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Aortic Aneurysm and Aortic Dissection

  • What are aortic aneurysm and aortic dissection?

    The aorta is the biggest artery in the body, exiting from the heart to supply blood to the whole body through branches of arteries. Disease or damage in the aorta can lead to abnormal narrowing and dilation (swelling) of the arteries. This includes aortic aneurysm and aortic dissection.

    Aortic aneurysm

    Aortic Aneurysm

    Aortic aneurysm refers to the abnormal dilation of the aorta. The dilation of the aorta’s wall may cause the aorta to tear or burst.

    The 2 main types of aortic aneurysms are:

    • Abdominal aortic aneurysm

      Abdominal aortic aneurysm occurs in the section of the aorta that passes through the abdomen
    • Thoracic aortic aneurysm

      Thoracic aortic aneurysm occurs in the section of the aorta that passes through the chest cavity (thorax).

    It is possible for a person to have both an abdominal aortic aneurysm and thoracic aortic aneurysm.

    Aortic dissection

    Aortic Dissection

    Aortic dissection refers to a tear in the inner layer of the aortic wall. Known as a dissection, this causes the one or more layers of the wall of the aorta to come apart. This allows blood to flow between the layers, further weakening the walls of the aorta.

    If the aorta is completely torn apart by the dissection, this can lead to massive internal bleeding and severe pain. An aortic dissection is a medical emergency.

  • Aortic aneurysm and aortic dissection are caused by conditions that lead to the weakening of the blood vessels wall. These conditions are commonly linked with uncontrolled high blood pressure or any of the following:

    • Chronic high blood pressure

      The increased pressure of blood flowing through the arteries can damage its inner lining and make the artery walls less elastic. This makes the aortic wall more prone to tearing.
    • Congenital conditions (conditions that you are born with)

      Some congenital heart conditions can weaken and dilate the aorta’s wall. One of these is Marfan Syndrome, in which faulty connective tissues can weaken the aorta and lead to aortic aneurysm or aortic dissection. Another is bicuspid aortic valve, in which a person is born with only two cusps instead of the normal three. This can cause the aortic valve to narrow, a condition called aortic valve stenosis, which reduces blood flow from the heart to the rest of the body.
    • Traumatic injury to the chest

      In rare instances, events that cause severe injury to the chest area, such as motor vehicle accidents, might lead to aortic dissections. An aortic dissection is when the inner layer of the aorta tears, allowing blood to surge through, separating or dissecting the inner and middle layers of the aorta.

    Other potential risk factors of aortic aneurysm and aortic dissection include:

    • Age and gender, as it occurs more frequently in men in their 60s and 70s.
    • Use of drugs such as cocaine, which increases blood pressure.
    • Pregnancy, likely due to changes in heart rate that result in greater force on the aortic wall.

    Reducing the risk of aortic aneurysm and aortic dissection

    You can help reduce your risk for aortic aneurysm and aortic dissection with these tips:

    • Control blood pressure to prevent damage to the arteries
    • Quit smoking to prevent hardening of arteries
    • Maintain a healthy body weight
    • Consume a low-salt diet
    • Eat more fruits, vegetables and whole grains
    • Get regular exercise

    If you are at risk for aortic aneurysm or have a family history of the condition, you should speak to your doctor about regular screening or monitoring.

  • Symptoms of aortic aneurysm and aortic dissection may feel similar to those of a heart attack. This includes:

    • Severe, abrupt pain in the chest, back or abdomen
    • Pain or weakness in arms or legs
    • Weakness
    • Shortness of breath
    • Fainting or loss of consciousness

    An aortic dissection can also affect blood flow to the heart and cause a heart attack or interrupt blood supply to the brain and cause a stroke.

  • Aortic aneurysm and aortic dissection can be diagnosed using imaging tests that reveal the location and size of the aneurysm, and as well as the surrounding structures.

    These tests may also be helpful for doctors to see if a rupture is likely to occur. If the likelihood is high, surgery may be scheduled. If it is not, regular monitoring may be advised. Proactive screening tests may also be advised for those who are at increased risk for aortic aneurysm.

    Tests for diagnosing abdominal aortic aneurysms include:

    • Ultrasound

      Ultrasound uses sound waves to construct images. It is a non-invasive way to screen for abdominal aortic aneurysms among those who may be at risk but have yet to experience any symptoms. It can also detect abdominal aortic aneurysms measuring 3cm in diameter or larger and allow doctors to check if small aneurysms grow in size over time.
    • Computerised tomography (CT)

      A CT scan may be advised in addition to ultrasound if symptoms are present or if the doctor suspects a possible rupture. It offers a more detailed view of its size and location, together with the surrounding structure, as well as potential signs of rupture.

    Thoracic aortic aneurysms involve more complex anatomy, with critical surrounding structures, blood vessels and organs. As a result, it requires different diagnostic tests to identify which structures or organs are likely to be affected if surgery is required.

    Tests for diagnosing thoracic aortic aneurysms include:

    • Computerised tomography (CT)

      CT scan can provide your doctor with a clearer and more detailed image of the aneurysm in relation to the surrounding anatomical structures.
    • Magnetic resonance imaging (MRI)

      An MRI takes many cross-sectional images and combines them into a 3-dimensional representation of the aortic aneurysm and its surrounding structures.
  • Treatment for an aortic aneurysm depends on its size. Smaller aneurysms may be treated with medication such as beta blockers and calcium channel blockers to reduce blood pressure and relax blood vessels. These medications help to reduce the risk of a rupture.

    If the aneurysm continues to increase in size or symptoms develop, surgery may become necessary.

    There are 2 types of surgery for aortic aneurysm, which depends on its size and location as well as your age and health condition.

    • Open abdominal surgery

      An open abdominal surgery is the conventional procedure to remove the damaged section of the aorta and insert a synthetic graft in its place. It usually takes at least a month for recovery.
    • Endovascular repair

      Endovascular repair is a less invasive procedure in which the synthetic graft is inserted into the aorta using a catheter. The graft is then expanded and fastened in place, reinforcing the weakened or damaged section to prevent a rupture. However, it may not be suitable for all patients.

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  • Aortic aneurysms develop gradually and may not be at risk of rupture. These rarely produce symptoms. Sometimes, however, aortic aneurysms may grow rapidly, and its large size can lead to severe or life-threatening symptoms due to the increased risk of rupture.

    Aortic dissection may also occur which refers to a tear in the lining of the aorta. This potentially fatal complication can damage the blood vessels and cause internal bleeding as well as stroke, neurological and organ damage.

    Other complications include aortic regurgitation or a leaky aortic valve, which can cause chest pain, palpitations, arrhythmias and heart failure.

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