aortic aneurysms


The aorta is the largest blood vessel of the body. It travels from the heart, through the chest and abdomen before branching to give the blood vessels supplying the legs. In the chest it is known as the thoracic aorta and in the abdomen, the abdominal aorta. If there is plaque build up within the aorta, it may cause swelling of the blood vessel, which is known as an aneurysm. They are more common later on in life and affect men more than women. There are usually no symptoms until the aneurysm gets very large causing compression of surrounding organs, producing pain. As the aneurysm gets larger, the risk of it rupturing also increases. Unfortunately, this is how some patients discover the presence of an aneurysm.

Most abdominal and thoracic aneurysms are detected on scans performed for other reasons. Abdominal aortic aneurysms (AAAs) can be imaged using abdominal ultrasound scans, CT and MR angiograms. However, only CT and MR Angiograms can reliably image thoracic aneurysms due to the position of the thoracic aorta behind the ribcage. There are three types of thoracic aneurysms depending on their location - ascending, aortic arch or descending. Abdominal aneurysms are classified by their relative location to the arteries supplying the kidneys – infrarenal, which are the most common, suprarenal which are the least common and juxtarenal.

Men are routinely offered an abdominal ultrasound at the age of 65 as part of the NHS screening programme for AAA detection. Once an aneurysm is found, it is monitored every 6-12 months.

Once an aneurysm becomes bigger than 5cm in size, it would be suitable for treatment. This is because the risk related to the repair is less than the risk of the aneurysm rupturing. There are two methods of treatment - open surgery or minimally invasive endovascular repair (EVAR), which is now the treatment of choice if possible.

Open surgery for both abdominal and thoracic aneurysms is a major procedure which involves opening the stomach or chest and repairing the aorta under direct vision. It is usually repaired with a synthetic fabric graft and stops blood flow through the aneurysm, thereby preventing further enlargement.

Endovascular repair (EVAR) is being used more widely to treat aneurysms now. A stent is passed through an artery in the leg and is placed in the aneurismal aorta under X-Ray guidance. Not all patients are suitable for EVAR however - the location and shape of the aneurysm are deciding factors.

Aneurysms which involve both the thoracic and the abdominal aorta, are called Thoracoabdominal aneurysms and their treatment is a major surgical challenge.

These complex aneurysms could now be treated, in

super-specialist tertiary centres with fenestrated and branched stentgrafts, with low morbidity and minimal mortality.

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Next: Aortic Dissections


Abdominal and Thoracic Aortic Aneurysms

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