What Is an Aortic Aneurysm?

Aortic Aneurysm

The aorta, the main artery (blood vessel) of the heart, plays a role in carrying oxygen-rich blood from the heart to the body. In some cases, the walls of the aorta weaken and ballooning may occur. This ballooning is called an aortic aneurysm, and depending on the diameter of the enlargement, if the risk of rupture is determined to be high, intervention aimed at treatment may be required in a short time. While early diagnosis makes control easier, it is most often detected after the aneurysm has ruptured, in a life-threatening state requiring emergency intervention. However, some people have symptoms that facilitate early diagnosis. At the same time, individuals considered at risk who undergo regular screening can have aneurysms diagnosed early and, with timely intervention, prevent rupture.

What Is an Aortic Aneurysm?

The aorta is the largest artery in the body, carrying oxygen-rich blood from the heart. Running from the heart through the chest and abdomen, the aorta distributes oxygen-rich blood to the tissues and organs of the body. An aneurysm is a balloon-like bulge of the vessel that develops due to blood pressure. Structurally, the aorta has thick walls that can withstand normal blood pressure. However, a weakness in the aortic wall can cause the vessel to widen at that site and an aneurysm to develop. When the diameter of the vessel increases to one and a half times its normal diameter, it is defined as an aneurysm. When the ballooning in an aneurysm grows, it can rupture and cause serious bleeding that may result in death. If not controlled, an aneurysm can cause damage by tearing the arterial wall, leaking blood between the wall layers, or forming a clot inside that later travels downstream, causing narrowing of peripheral arteries. Aortic aneurysms are divided into two main types according to the region where they occur.

Abdominal Aortic Aneurysm

The most common location for an aneurysm is the abdominal region. The abdominal aorta, which forms the abdominal part of the aorta, works to deliver oxygen-rich blood to the abdomen and lower limbs. Abdominal aortic aneurysm refers to the ballooning that occurs in this region.

Thoracic Aortic Aneurysm

The thoracic aorta is in the upper part of the aorta, shaped like an inverted U, and forms the chest portion of the aorta. That is, the part from the heart until it reaches the abdominal region is called the thoracic aorta. Thoracic aortic aneurysm refers to the swelling or ballooning that occurs in this part of the aorta, located above the diaphragm from the heart. It is also called a heart aneurysm.

What Causes an Aortic Aneurysm?

An aneurysm is a condition that occurs due to weakening of the vessel wall. Therefore, conditions that cause weakening of the vessel wall are also risk factors for an aneurysm. An aneurysm may be present from birth or may develop later. In particular, advancing age, genetic and environmental factors play a role in the formation of an aortic aneurysm. Aortic aneurysm risk is considered high especially in adults over 65. Aortic aneurysm is also more commonly encountered in males. A history of aortic aneurysm in first-degree relatives is also among the risk factors. The reason smoking is considered a risk factor is that it increases the risk of aortic aneurysm rupture. Atherosclerosis, the buildup of fatty deposits in the vessels causing narrowing, is among the most common causes. The general causes and risk factors of aortic aneurysm are as follows:

Atherosclerosis (hardening of the arteries)

Arteritis

Genetic factors (Marfan Syndrome and Ehlers-Danlos Syndrome)

Aortic injuries

Syphilis

Infections

High blood pressure

Injuries due to sudden trauma

High cholesterol

Family history of aneurysm

Advancing age

Smoking

Aneurysms in other parts of the body

Kidney failure

COPD

Vasculitis

What Are the Symptoms of an Aortic Aneurysm?

The location where the aortic aneurysm occurs plays a role in symptoms. Shortness of breath, back or shoulder pain, stomach pain, and a feeling of fullness are general symptoms that may vary depending on the cause. However, aneurysms often do not cause symptoms until they rupture. If an aneurysm has ruptured and is causing a symptom, it requires emergency treatment. Symptoms of an aneurysm depend as much on the site where it occurs as on the stage of the process. If the aortic aneurysm has not yet ruptured and is growing, the symptoms are as follows:

Shortness of breath

Feeling of fullness

Pain in the area where the aneurysm is located

Difficulty swallowing

Swelling in the arms, neck, or face

However, if the aneurysm has ruptured and requires emergency intervention, it leads to the following symptoms in the person:

Dizziness

Rapid heartbeat

Sudden and severe chest pain, abdominal pain, or back pain

Symptoms of Abdominal Aortic Aneurysm

If the aneurysm is an abdominal aortic aneurysm, it usually causes symptoms affecting the abdominal region. If the aneurysm has not ruptured, these appear as persistent abdominal and lower back pain and a sensation of heartbeat in the abdomen. However, if an aneurysm located in the abdomen has ruptured, it presents with sudden pain in the abdomen and back, dizziness, sweating, rapid heartbeat, pallor, and fainting.

Symptoms of Thoracic Aortic Aneurysm

Thoracic aortic aneurysm grows slowly in the chest and initially does not cause symptoms. However, as it begins to grow, it may cause back pain, cough, hoarseness, shortness of breath, and tenderness in the chest. If this enlargement leads to aneurysm rupture, loss of consciousness, shortness of breath, a drop in blood pressure, and difficulty swallowing occur.

How Is an Aortic Aneurysm Diagnosed?

Most aortic aneurysms do not cause symptoms, but they can be diagnosed without difficulty through routine check-ups. However, if a person does not undergo routine check-ups, there is a high risk that the aneurysm will be diagnosed only after it has ruptured. If the person has a high risk of aortic aneurysm or has symptoms suggesting an aneurysm, imaging techniques are used. These may include computed tomography, angiography, and ultrasound. Before imaging techniques, a physical examination is performed by a physician. During this examination, the physician listens to the heart, checks the pulse, and evaluates symptoms. Afterward, the diameter of the aorta is examined with ultrasound. If the aortic diameter is larger than it should be, other screening tests may be used. The tests used to evaluate aortic aneurysm are as follows:

Ultrasound:Ultrasound can help monitor the aorta over time and can also provide information about the size of the aneurysm. It is especially preferred for abdominal aortic aneurysm.

Echocardiography:It provides information about the size of the aortic aneurysm while also allowing information about the thoracic aorta.

MRI:MRI helps obtain information about the size, shape, and location of the aneurysm.

Who Should Undergo Aortic Aneurysm Screening?

Some people need to be screened regularly for aortic aneurysm, because this condition usually does not show symptoms and, when detected early, can be controlled before it ruptures. The characteristics of people for whom aortic aneurysm screening should be performed are as follows:

Individuals aged 65-75 who have previously smoked (especially males)

Individuals with a family history of aneurysm even if they have never smoked

Individuals aged 75 and over in whose first-degree relatives an aneurysm has been found

Individuals with a history of peripheral artery disease (5)

Treatment Methods for Aortic Aneurysm

Treatment of aortic aneurysm varies depending on whether the aneurysm has ruptured. If the aneurysm has not yet ruptured, it must be prevented from growing to the point of rupture. During this process, the growth level of the aneurysm is also regularly monitored with screening tests. The aim is to prevent the aneurysm from growing large enough to rupture. During this period, cholesterol-lowering medications or medications that regulate blood pressure may be prescribed to prevent the aneurysm size from increasing.

Depending on the size of the aneurysm and its growth rate, a surgical procedure may be preferred. After the operations performed, complications such as bleeding around the graft (referred to as a valve), blood clotting, infection, and displacement of the graft from its place may occur. Therefore, the person needs to continue regular check-ups after treatment. Also, lifestyle changes the person makes play a role in the treatment process. Changes that can be made in lifestyle are as follows:

Quitting smoking: Smoking can cause the aneurysm to grow rapidly, leading to ruptures.

Adopting a heart-protective diet: A diet that supports cardiovascular health helps prevent ruptures by lowering high blood pressure and cholesterol.

Stress management: A stressful lifestyle can cause blood pressure to rise. This may contribute to the existing aneurysm worsening.

Being physically active: Physical activities performed under physician supervision can support the person's treatment process (5).

Surgical Method

Surgical aneurysm repair, performed through an operation, is preferred especially in cases of rupture. This method, also called open surgery, aims to repair the rupture of the aneurysm or the damage after rupture. The area of the aorta with the problem is opened, the damaged section is removed, and this area is replaced with a synthetic tube called a graft. This tube allows blood to pass safely through the vessel. If the aneurysm is abdominal, an incision is made slightly below the abdomen. However, if the aneurysm is thoracic, an incision in the chest is required.

Endovascular Method

In the endovascular method, the graft used in the surgical method is placed into the vessel without large incisions. For this, the graft is delivered to the required area using a catheter with a minimally invasive technique. Through an incision made at an appropriate point, a tube called a catheter advances the new valve up to the aorta. By placing a graft at the weak point to be repaired, the aim is to prevent ballooning. The placed stent graft does not adversely affect blood flow, and blood circulation continues healthily.

Aortic aneurysm is a condition that can pose a life-threatening risk when it ruptures. Therefore, people at risk need to monitor the presence of an aneurysm through regular check-ups. Similarly, for individuals in whom an aneurysm has been detected, monitoring its growth is of vital importance. Closely related especially to advancing age and genetic factors, this condition can be controlled through lifestyle changes and surgical procedures. If a person has an aortic aneurysm and unexpected symptoms develop, they should apply to a healthcare facility as soon as possible due to the risk of rupture.