Transcript Aortic Aneurysm

Aortic Aneurysm
Victor Politi, M.D., FACP
Medical Director, SVCMC,
School of Allied Health
Professions, Physician
Assistant Program
The Aorta
The aorta is the largest human artery
It is the primary artery that carries blood
from the heart to the head and
extremities
During an average lifetime it transports
200 million liters of blood and withstands
the force of up to 3 billion heartbeats
The Aorta
The aorta is one inch in diameter
It divides at the hip into the two iliac
arteries that supply blood to the legs
The arteries that feed all of the body’s
organs branch off from the aorta
The Aorta
The aorta emerges from the heart and
runs the length of the torso
thoracic aorta - as it leaves the heart,
ascends, arches, and descends through the
chest until it reaches the diaphragm
abdominal aorta - after passing the
diaphragm - continues down abdomen- ends
where it splits at two iliac arteries
Where do they develop
Can develop anywhere along the aorta
In the chest - called thoracic aneurysm
More than 3/4 of aortic aneurysms occur
in the abdomen - most often below the
renal arteries
About 2/3 of abdominal aneurysms extend
from the aorta into one or both of the iliac
arteries
What is an aortic
aneurysm
An aneurysm can be caused by pressure
on a weakened section of the arterial wall
or by dissection - a split in the three
layers of tissue comprising the aortic wall
- blood seeps between them, the wall
stretches, increasing the risk of rupture
Three common types of
aortic aneurysms
Saccular
involves only the muscular middle layer of aorta with
a localized out-pocketing (balloon-like swelling)
Fusiform
most common form, spindle shaped, widens all
around circumference of aorta (balloon-like swelling)
Dissecting
longitudinal, blood-filled split in the lining of the
artery, usually in the aortic arch near the heart
Incidence
On average 15,000 Americans die
suddenly each year from rupture of an
aortic aneurysm
It is the 9th leading cause of death from
men over age 55
Incidence
Increases with age > 60 at greater risk
Males more common than females (5:1)
5% of men over age 60 develop an
abdominal aortic aneurysm
Incidence
Most common cause - arteriosclerosis
(80% of cases)
post physical trauma to aorta
Other Risk factors
connective tissue disease, arteritis,
congenital malformation, Marfan syndrome,
atherosclerotic risk factors (smoking, HTN,
hyperlipidemia, diabetes)family hx of
aneurysm
Symptoms
Aneurysms can be small or grow to the
size of a grapefruit
Most are symptomless, especially when
small
Symptoms tend to increase as aneurysms
enlarge and press on nerves, organs, or
other blood vessels
Symptoms occur in only 25% of patients
Symptoms
Most common symptom is a throbbing, or
pulsation in the abdomen
May cause lower back pain
Symptoms
In thoracic aneurysm symptoms may
include:
pain in the shoulders, lower back, neck or
abdomen
a dry cough
hoarseness from pressure of aneurysm on
nerves controlling vocal cords
many of these are frequently misdiagnosed!
Symptoms
Other symptoms
throbbing lump in abdominal area
severe backache
leg pain/coldness in leg (due to embolus
from clot formed in abdominal aneurysm)
severe abdominal pain (rupture)
Diagnosis
Abdominal palpitation
may reveal abnormally wide pulsation of the
abdominal aorta
characteristically felt on both sides of the
aorta which is midline
Even large aneurysms can be difficult to
detect on exam in overweight people
Aneurysms that are rapidly enlarging and on
the verge of rupture are often tender
Diagnosis
Abdominal aortic aneurysm
x-ray (shows calcium deposits in 90% of
cases)
CT Scan w/contrast
MRI
abdominal Ultrasound -(98% accuracy in size
measurement)
abdominal aortography
Aortic Aneurysm
 The aorta (short arrow) looks like a white "candy-cane"
in the middle of this image. The aneurysm (long arrow)
is the thin line running through the candy cane.
Diagnosis
thoracic aortic aneurysm
chest x-ray
TEE
MRI
CT scan
Complications 1/2 of all persons with untreated
abdominal aortic aneurysms die of rupture
within 5 years
Abdominal aortic aneurysms - 13th
leading cause of death - overall - in the
US
Complications
Rupture
highly lethal - causes profuse bleeding, leads
to shock- death
uncommon < 5cm wide
More common > 6cm wide
Peripheral embolization of clot within the
aneurysm
Infection of aneurysm
Spontaneous blockage of the aorta
Treatment
Symptomatic aneurysms require early or
urgent treatment
Surgical treatment involves replacing the
part of the aorta affected by the
aneurysm with a synthetic graft
 - risk of death from rupture 50%- even
during surgery
Surgery only treatment
Treatment
Treatment of dissecting aneurysm
lowering of BP to reduce force on the tearprior to surgery
if left untreated- most people die within a
few weeks
Treatment
Repair can be done surgically or by
installation of a stent graft
Surgical repair
recommended for all aneurysms over 6cm wide
usually recommended for aneurysms 4-6cm in
good surgical risk cases
Stent graft - minimally invasive -may be
option in some cases
Questions??