What is aortic aneurysm?Infogram on the anatomy and location of an aneurysm in the brain and its operative therapy. Click on the image to enlarge.
An aortic aneurysm is a vascular dilation (aneurysm) that occurs at the main artery (aorta). Most an aortic aneurysm shows a saccular or spindle-like shape.
In medicine, a distinction is made between the aortic aneurysm, which occurs at the level of the abdomen, and the aortic aneurysm, which develops at the level of the thorax. According to statistical data, the abdominal aorta is most often affected by an aortic aneurysm.
An aortic aneurysm is comparatively common in older people. It is estimated that about 1-2% of German citizens are affected (often unknowingly). An aortic aneurysm is not always associated with noticeable symptoms (pain); Such a symptom-free aortic aneurysm is also referred to as an asymptomatic aortic aneurysm.
As the size of an aortic aneurysm increases, so does the risk of a rupture of the aortic aneurysm; If this is the case, there is a so-called ruptured aortic aneurysm.
One reason that elderly people are particularly affected by an aortic aneurysm is the decreasing elasticity of the vessel walls in old age. Since the main artery is exposed to a relatively high blood pressure, the less elastic vessel walls react with the formation of an aortic aneurysm.
An aortic aneurysm is also favored by various risk factors, such as calcification of the vessels (also known as arteriosclerosis). Hypertension is also a factor that can be causally involved in an aortic aneurysm. In addition, a hereditary component is assumed, especially in males: men whose family is more frequently diagnosed with the disease have a higher risk of developing an aortic aneurysm themselves.
Rarely an aortic aneurysm can be caused by inflammation of the vessel walls; such inflammatory processes may be consequences of tuberculosis or syphilis. In some cases, genetic defects may also favor an aortic aneurysm.
Symptoms, complaints & signs
As a rule, an aortic aneurysm causes many different complaints. These depend strongly on the affected area, so that a general prediction of the symptoms is not possible. If the aortic aneurysm occurs in the chest, it usually comes to a strong cough and continue to hoarseness.
In severe cases, these symptoms are also accompanied by a shortness of breath, so that those affected can also lose consciousness. Likewise, it may cause dysphagia or disruption of blood circulation. In many cases, patients also suffer from chest pain. An aortic aneurysm in the abdomen usually leads to a strong urinary urgency and also to severe back pain.
These can lead to restrictions in the movement and thus to restrictions in the everyday life of the person concerned. Back pain often spreads to the legs. Furthermore, it can come through the aortic aneurysm in the stomach to diarrhea or constipation. As a rule, these are not the only symptoms. Other complaints may also depend on the severity of the disease, so that no universal prediction is possible.
Diagnosis & History
Often an aortic aneurysm is diagnosed by chance during routine examinations. A diagnostic method by which, for example, an aortic aneurysm in the area of the abdomen can be detected is the ultrasound procedure.
This method allows a visual representation of structures inside the body. MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) can also detect an aortic aneurysm. If an aortic aneurysm in the abdomen is pronounced, it can often be palpated by the doctor in lean people.
An aortic aneurysm involves a risk of rupture in its course. If such a complication occurs, the ruptured aortic aneurysm can be fatal.
Complications caused by an untreated aortic aneurysm depend on the location and severity of the aneurysm. By far the most threatening complication is the rupture of the aorta with immediate bleeding into the chest or abdomen. The risk of such immediate life-threatening complications increases with increasing size of the aneurysm.
For example, if the bulge in the abdominal aorta exceeds a diameter of 5 to 5.5 centimeters, the risk of aortic rupture increases steeply. Since the symptoms of an aortic aneurysm, which is less than 4 to 4.5 centimeters in diameter, ranging from nonspecific to unnoticeable, treatments are usually performed only in larger aneurysms. Either open surgery or endovascular therapies are recommended.
Both types of intervention involve certain different risks of complications. Above all, there is also the risk of late complications. For example, in very rare cases infections can occur within about three years. There is a low risk of using one of the endovascular therapies.
This can be manifested in the fact that leaks gradually occur at the junctions between the artificial aortic stent and the natural tissue, possibly requiring a second intervention. In very rare cases the formation of aortoenteric fistulas was observed as a further complication.
When should you go to the doctor?
An aortic aneurysm - which is the name given to the main body artery (aorta) - tends to affect older people more than children, adolescents or young adults. Most of the time, sufferers are unaware that aneurysm has formed on their aorta because it does not always cause symptoms or misinterpret non-specific symptoms. Frequently, the aneurysms are discovered by chance during an ultrasound scan. There are no universally valid answers to the question of whether or when an aortic aneurysm should be treated.
In general, the Ausackungen are only in need of treatment from a size of 4 to 4.5 centimeters. With such large and even larger aneurysms, there is a risk that the pulsating blood pressure ruptures in the aortic wall. This leads to an immediate life-threatening internal bleeding that is difficult to stop. The risk of developing an aortic aneurysm increases significantly in persons whose arteries have arteriosclerotic changes in the vessel walls.
If there are clear symptoms such as chronic cough, hoarseness, shortness of breath and circulatory disorders, for example, aortic ultrasound examination is recommended. The same recommendation applies to complaints such as frequent urination, unspecific back pain, constipation and diarrhea, which can also occur alternately. The ultrasound examinations can also take place at the family doctor if he has a suitable ultrasound device.
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Treatment & Therapy
The way in which an aortic aneurysm is adequately medically treated depends, among other things, on the degree of an aortic aneurysm. In a symptom-free aortic aneurysm whose diameter is less than about four centimeters, a regular medical observation may be sufficient initially; depending on the individual case, such a check is carried out, for example, once or twice a year using ultrasound.
In order to ensure that the blood pressure remains constant and does not increase, in individual cases a drug administration of beta-blockers may also be useful in the case of an aortic aneurysm.
According to experts, an aortic aneurysm should be treated if it exceeds a diameter of about five centimeters. Which measure makes sense depends, among other things, on the situation that has the aortic aneurysm and on the constitution of a patient.
One way to counter an aortic aneurysm is, for example, the laying of a so-called stent, ie a narrow tube, which gives the aortic aneurysm support from inside. Alternatively, an aortic aneurysm can be removed during surgery and replaced with a vascular prosthesis.
Outlook & Forecast
An aortic aneurysm is often discovered by chance in a routine examination. If the doctor determines that the aneurysm needs surgery, this operation carries a corresponding risk. If there is an injury to the aneurysm under the operating room, life-threatening bleeding may occur in rare cases, with at least fatal outcome. A successful operation of an aneurysm, on the other hand, offers the possibility of a largely normal life without medical restrictions.
If an aneurysm remains unrecognized and there is a rupture, it is a medical emergency with a rather unfavorable prognosis. Even with immediate medical intervention, many patients die of circulatory failure due to heavy blood loss. If such an aortic aneurysm tears internally and if this is not recognized at all, a rapid dying of the affected person is very likely. The prognosis in such a case is accordingly extremely unfavorable. However, if the situation that causes the bursting of the aortic aneurysm causes rapid surgery, there is a realistic prospect today of surviving the rupture.
With regard to the prognosis of an aortic aneurysm, precaution also plays an important role. Because aneurysms are often hereditary, special screening examinations offer the opportunity to detect the aneurysm and remove it in a planned surgery. Here are rather favorable prospects for healing.
In order to prevent an aortic aneurysm, regular preventive medical check-ups are advisable. Thus, the risk can be limited that an aortic aneurysm has already assumed a diameter that can be life-threatening upon its discovery.
In order to prevent an aortic aneurysm or its enlargement, it may also be useful to combat or not to develop appropriate risk factors; Risk factors that may favor an aortic aneurysm include arteriosclerosis and high blood pressure as well as poor nutrition and physical inactivity.
The aftercare options are usually relatively difficult in an aortic aneurysm. First and foremost, the disease itself must be treated in order to prevent further complications and not to reduce the life expectancy of the person affected. If the aortic aneurysm is not discovered and treated early, it can lead to the death of the patient or to a significantly reduced life expectancy in the worst case.
Therefore, an early diagnosis with timely treatment has a very positive effect on the further course of the disease. Since the aortic aneurysm is usually treated with the help of medication, the person concerned must in any case pay attention to a regular intake of the medication. In doing so, possible interactions with other drugs should be taken into account, whereby a doctor can also be consulted.
In some cases, however, surgery is required to fully treat the aortic aneurysm. After such an intervention sufferers should rest and spare the body. Excessive activities or stressful activities should be avoided. Even a healthy lifestyle with a balanced diet has a positive effect on the course of the disease.
You can do that yourself
If an aortic aneurysm bursts, a life-threatening situation occurs within a very short time. Only through immediate intensive care therapy is the possibility of survival given. In this respect, there is no possibility of self-help in an acute emergency, due to a rupture of the aneurysm.
The immediate discontinuation of the emergency call is the only thing that you can actually do in the case. Therefore, in the field of self-help in everyday life in an aortic aneurysm of self-observation and early detection is of great importance.
For example, it is known that aneurysms are common in some families. An hereditary component is therefore to be assumed. Who knows that cases of aneurysms have occurred in their own family, should definitely be examined. Discovered early on, it is possible to wait under close control or to operate promptly.
Once an aneurysm has been discovered, it is important that those affected are aware of this danger in everyday life. So they not only have to exercise the necessary controls. You must continue to pay attention to unclear symptoms such as palpitations, any form of circulatory problems or diffuse abdominal pain quickly visit a doctor and address the problem of aneurysm self-initiated. All persons in the immediate vicinity should also know so that they react immediately in an emergency.