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An abdominal aortic aneurysm is a abnormal dilation of
degeneration of the abdominal aorta,
which is a main blood vessel within our abdomen.
It can cause it to enlarge, bulge, or dilate over time and
place it at risk of rupture.
That rupture can be potentially fatal to the patient.
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A thoracic aortic aneurysm is an abnormal dilation, or
enlargement, of the aorta within the chest.
And in some cases, that can be due to degeneration secondary to
aging or hypertension or genetic influences.
And it can also be due to aortic dissection,
which is where the different layers of the thoracic aorta
start to delaminate and tear, and again,
place the patient at risk for rupture.
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>> Aneurysms are caused by a degeneration of the aorta,
where it begins to balloon and get bigger and
put you at risk for rupture.
The most common risk factors for aneurysms are a history of
smoking, a family history of aneurysmal disease, or genetic
disorder such asMarfan Syndrome or Loeys-Dietz Syndrome.
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Aneurysms are typically detected incidentally in patients who
are undergoing an ultrasound, a CAT scan, or an MRI for
other reasons.
Your doctor may also feel a pulsatile abdominal mass,
which signifies an enlarging abdominal aorta.
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>> Thoracic aneurysms can cause a variety of symptoms.
Most commonly we believe that symptoms of a thoracic aneurysm
be something simple as chest pain or back pain.
However, the type of pain is very specific in that it's
pulsing, throbbing pain and often times, very severe, and
quite different from the pain that one might experience after
raking too many leaves or shoveling too much snow.
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The most common symptoms of an abdominal aneurysm are usually
pain in the abdomen or the back.
Sometimes the pain in the back will wrap around the sides, as
we call the flanks in medicine, or even down towards the groin.
As a matter or fact, the most common error in diagnosing
an aneurysm when it starts to leak or
rupture is that people call it kidney stone.
Because of the severity of the pain as well the throbbing and
intense nature of the pain can be quite similar to
a kidney stone.
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In terms of patients who are at risk for developing aortic
aneurysms, there's clearly a strong family influence.
And some of these can be related to genetic influences that
patients carry even from birth all the way until older age.
But in fact most aneurysms are associated simply with aging,
and to some level, hypertension as well as cholesterol.
But clearly smoking accelerates the growth of aneurysms in
almost every patient, regardless of genetic influence or not.
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>> The most common types of aortic aneurysms are abdominal
aortic aneurysms and thoracic aortic aneurysms.
Both of these types can easily be treated with endo graphs or
stent grafts that are performed with minimally invasive
techniques.
Aneurysms that involve the branches of the aorta
that go to the kidney arteries, the intestines, the liver, and
spleen, represent more complicated aneurysms.
Because these vessels have to be preserved during repair
in order to continue perfusing your kidneys and intestines.
Most places across the country repair these by open means
with a large incision, a long hospital stay, and
a complicated post-operative course.
However here we offer endo graphs or minimally invasive
stent grafts to preserve these branch vessels with stents and
small incisions and quicker recoveries.
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>> Cholesterol as well as genetic influences or genetic
mutations can certainly incite or inflame the development of
aortic aneurysms throughout the entire arterial tree.
In fact, genetic influences are probably more important for
the patients who we see who are younger, the 30, 40,
50 year old man or woman who have an aneurysm.
And cholesterol,
as it relates particularly to Atherosclerosis, might be more
of an important mediator of aneurysm development,
particularly as the patients get older and
go through the process of aging.
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Aneurysms are treated as they begin to enlarge towards five or
six centimeters in overall diameter.
But in fact the majority of aneurysms
we see at Hopkins were very small, and the risk for
rupture on an annual basis is incredibly low.
So in those patients, we'll follow them year in and
year out, with ultrasounds or CAT scans or MRI to make sure we
safely follow their aneurysms over time,
and that there's no increased risk for rupture for
the patient that they can be at risk for.
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>> Abdominal aortic aneurysms are typically followed with
ultrasound because it is non-invasive and
poses no radiation exposure.
As the aneurysm gets bigger and nears the threshold for repair,
which is approximately five centimeters,
we typically perform a CAT scan with intravenous contrast.
Not only to determine whether you're a candidate for
a stent graft, but
also to determine which branch vessels may be involved.
Including the branches to the kidneys, the liver, and
the intestines.
For thoracic aortic aneurysms,
we almost always perform CAT scans with contrast,
because ultrasounds cannot penetrate the chest wall.
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