Aortic aneurysm

A Aortic aneurysm carries many risks. Various behavioral measures can help prevent an aortic aneurysm in advance.

What is aortic aneurysm?

An aortic aneurysm is a vasodilatation (aneurysm) that occurs in the main artery (aorta). An aortic aneurysm usually has a sac-like 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 chest. According to statistical data, the abdominal aorta is most often affected by an aortic aneurysm.

An aortic aneurysm is relatively common in people of older age. It is estimated that around 1-2% of German citizens are (often unknowingly) affected. 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 that the aortic aneurysm will tear; if this is the case, a so-called ruptured aortic aneurysm is present.

causes

One reason that older people in particular are affected by an aortic aneurysm is the decreasing elasticity of the vascular walls with age. Since the main artery is exposed to a comparatively 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). Existing high blood pressure is also a factor that can be causally involved in an aortic aneurysm. In addition, a hereditary component is assumed, especially in men: men whose families have more than one disease are at higher risk of developing an aortic aneurysm themselves.

An aortic aneurysm can rarely be caused by inflammation of the vessel walls; Such inflammatory processes can be the result of tuberculosis or syphilis. In individual cases, genetic defects can also promote an aortic aneurysm.

Symptoms, ailments & signs

Typically, an aortic aneurysm leads to a variety of conditions. These depend strongly on the affected region, so that a general prediction about the symptoms is not possible. If the aortic aneurysm occurs in the chest, in most cases there will be a strong cough and a hoarseness.

In severe cases, these symptoms are also accompanied by shortness of breath, so that those affected can also lose consciousness. It can also lead to swallowing difficulties or disturbances of the blood circulation. In many cases, patients also experience chest pain. An aortic aneurysm in the abdomen usually leads to a strong urge to urinate and also to severe back pain.

These can lead to restrictions in movement and thus also to restrictions in the everyday life of the person concerned. The back pain often spreads to the legs as well. The aortic aneurysm in the abdomen can also cause diarrhea or constipation. Usually these are not the only symptoms. Other complaints can also depend on the severity of the disease, so that no universal prediction is possible.

Diagnosis & course

Often times, an aortic aneurysm is diagnosed by chance as part of routine examinations. A diagnostic procedure that can be used to detect an aortic aneurysm in the abdomen, for example, is the ultrasound procedure.

This procedure enables a pictorial representation of structures inside the body. An aortic aneurysm can also be detected using MRI (magnetic resonance imaging) or CT (computed tomography). If an aortic aneurysm in the abdomen is very pronounced, it can often be felt by the doctor in slim people.

An aortic aneurysm carries the risk of rupture (tear) in its course. If such a complication occurs, the ruptured aortic aneurysm can be fatal.

Complications

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 immediately life-threatening complications increases with the size of the aneurysm.

For example, if the bulge in the abdominal aorta exceeds 5 to 5.5 centimeters in diameter, the risk of an aortic rupture increases sharply. Since the symptoms of an aortic aneurysm that is less than 4 to 4.5 centimeters in diameter range from unspecific to not noticeable, treatments are usually only carried out for larger aneurysms. Either open surgery or endovascular therapies are recommended.

Both types of surgery involve certain different risks of complications. Above all, there is also the risk of a late complication. For example, in very rare cases, infections can occur within about three years. There is little risk in using one of the endovascular therapies.

This can manifest itself in the fact that leaks gradually occur at the transition from the artificial aortic stent to the natural tissue, which may require a repeated 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 - as bulges in the main body artery (aorta) are known - affects older people more often than children, adolescents or young adults. In most cases, those affected are not aware that an aneurysm has formed on their aorta because it does not always cause symptoms or the unspecific symptoms have been misinterpreted. The aneurysms are often discovered by chance during an ultrasound scan. There are no general answers to the question of whether or from when an aortic aneurysm needs to be treated.

As a rule, the bulges only require 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 will cause a tear (rupture) to form in the aortic wall. This leads to an immediately life-threatening internal bleeding that is difficult to stop. The risk of developing an aortic aneurysm increases greatly in people whose arteries show atherosclerotic changes in the vessel walls.

If there are clear symptoms such as chronic cough, hoarseness, shortness of breath and circulatory disorders, we recommend, for example, an examination of the aorta by ultrasound.The same recommendation applies to symptoms such as frequent urination, unspecific back pain, constipation and diarrhea, which can also take place alternately. The ultrasound examinations can also take place at the family doctor, provided that he has a suitable ultrasound device.

Doctors & therapists in your area

Treatment & Therapy

The appropriate medical treatment for an aortic aneurysm depends, among other things, on the severity of the aortic aneurysm. With a symptom-free aortic aneurysm, the diameter of which is less than about four centimeters, regular medical observation may initially be sufficient; Depending on the individual case, such a check is carried out, for example, once or twice a year using the ultrasound.

In order to ensure that the blood pressure remains constant and does not rise, administration of beta blockers with medication can also be useful in individual cases with an aortic aneurysm.

According to experts, an aortic aneurysm should be treated if it exceeds a diameter of about five centimeters. Which measure is sensible for this depends, among other things, on the position of the aortic aneurysm and on the constitution of the patient.

One way to counteract an aortic aneurysm is, for example, to lay a so-called stent, i.e. a narrow tube that holds the aortic aneurysm from the inside. Alternatively, an aortic aneurysm can be removed during surgery and replaced with a vascular prosthesis.

Outlook & forecast

An aortic aneurysm is often discovered accidentally during a routine examination. If the doctor determines that the aneurysm needs to be operated on, this operation carries a corresponding risk. If the aneurysm is injured during the operation, life-threatening bleeding can occur in rare cases with, in the worst case, fatal outcome. A successful operation of an aneurysm, on the other hand, offers those affected the possibility of a largely normal life without medical restrictions.

If an aneurysm remains undetected and a rupture occurs, it is a medical emergency with a rather poor prognosis. Even with immediate medical intervention, many patients die of circulatory failure due to severe blood loss. If such an aortic aneurysm tears internally and this is not recognized at all, the affected person is very likely to die quickly. The prognosis in such a case is accordingly extremely poor. If the situation in which the aortic aneurysm bursts allows for a quick operation, there is now a realistic prospect of surviving the rupture.

When it comes to the prognosis of an aortic aneurysm, prevention also plays an important role. Since aneurysms are often hereditary, special examinations for early detection offer the chance to track down the aneurysm and remove it in a planned operation. The prospects for a cure are more favorable.

prevention

In order to prevent an aortic aneurysm, regular preventive examinations are advisable. This reduces the risk that an aortic aneurysm, when it is discovered, has assumed a diameter that can be life-threatening.

To prevent an aortic aneurysm or its enlargement, it can also be useful to combat corresponding risk factors or not to allow them to develop; Risk factors that can favor an aortic aneurysm include arteriosclerosis and high blood pressure as well as poor diet and lack of exercise.

Aftercare

Follow-up care options for an aortic aneurysm prove to be relatively difficult in most cases. First and foremost, the disease itself has to 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, in the worst case, lead to the death of the person affected or to a significantly reduced life expectancy.

Therefore, 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 affected must ensure that the medication is taken regularly. Possible interactions with other medicinal products must be taken into account, and a doctor can also be consulted.

In some cases, however, surgery is necessary to fully treat the aortic aneurysm. After such an operation, those affected should rest and take care of their bodies. Avoid strenuous or stressful activities. A healthy lifestyle with a balanced diet also 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. Survival is only possible through immediate intensive medical therapy. In this respect there is no possibility of self-help in an acute emergency due to a rupture of the aneurysm.

Immediately sending the emergency call is the only thing that you can actually do yourself in this case. Therefore, in the area of ​​self-help in everyday life with an aortic aneurysm, self-observation and early detection are of great importance.

For example, it is known that aneurysms are more common in some families. A hereditary component can therefore be assumed. Anyone who knows that there have been cases of aneurysms in their own family should definitely be examined. Discovered at an early stage, it is possible to wait under close supervision or to operate promptly.

Once an aneurysm is discovered, it is therefore important that those affected are aware of this danger in everyday life. Not only do they have to carry out the necessary controls. You must also ensure that you consult a doctor quickly in the event of unclear symptoms such as palpitations, any form of circulatory complaints or diffuse pain in the abdominal cavity and address the problem of the aneurysm on your own initiative. Everyone in the immediate vicinity should also be informed so that they can react immediately in an emergency.