Aortic Aneurysm

An aortic aneurysm is a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso. Aortic aneurysms can dissect or rupture: The force of blood pumping can split the layers of the artery wall, allowing.

The Aorta is the largest artery in the body, stretching out from the heart through the chest and the abdomen region. Aortic diseases, to a great extent, affect the elderly and are more common as age progresses. They account for significant cardiovascular morbidity and mortality around the world.

• An aortic aneurysm is an infection that results in a balloon-like dilatation of the aorta (main blood vessel supplying blood to the entire body), and it continues to extend after some time. 
• Aortic aneurysm and aortic dissection are serious medical conditions. Rupture of aortic aneurysm is one of the leading causes of death around the world, and 50% of the patients die even before reaching the hospital. 

• Abdominal Aortic Aneurysm (AAA)- Involving the part of the aorta in the abdominal cavity
• Thoracic Aortic Aneurysm (TAA)- Involving the part of the aorta in the chest
• Thoraco-Abdominal Aortic Aneurysm (TAAA)- Involving parts of the aorta in the chest as well as abdomen

• Old age (>60 years)
• Tobacco consumption—smoking or chewing (Any age group)
• Diabetes mellitus
• High blood pressure
• High blood cholesterol levels, obesity

• Sudden, severe abdominal pain
• Severe back pain
• The feeling of swelling/heaviness in the stomach
• Reduced hunger sensation/appetite, the diagnosis may be confused with renal stone, gastritis, hernia or lumbar spine disease.
   

Consult a qualified vascular-endovascular surgeon immediately. Investigations needed include abdominal ultrasonography/CT scan (as advised by the vascular surgeon)
 

What happens if the aneurysm gets ruptured before treatment?

If neglected, an aortic aneurysm can get ruptured in a process similar to an expanding balloon, leading to on-the-spot death of the patient. The patient could even die before reaching the hospital.

Medical treatment: Patients with an aneurysm smaller than 5.5 cm in men and smaller than 5 are usually treated by medications and 6-monthly serial evaluation with CT scan. If the aneurysm increases in size, the patient is advised to undergo therapeutic intervention.

Who needs urgent intervention?

• Aneurysm size is more than 5.5 cm in men and more than 5 cm in women.
• Expanding aneurysm on serial CT scans
• Ruptured/impending rupture of an aneurysm

1. Endovascular Aortic Repair (EVAR/TEVAR) - now considered to be the standard of care.

The procedure is performed at a dedicated vascular cath lab. It involves the placement of an endovascular stent graft through small incisions at the top of the leg into the aorta. This graft covers the abnormal portion of the aorta and prevents blood flow into the aneurysm. Consequently, the aneurysm gets closed and shrinks over a period of time. As compared to open surgery, EVAR/TEVAR has a lower risk of complications and death in the short term along with the advantage of a shorter hospital stay (3-4 days).