries—the blood vessels that carry oxygen-rich blood from the heart—lose their resilience and become less durable. As pressure of the blood being pumped by the heart continues to build, the artery wall can bulge or balloon at its weakest point, which is called an aneurysm.

Typically, the walls of the artery are thick and strong to withstand the pressure of the circulating blood. These walls are also continually being damaged and repaired. But with aneurysmal disease, certain medical problems, genetic conditions, or trauma can cause these walls lose their ability to repair themselves over time, increasing the likelihood of an aneurysm to occur.

For the most part, small aneurysms don’t cause problems. However, if an aneurysm continues to grow in size, there is an increased risk for:

  • rupture – in which the aneurysm bursts and blood leaks into the surrounding tissue
  • dissection – which is a split in one or more layers of the artery wall, causing bleeding into the other layers
  • occlusion – in which the blood clot within the aneurysm blocks blood flow in the artery completely; this most commonly occurs in the popliteal artery, behind the knee

All of these situations are considered emergency events. Ruptures and dissections are the leading causes of deaths from aortic aneurysms, while occlusions can lead to amputation of the leg.

Types of aneurysms

Aneurysms can occur anywhere in the body, however, they tend to be more common in some areas than others. The two main types of aneurysms include:

  • Aortic – which is the major blood vessel that carries blood from the left ventricle of the heart to the rest of the body. This is the most common type of aneurysm, which can develop in two areas of the aorta:
    • abdominal aortic aneurysms occur in the section that passes through the abdomen
    • thoracic aortic aneurysms occur in the section that runs through the chest cavity, but less often than those in the abdomen
  • Cerebral – which occur in an artery in the brain

Because aortic aneurysms are more common, the remainder of this section will focus on them.

Risk factors

Though anyone can develop an aortic aneurysm, they tend to be more common in men, Caucasians, smokers, and people who are 65 years or older. Other risk factors include:

  • genetic conditions, such a Marfan disease
  • family history of aortic aneurysms or heart disease
  • being born with weakened artery walls
  • narrowing of the arteries (atherosclerosis)
  • high cholesterol
  • high blood pressure
  • obesity
  • infections
  • traumatic injury (fall, car accident)

It is estimated that up to 15,000 Americans die from aortic aneurysms, most of which are the result of rupture or dissection. However, early diagnosis and treatment can help prevent these events from happening.

What are the symptoms of an aneurysm?

Symptoms of an aortic aneurysm depend on a number of factors, including type, location, size, and how quickly it is growing. Aneurisms can grow for several years without any notable signs or symptoms, which can make them hard to detect. When symptoms do develop, it's because the aneurysm has ruptured, grown to a size that it is pressing on other body parts, or is blocking blood flow.

The majority of aortic aneurysms occur in the abdominal aorta. If or when a patient develops symptoms, they can include:

  • a throbbing feeling in the abdomen
  • steady pain in the abdomen that can last for hours or days
  • abdominal pain that can spread to the back
  • deep pain in the back or side
  • pain in the buttocks, groin, or legs

For aneurysms that continue to grow and start pressing against organs in the chest or against the spine, symptoms that may develop include:

  • coughing
  • a loss of voice
  • problems breathing or swallowing

If an abdominal aortic aneurysm ruptures, the symptoms can be more immediate and severe and may include:

  • sudden, searing pain in the abdomen and back
  • nausea and vomiting
  • increased heart rate
  • dizziness or light-headedness
  • sweating
  • constipation and problems urinating

Abdominal aortic aneurysm ruptures cause internal bleeding, which can lead to the patient going into shock. When this happens, his or her blood pressure drops to unsafe levels and keeps blood from circulating to the body's vital organs. Without immediate treatment, shock can be fatal.

Though less common, thoracic (chest) aortic aneurysms also may not cause any symptoms until it grows large or dissects. Symptoms of these types of aneurysms may include:

  • sudden sharp pain in the chest, upper back, jaw, or neck
  • shortness of breath
  • difficulty breathing and/or swallowing
  • coughing and/or hoarseness

If a thoracic aortic aneurysm ruptures or dissects, symptoms may include:

  • sudden, severe, sharp/stabbing pain that begins in the upper back, then moves down to the abdomen
  • possible pain in the chest or arms

As with abdominal aortic aneurysm ruptures, a thoracic aortic aneurysm rupture or dissection can quickly lead to shock.

Any of these events require immediate medical attention. If you experience any symptoms of an aortic aneurysm rupture or dissection, call 911 right away.

How are aneurysms diagnosed?

Diagnosing aortic aneurysms can be difficult because there usually aren’t any symptoms. When a doctor does find one, it could be by chance during a physical exam:

  • an abdominal aortic aneurysm may be discovered as a throbbing mass in the stomach that can be painful when pressed
  • a thoracic aortic aneurysm may be found as the cause of a heart murmur

More commonly, aortic aneurysms are uncovered during diagnostic tests that are performed for problems such as heart or abdominal pain. The type of test that is used often depends on the location of problem.

These tests can also help doctors pinpoint the location of an aneurism and determine its shape and size.

They include:

  • ultrasound or echocardiogram, which each use sound waves to create a moving image of the structures in the body
  • computerized tomography (CT) scan, which uses a large machine with a big hollow ring in the middle and a table that you lay on; the table slowly slides into the scanner, where the x-ray pictures are taken of your organs
  • magnetic resonance imaging (MRI), which is a long tunnel-like machine with a sliding table you lay on; the machine uses magnets, radio waves, and a computer to capture images of organs and structures in your body
  • angiography, which involves adding contrast dye to the tests to highlight your arteries, including the inside of the aorta, to detect blockages and damage

If our doctor suspects or finds that you have an aneurysm, he or she may refer you to one of the following specialists:

  • vascular surgeon – who performs surgery on the aorta and other blood vessels
  • cardiothoracic surgeon – who specializes in surgery on organs and structures in the chest, including the aorta

Because there is a greater risk of rupture as they grow larger, aneurysms that are detected should be monitored. Your doctor may recommend surgery to repair them if they reach a certain size.

How are aneurysms treated?

The goals for treating aortic aneurysms vary and are unique for each patient. Depending on your situation, your doctor's goal may be to:

  • prevent the aneurysm from growing
  • prevent or treat a rupture or dissection
  • prevent or reverse damage to other organs
  • enable you to maintain normal activities

Treatment for an aortic aneurysm is determined based on its size. If the aneurysm is smaller than 5 centimeters (about 2 inches across) and there are no symptoms, your doctor may want to just continue observing it with periodic routine testing. The size of the aneurysm and the rate at which it is growing will determine how often you need to be tested.

But if the aneurysm is larger than 5.5 centimeters, growing more than 1 centimeter a year, or appears to be at a high risk of rupturing, surgery may be the way to go.

Treatment options

There are two main treatments for aortic aneurysms: medications and surgery.

Your doctor may prescribe medications to lower blood pressure, relax blood vessels, and reduce the risk of the aneurysm rupturing. These medications can be prescribed before the surgery, or in place of having surgery. They include:

  • beta-blockers – which slow down the heart rate and reduce blood pressure; they may also reduce the rate at which aneurysms grow, as well as reduce the risk of rupture
  • calcium channel blockers – which relax blood vessels and increase the supply of blood and oxygen to the heart, lowering blood pressure; this medication is typically only used if the patient has a condition that would bar the use of beta-blockers

If your doctor finds that your aneurysm is growing quickly or at risk of rupture or dissection, he or she may recommend surgery to repair or to replace a section of your aorta. The two main types of surgery are:

  • Open Abdominal/Open Chest Repair – Depending on the location of the aneurysm, a large cut is made in your abdomen or chest and the aneurysm is removed. The affected area of the aorta is replaced with a synthetic graft made of Dacron® or Teflon®. General anesthesia is used to put you to sleep during surgery; the surgery can last 3 to 6 hours, and the hospital stay can last about a week. It typically takes about a month to return to full activity, and most patients make a full recovery.
  • Endovascular Repair (also called Endovascular Stent Graft) – which is a minimally invasive procedure that does not require cutting the skin. During the procedure, a small tube carrying a graft (also called a stent graft) is inserted into an artery in your groin and threaded to the aneurysm in the aorta. Once there, the graft is expanded and attached to the weakened section of the aorta to stabilize blood flow and keep the aneurysm from rupturing. General anesthesia is also used for this method, but recovery time may be reduced.

The decision whether to use one surgical procedure over the other depends on the size and location of the aneurysm. Surgical repair of an aneurysm is a complicated procedure and requires an experienced surgical team.

Advanced Cardiovascular Care at Jeanes Hospital

If you're experiencing symptoms of aneurysmal disease or believe that you may be at risk of developing an aneurism, the academic-level vascular surgeons at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your condition.

The Temple vascular surgeons at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious vascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there's no need to travel to another institution to have it done. Since 2006, Temple vascular surgeons have been performing vascular surgery and procedures at Jeanes Hospital. Our state-of-the-art surgical facility and our Cath Lab feature the latest technology to support our surgeons.

Services and procedures offered here for treatment of aneurysmal disease include:

  • Diagnosis of aortic and peripheral aneurysmal disease
  • Open repair of abdominal and thoracic (chest) aortic aneurysms
  • Endovascular aortic repair (EVAR) of aneurysms

Our surgeons are supported by a full-time team of anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

This is the level and quality of care you would expect to find downtown or in another city. Yet, it’s available right here, in your own community.

To schedule an appointment with a vascular surgeon at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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