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Aortic aneurysm: definition, symptoms, therapy

by Josephine Andrews
Published: Last Updated on 198 views

An aortic aneurysm is a fusiform or saccular enlargement of the main artery. Such bulges occur in all areas of the aorta, i.e. both in the chest and in the abdomen. The main danger with an aortic aneurysm is that it suddenly ruptures (ruptures) and life-threatening bleeding occurs.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

I71

quick overview
  • Symptoms: Often without symptoms, possibly pain in the abdomen and back (abdominal aortic aneurysm), possibly coughing, hoarseness, shortness of breath (thoracic aortic aneurysm), if there is a tear (rupture) devastating pain, shock, unconsciousness
  • Treatment: Depending on the size and growth of the aneurysm, surgery, stenting or vascular prosthesis if the size is at risk
  • Examination and diagnosis: often incidental findings, ultrasound examination, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), angio-computed tomography (angio-CT)
  • Causes and risk factors: Risk increases with age, arteriosclerosis, high blood pressure, smoking, predisposition, rarely hereditary diseases such as Marfan syndrome, Ehlers-Danlos syndrome, infections
  • Prevention: Measures that contribute to vascular health, healthy lifestyle, not smoking, treatment and control of high blood pressure, screening for specific groups of people to prevent life-threatening complications such as a rupture

What is an aortic aneurysm?

About 40 out of 100,000 people develop an aortic aneurysm annually People over the age of 65 are most commonly affected. Men are about six times more likely to develop an aortic aneurysm than women .

In more than 90 percent of cases, the aortic aneurysm is located in the abdomen, especially below the outlet of the renal vessels (infrarenal aortic aneurysm).

Sometimes the vascular bulge is also in the chest (thoracic aortic aneurysm). Even an aneurysm in the heart is possible. In about half of the cases, it is located in the ascending part of the main artery of the heart ( aorta ascendens), in 40 percent in the descending part (aorta descendens) and in every tenth affected person in the so-called aortic arch.

Normally, the diameter of the aorta is 3.5 centimeters in the thoracic region and 3 centimeters in the abdominal region. In the case of an aortic aneurysm, the diameter is sometimes twice as large.

What are the symptoms of an aortic aneurysm?

Aortic aneurysm: abdominal symptoms

An aortic aneurysm of the abdominal artery usually causes no symptoms at first and is therefore not recognized early. However, if the aneurysm becomes so large that it presses on surrounding structures, symptoms often arise.

An abdominal aortic aneurysm then leads, for example, to symptoms such as back pain radiating into the legs and digestive problems. In rare cases, the doctor feels the aneurysm in the abdomen as a pulsating growth under the abdominal wall.

Aortic aneurysm: chest symptoms

An aortic aneurysm in the chest (thoracic aortic aneurysm) often causes no symptoms. However, if symptoms do occur, they are sometimes the following:

  • chest pain
  • Cough
  • hoarseness
  • dysphagia
  • shortness of breath

Ruptured aortic aneurysm

The larger the aortic aneurysm, the greater the risk of a tear (rupture). An abdominal aortic aneurysm larger than 5.5 centimeters in men and 5.0 centimeters in women is considered risky and requires treatment.

If an aneurysm bursts, this is accompanied by massive pain (“annihilation pain”), which occurs in the chest or abdomen, depending on the location, and radiates to the back. There is also nausea and vomiting. The heavy internal bleeding quickly causes circulatory shock.

How is an aortic aneurysm treated?

Aortic aneurysm – surgery or wait and see?

The right treatment for an aortic aneurysm depends primarily on its size. The doctor checks smaller, symptom-free aortic aneurysms once a year, larger ones twice a year using ultrasound . It is important that the blood pressure remains in the lower normal range (120/80 mmHg). The doctor may prescribe an antihypertensive drug for this purpose.

It is also important to treat other risk factors for an aortic aneurysm, such as dyslipidemia or diabetes mellitus. It is also highly advisable to stop smoking.

Certain factors and behaviors increase the pressure in the abdomen or chest. These should be avoided by people with an aneurysm. This includes, for example, not lifting heavy. It is also helpful for sufferers to learn how to breathe properly under stress.

Accompanying diseases such as bronchial asthma or chronic bronchitis must also be treated, as coughing increases the pressure in the vessels.

If an aortic aneurysm in the abdominal aorta reaches a diameter of 5.5 centimeters in men and 5.0 centimeters in women, doctors recommend surgery. The same applies to a thoracic aneurysm with a diameter of 5.5 centimeters or more, as well as to a smaller aneurysm if the doctor observes that it is enlarging by more than 10 millimeters per year.

Treatment of abdominal aortic aneurysm

There are basically two treatment methods for an abdominal aortic aneurysm. Which one is used depends on the location of the aortic aneurysm and the condition of the vessels.

  • Stent (endovascular procedure): The doctor pushes a small tube (stent) through the groin artery up to the wall bulge – the stent stabilizes the vessel and bridges the aortic aneurysm.
  • Surgery: In surgery, the surgeon removes the enlarged portion of the artery wall through an abdominal incision and replaces it with a tubular or Y-shaped vascular prosthesis.

Treatment of thoracic aortic aneurysm

In most cases, an aortic aneurysm in the chest area requires surgery and a vascular prosthesis. If there is an enlargement near the heart, the aortic valve often has to be replaced (artificial valve).

How is an aortic aneurysm diagnosed?

Doctors often discover an aortic aneurysm incidentally during a routine exam. An abdominal aortic aneurysm, for example, is more frequently detected by physicians during an abdominal ultrasound examination.

When listening with a stethoscope, the doctor sometimes notices flow noises over the vascular sac. In slim people, a larger aneurysm of the abdominal aorta can possibly be felt with the hands through the abdominal wall.

An aortic aneurysm of the thoracic artery is also usually discovered by doctors by accident, most commonly during a chest x- ray . The doctor gets a more precise picture by means of a heart ultrasound. Parts of the aorta are also clearly visible in this examination.

Computer tomography (CT) or magnetic resonance imaging (MRI) and possibly magnetic resonance angiography (MRA, imaging of the vessels) provide details about the size and danger of an aortic aneurysm.

Abdominal aortic aneurysm screening for over 65s

The recommendations of various specialist societies for screening programs vary in some cases. The European Society of Cardiology (ESC) currently recommends screening for early detection of an aortic aneurysm by ultrasound examination for the following people:

  • men aged 65 and over
  • Women aged 65 and over who are current smokers or have smoked in the past
  • Individuals of any age who have first-degree relatives with an aortic aneurysm

According to statistics, nine out of every hundred men between the ages of 65 and 75 are affected by an abdominal aortic aneurysm – and the trend is rising. For example, 22 percent of those over 85 are already affected. Although an aneurysm rarely ruptures, if it does, there is a risk of the patient bleeding to death.

Women are significantly less likely to develop an abdominal aortic aneurysm. Two percent of women between the ages of 65 and 75 are affected, as well as slightly more than six percent of those over 85 years of age. Therefore, the recommendation for screening does not generally apply to all women of this age. However, experts recommend that women at higher risk should also be examined.

What are the causes and risk factors of an aortic aneurysm?

The risk of an aortic aneurysm increases with age. The reason is that the structure of the vessel wall changes over the years. It loses elasticity and is therefore less able to absorb the high pressure in the main artery.

In more than 50 percent of cases, vascular calcification (arteriosclerosis) is the cause of an aortic aneurysm. It is also common in people with high blood pressure (hypertension). High blood pressure puts a strain on the vessels and is also a risk factor for arteriosclerosis.

Bacterial infections are also sometimes involved in the development of an aneurysm. The infection causes the vascular wall to become inflamed and eventually change in such a way that the vascular sac develops. This is called a mycotic aneurysm .

Aortic aneurysm: Rare causes

Very rare causes of an aortic aneurysm are inflammation of the vessel wall, for example in infections such as advanced syphilis or tuberculosis.

Another possible cause of an aortic aneurysm is a so-called type B dissection, i.e. a splitting of the individual layers of the vessel wall in the aorta. Doctors also speak of an aneurysm dissecans when the artery wall has split open .

Rare congenital diseases such as Marfan syndrome or Ehlers-Danlos syndrome are also associated with a higher risk of an aortic aneurysm. Both syndromes are hereditary diseases that lead to a defective structure of the connective tissue.

How can an aortic aneurysm be prevented?

Some risk factors for an aortic aneurysm, such as atherosclerosis and high blood pressure, can be prevented by taking certain measures.

These include, for example:

  • Healthy eating
  • Enough exercise
  • Healthy blood pressure, blood sugar and cholesterol levels (or their treatment and control if necessary)
  • Do not smoke

Make sure you have regular check-ups with your doctor, because the diagnosis is usually an incidental finding. Regular health checks increase the chance of early detection of an aortic aneurysm before it develops into a life-threatening size.

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