“Ticking time bomb.” “Silent killer.” These terms are commonly used to refer to aortic aneurysms. While aortic aneurysms can be scary, if detected early, they can be managed and may not even need surgical intervention. So, what exactly is an aortic aneurysm, where does it happen in the body and is there a possibility of a positive outcome? Read on as Dr. Wilson Szeto, professor of surgery of the division of cardiovascular surgery, answers our questions about aortic aneurysms.
What is an aortic aneurysm?
The aorta is the main blood vessel that carries most of blood throughout the body. An aortic aneurysm, also referred to as complex aortic disease, is an outgrowing or dilatation of the aorta. They may start in and involve the aortic root which includes the aortic valve, aortic arch, or the descending aorta, and stretch all the way down to the vessels in the legs. There are simple aorta problems, such as aneurysms in the lower part of the aorta that can be treated with minimally invasive techniques. There are also more complicated aneurysms that can involve multiple levels of the aorta as well as the heart.
What are the symptoms and how is it diagnosed?
The main symptoms of an aortic aneurysm are severe chest, back or abdominal pain. In patients who do not know that they have aneurysm, it can be a bit difficult to sort out what the actual problem is. The symptoms can often be confused for a heart attack, ulcer pain or other abdominal conditions, pulmonary embolisms or blood clots in the lungs. It is only when a CAT scan is done that the actual diagnosis can be made.
Are aneurysms avoidable?
Aortic aneurysms can be difficult to avoid because they usually do not present any symptoms until the situation is already potentially dangerous. They can actually can grow silently inside you for a long time. When we look back on the string of events leading up to an operation for an aneurysm, it is often detected when a patient was being tested for something else, such as an echocardiogram (a test that uses sound waves to create a picture of the heart) for their heart or a CAT scan for their chest. We know there are some people who are at a greater risk for developing aneurysms such as patients with connective tissue disorders, i.e. Marfan’s syndrome, a genetic disorder that causes a breakdown of some of the proteins that hold the aorta together. A few other factors we’ve seen include long histories of smoking and, more commonly, high blood pressure.
Who should be screened?
Anyone with a strong family history of aneurysms or aortic disease, patients who have a long history of high blood pressure and echocardiograms, that have shown ascending aneurysms should be followed by their health care provider. Unfortunately, most of these patients’ aneurysms are found by chance.
What are the surgical options and how invasive are they?
There are two main approaches to dealing with aortic diseases in the chest. The first is endovascular surgery which is catheter-based. In this case, the patient can typically go home in three or four days without any incisions and minimal pain. The second approach is traditional surgery and is often used for more complicated aorta diseases. This involves either a full sternotomy or a minimally-invasive partial sternotomy, both of which involve a vertical incision along the sternum.
Does an aneurysm automatically lead to surgery?
Most people with an aortic aneurysm can initially be managed medically and with good medical therapy, people can actually avoid surgery. The key elements of medical therapy are, first and foremost, good blood pressure control, and for that we usually recommend beta blockers. We really try to keep patients’ blood pressures stable at all times and ask them to monitor their blood pressure very carefully. Another very important factor is smoking cessation. The number one risk factor for aortic growth in patients who have a known aneurysm is if they continue to smoke.