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An aortic aneurysm is a weakening of the abdominal aorta which is
the main blood vessel of the body it tends to occur over
time and has a consequence of aging or of various diseases of
the connective tissues that help to build the structure of the aorta itself.
The aneurism in general usually implies that the vessel is dilated to
over twice its normal diameter and usually is at risk for rupture.
Or a tear that could cause significant injury to the patient.
A thoracic aorta aneurysm is a bulging or weakening of the aorta within the chest.
Aorta within the chest is generally about the size of a garden hose.
But over time, with aging or structural abnormalities of the
thrasciorta, they can begin to dilate and enlarge towards an aneurysm.
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>> It's not completely understood how aortic aneurysms develop.
In some cases, it's related to a history of smoking.
In other cases it's related to genetic disorders
such as Loeys-Dietz Syndrome or Marfan Syndrome where
there's an abnormal breakdown of the aortic wall
which results in a ballooning of the aorta itself.
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Aortic aneurysms are typically found incidentally, meaning that
the patient didn't know that they had it.
It can be felt on a physical exam in the abdomen as a
pulsitile mass, or it can be seen on an ultrasound or a CAT scan.
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>> Aneurysm within the chest, those being the
thoracic aneurysms will give patients episodes of chest pain.
The chest pain itself can be rather pulsitile in nature.
A pounding sort of pain, often times on either the front
of the chest or between the shoulder blades towards the spine.
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In the abdominal aorta, the symptoms can also be quite diverse but in general,
usually it's low back pain or perhaps pain in the center of the abdomen.
Again quite classically it tends to be pulsatile
nature or pounding with every heartbeat more so than
a typical ache and pain one might experience
with raking the leaves or shoveling too much snow.
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Smoking is the greatest risk factor both for the establishment of
aneurysms as well as their growth once an aneurysm has been diagnosed.
The correlation between smoking and aneurysm is quite to the point
that now in the past several years, Medicare has allowed a one
time screening for patients that hit 65 years of age who
have a history of smoking to rule out an abdominal aortic aneurysm.
before, of course, it becomes symptomatic and leads to trouble.
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People at risk for aortic aneurysm disease include patients over the age of 50.
It's more likely to be found in men than women and it also can
be found in certain genetic disorders such
as Lois Deet Syndrome or Marfin's Syndrome.
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The most common cause of aneurysms in
general is related to smoking and hyper-tension.
We also are now beginning to understand that high
cholesterol also plays a roll in development of aneurysms.
And in Hopkins we have a very long and
established track record of dealing with patients with genetic disorders.
Which lead them to inherited weaknesses of the aortas that run through
the chest and the abdomen and require surgery at earlier ages then
we would typically see in patients who are smokers or who have
high blood pressure who are coming to require aneurysm treatment in their 60s.
The treatment from thoracic aortic aneurisms in terms
of the threshold for which we move forward with
the repair, whether it's an endovascular or open repair
are different than those of an abdominal aortic aneurism.
Abdominal aortic aneurisms have been much more studied and we have longer data,
longer-term data to support The treatment thresholds
that we use for the abdominal aorta.
Now thoracic aorta, we generally draw the line at six centimeters to repair a
thoracic aorta aneurysm whether we're doing it
with an open repair or an endovascular repair.
However, if we see a thoracic aorta
aneurysm is growing rapidly such as, growing five
millimeters in six months or even a centimeter
in a year, we may very well intervene
upon that patient at a diameter less than six centimeters in size for fear that the
rapid growth rate of their aneurysm is predicting
a higher risk for rupture in the future.
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>> Ultrasound is the most common
screening test for abdominal aortic aneurysm.
Once you get close to having an aneurysm that
needs to be repaired CAT scans are ordered because these
tell us more definition about the anatomy and whether
you're a suitable candidate for a minimally invasive endovascular repair.
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