- What is an aneurysm?
- What are the different types of aortic aneurysms?
- What causes aneurysms?
- Who is at greatest risk?
- Why are aneurysms so dangerous?
- How can I find out if I have an aortic aneurysm?
- If I have an aneurysm, what is the risk of death from rupture?
- How will my doctors determine when I need surgery?
- What is AAA monitoring?
- Is there anything one can do while “waiting?”
- What are the risks of surgical repair?
- What do you use to replace the part of the aorta with the aneurysm, and how long does the replacement part last?
- Can I have some sort of stent instead of regular surgery to fix my aortic aneurysm?
- How long does it take to recover, and what is the likelihood of returning to a normal life?
- Can the aneurysm come back if I have surgery to fix it? Will I still need to take medication after surgery?
Other Aortic Conditions
- What is Marfan syndrome?
- What is a bicuspid aortic valve?
- What is an aortic dissection? How is it different from an aneurysm?
- What are the symptoms of an aortic dissection?
- What is the risk from an aortic dissection?
- Do the surgeons of the Methodist DeBakey Heart & Vascular Center perform minimally invasive procedures?
What is an aneurysm?
An aneurysm is a dilation or “bulging” of a blood vessel that looks like a small balloon. Aneurysms pose a serious health risk due to the potential for rupture, clotting, or aortic dissection (a tear in the inner wall of the aorta causes blood to flow between the layers of its wall). If an aneurysm in the brain ruptures, a stroke will result, and rupture of an abdominal aneurysm causes severe abdominal pain and shock.
What are the different types of aortic aneurysms?
The two main types of aneurysm are:
- Abdominal aortic aneurysms (AAAs) occur in the abdominal portion of the aorta, usually near the kidneys. Small AAAs rarely rupture, but they can grow very large without causing symptoms. AAAs are usually found while performing CT scans for other medical conditions.
- Thoracic aortic aneurysms (TAAs) occur in the chest portion of the aorta, above the diaphragm. Even large TAAs don’t always cause symptoms, but they can be identified through chest X-rays or CT scans.
Aneurysms can also occur in the brain and in arteries other than the aorta.
What causes aneurysms?
The health factors that can contribute to the formation and growth of aortic aneurysms include the natural aging process, hypertension (high blood pressure), atherosclerosis (cholesterol buildup and hardening of the arteries), a prior aortic dissection, giant cell arteritis (arterial inflammation), Takayasu arteritis, syphilis and smoking.
Certain congenital conditions (abnormal conditions present at birth) are associated with aortic aneurysms, including bicuspid aortic valve, Marfan syndrome, Ehlers Danlos syndrome, and Turner syndrome.
Those who have a family history (ex: parents, siblings, or children) with aortic aneurysms may share a genetic abnormality and therefore are more likely to have an aortic aneurysm themselves.
Who is at greatest risk?
White men over age 55 are at the greatest risk for developing aneurysms, which ranks among the top ten causes of death among this group. By about age 80, over 5 percent of white males will have developed an aneurysm. Abdominal aortic aneurysms occur less frequently in white women, and they are relatively uncommon in African Americans of both sexes.
Why are aneurysms so dangerous?
Aneurysms are dangerous because they are usually silent until a medical emergency such as a rupture, clotting, or aortic dissection (a tear in the inner wall of the aorta causes blood to flow between the layers of its wall) occurs.
How can I find out if I havean aortic aneurysm?
Many aneurysms are discovered incidentally as a result of medical imaging for other conditions, such as ultrasound exams, CAT scans, MRIs, or even plain X-rays. If you are over 55 and other members of your family have had aneurysms, be sure to discuss it with your doctor so that you can be screened for aneurysms if needed.
If I have an aneurysm, what is the risk of death from rupture?
If a rupture occurs, the chances of surviving are slim. The best predictor of risk of rupture is the size of the aneurysm.
The diameter of a normal aorta is about 2 centimeters (a little less than an inch). Once an aneurysm has reached 5–6 centimeters in diameter (about the size of an orange) the risk of rupture is very substantial, probably about 50 percent over the next few years following diagnosis.
Most cardiovascular surgeons would agree that large aneurysms should be repaired, unless a patient’s other medical factors make the operation too risky. There is less agreement over smaller aneurysms, since the risk of rupture is much lower. Some surgeons are now recommending repair of smaller aneurysms, but others advise watchful waiting.
How do my doctors determine when I need surgery?
Surgery is recommended when aneurysms grow large enough that they have a significant risk of tearing. The specific size at which surgery is recommended depends on the location of the aneurysm, how quickly the aneurysm is growing, and the age of the patient.
What is aneurysm monitoring?
Most cardiovascular surgeons monitor patients with small aneurysms through an ultrasound examination every 6 months. The average growth rate of an aneurysm is less than 0.5 cm per year, and some grow much more slowly. Others may demonstrate “growth spurts,” which is a serious warning sign.
I have a small aneurysm; what should I do while my physician is monitoring it?
If your doctor is monitoring a small aneurysm, he or she may advise certain lifestyle changes, such as quitting smoking, controlling your blood pressure, and engaging in mild exercise to improve your overall fitness. In some instances, specific medications have been shown to significantly slow the progression of aneurysm growth.
What are the risks of surgical repair?
Patients without any history or signs of heart disease generally do very well in surgery. Those with known coronary artery disease should have a thorough cardiological evaluation in advance to ensure they are fit for surgery.
What do you use to replace the part of the aorta with the aneurysm, and how long does the replacement part last?
The aorta is replaced with an artificial tube, much like you’d replace a broken piece of pipe with a new one. In this case the replacement tube is made out of a tightly woven fabric called Dacron® or Gore-Tex®. The material is highly durable and the graft will last for the rest of your lifetime.
Can I have some sort of stent instead of regular surgery to fix my aortic aneurysm?
In certain circumstances and for certain aneurysms, a new technique known as stent graft repair offers a minimally invasive approach for aneurysm repair. This procedure can only be performed at select medical centers such as Methodist, where physicians have been specifically trained in this field. In addition, stent-grafts can only be performed if the patient’s aortic anatomy is appropriate; if not, a standard surgical procedure will have to be performed. The major advantage of this method is the avoidance of the large chest incision that open surgery requires.
How long does it take to recover from surgery, and what is the likelihood of returning to a normal life?
The average hospital stay following surgery is 5-10 days, and most patients take about 6 weeks to recover before returning to work. The majority of patients return to a normal survival curve for life expectancy, comparable to other individuals of the same age and with similar underlying health (e.g., heart condition, renal function, etc.).
One unfortunate complication, about which male patients with abdominal aortic aneurysms should be forewarned, is the possibility of sexual dysfunction. For more information, please consult with your doctor.
Can the aneurysm come back if I have surgery to fix it? Will I still need to take medication after surgery?
When a portion of the aorta is replaced surgically, the aneurysm is removed and cannot recur in that location. In some instances, such as with some aneurysms of the ascending thoracic aorta, there is only one segment of the aorta that is abnormal, and once that segment has been replaced, the risk of aortic aneurysms forming elsewhere is slight.
However, when aneurysms are due to a systemic problem, such as atherosclerosis or Marfan syndrome, the risk of future aneurysms in other segments of aorta is significant. Therefore, almost all patients who have had a aortic aneurysm repair should still undergo periodic surveillance imaging with ultrasound scans, CT scans or MRI scans indefinitely.
Given that after surgery most patients still have a risk of future aortic aneurysms, your physician will probably prescribe blood pressure medications to keep your blood pressure at the lower side of normal for the long run.
What is Marfan syndrome?
Marfan syndrome is a genetic disorder that contributes to the formation of thoracic aortic aneurysms. It is due to an abnormality in the gene responsible for the formation of fibrillin-1, a major structural component of the fibers called elastin that give the normal aorta its remarkable strength. A defect in this elastin makes the aorta weak, and a weak aorta is prone to stretch over time and become an aneurysm. Patients with Marfan syndrome are at markedly increased risk for both aortic aneurysm formation and the occurrence of aortic dissection.
What is a bicuspid aortic valve?
The aortic valve, located at the base of the aorta, opens when the heart beats to allow blood to be pumped out and then, when the heart relaxes, closes and prevent blood from leaking backward. The normal aortic valve is “tricuspid,” which means it has three separate leaflets or cusps that meet in the middle to form an effective seal when the valve closes.
In some cases, however, a baby is born with only two aortic valve cusps instead of the normal three; in other words, a “bicuspid” valve has developed. Bicuspid valves may function relatively well, but in most cases they are either narrowed (a condition known as aortic stenosis) or they leak (a condition known as aortic insufficiency or regurgitation). Individuals with bicuspid aortic valves have been shown to have premature aortic valve degeneration and also have abnormal tissue structure of the aorta – leading to a predisposition to a faster aortic aneurysm growth rate.
What is an aortic dissection? How is it different from an aneurysm?
An aortic dissection is a life-threatening condition that involves a tearing away of the innermost lining of the aorta. An aortic dissection occurs when a weakened aortic wall develops a tear in its inner lining, which allows blood from within the aorta to penetrate into the middle layer. Although most patients with an aortic dissection have an underlying aortic aneurysm, some do not. Similarly, not all patients with an aortic aneurysm go on to develop an aortic dissection.
What are the symptoms of an aortic dissection?
Almost all patients with an acute aortic dissection experience pain in the chest, neck, back, abdomen, or legs, depending on the location of the dissection. The pain often comes on suddenly and is at its most severe at the start. Patients often describe it as “sharp,” “stabbing,” or “tearing.”
Symptoms of an aortic dissection are usually different from those associated with a heart attack, but there can be overlap. It is essential that anyone with an aortic aneurysm knows the symptoms associated with aortic dissection and can undergo an assessment in a nearby emergency department, including a CT scan to determine whether or not an aortic dissection has occurred.
What is the risk from an aortic dissection?
The early mortality (death rate) from aortic dissection is about one percent per hour, so the sooner it is diagnosed and treated, the better the outcome. Aortic dissections that involve the ascending thoracic aorta are at high risk of aortic rupture, which can be fatal. This condition requires immediate surgery to replace the ascending portion of the aorta. Conversely, aortic dissections that do not involve the ascending thoracic aorta are at much lower risk of aortic rupture, and are usually managed with medications rather than surgery.
Do the surgeons of the Methodist DeBakey Heart & Vascular Center perform minimally invasive procedures?
At the Methodist DeBakey Heart & Vascular Center, our goal is to maintain excellent outcomes while approaching surgery in a less and less invasive fashion. Our surgeons are leaders in catheter-based stent treatment of aortic disease and even catheter-based aortic valve replacement.