The aorta is the largest blood vessel in the body and carries the blood pumped from the heart to the rest of the body. The aorta has elastic and expandable walls allowing it to absorb the pumping force of the heart. On occasion, the walls of the aorta may become damaged or weak, making the aorta less capable of withstanding the force of the pumping heart. When this happens, the walls of the aorta may expand and bulge. Over time, this bulge grows and forms a balloon-like growth. When the ballooning area reaches more than 1 and ½ times the size of normal (1.2 inches in the abdomen or 1.6 inches in the chest), it is called an aneurysm.
Aneurysms in the aorta kill more than 15,000 people and cause approximately 60,000 hospital stays per year. More than 9 out of 10 of aneurysms occur in the abdomen. In general, aneurysms form in the second half of life, after the age of 50, in men more commonly than women. You are at greater risk for the development of an aortic aneurysm if you smoke cigarettes, now or in the past, or have a relative who has an aortic aneurysm.
Most patients do not have any symptoms from the aneurysm until it bursts. When it bursts, most patients die before coming to the hospital. Therefore, it is important to detect the aneurysm when it is small and treat it before it gets large enough to burst.
Until recently, most aneurysms were found because a radiology study was performed for another problem and the aneurysm was discovered unexpectedly. In some cases, a doctor may feel the aneurysm while examining the patient’s abdomen. When discovered, aneurysms are usually followed with ultrasounds, MR or CT scans until they reach the size when they should be repaired. Congress has approved a special provision to pay for a one-time screening test for men between the ages of 65 and 74 who have a history of cigarette smoking because of the high likelihood in this group – about 1 in 14 scanned will have an aneurysm.
Once diagnosed, the standard therapy involves controlling blood pressure to normal levels, discontinuation of cigarette smoking, and following the aneurysm with periodic scans until it is time for repair. Currently, two methods are available to repair the aneurysm. The first is an open surgical procedure in which the ballooning segment is replaced with a graft. The surgery is a big procedure, usually requires a week-long hospital stay, and prolonged recovery period. Recently, a new procedure called stent-grafting has been used to repair the aneurysm. In this procedure, a cloth sheath supported by metal struts (stent graft) is put in the aorta to exclude the aneurysm from the pulsing of the blood. This stent graft is placed through two smaller incisions in the groin. The surgery is smaller, requires a several day stay, and the recovery period is shorter, however, patients will require yearly CT scans and the same number of patients who die by the end of two years is the same as with open surgery. Both methods nearly eliminate the chances of dying from an aneurysm.
Learn More about Abdominal Aortic Aneurysm
Learn More about Thoracic Aortic Aneurysm
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