Being diagnosed with an aortic aneurysm is frightening. It’s natural to worry about what it means for your health and your future. But take heart: Though this is a serious diagnosis and aortic aneurysms can be fatal, with careful monitoring and treatment your doctor can help you manage an aortic aneurysm and avoid a life-threatening rupture.
We talked to UNC Health cardiothoracic surgeons John S. Ikonomidis, MD, PhD, and Tommy Caranasos, MD, to learn more about what an aortic aneurysm is and how your healthcare team can care for an aortic aneurysm before it ruptures.
What is an aortic aneurysm?
The aorta is the main artery in the body that moves blood and oxygen from the heart to other areas, such as the brain, muscles and other cells. Shaped liked a candy cane, the aorta has thick walls and is more than an inch wide in some places. An aortic aneurysm is a weakened or bulging area on the wall of the aorta.
“An aortic aneurysm is defined as greater than 50 percent enlargement of the aorta relative to its normal size,” Dr. Ikonomidis says.
This may occur anywhere along the aorta, including in the abdomen (abdominal aortic aneurysm) or chest (thoracic aneurysm). Aneurysms tend to develop over time. The bulging is not fatal, but if it bursts, it can cause life-threatening internal bleeding.
The aorta can weaken in response to risk factors such as high blood pressure and smoking, Dr. Ikonomidis says. The aorta starts to dilate, or get larger, increasing the tension on the surface of the aorta. This tension “increases the likelihood of catastrophic events like bursting of the aorta, rupture or a condition called aortic dissection,” he says.
While uncommon, an aortic dissection can cause blood to leak in between the layers of the aorta, which makes the artery narrow. When this happens, it is harder for blood to move from the heart to other areas of the body. The separation of the aortic layers can weaken the artery, which can cause the aneurysm to rupture.
What are risk factors for an aortic aneurysm?
While doctors can’t pinpoint exactly what causes someone’s aorta to dilate, there are certain risk factors including:
- High blood pressure
- High cholesterol
- Family history of aortic aneurysms
Aortic aneurysms are more common in men, people older than 65 and people with certain hereditary conditions including Marfan syndrome, Ehlers-Danlos syndrome and Loeys-Dietz syndrome.
How are aortic aneurysms detected?
In many cases, people do not know they have an aortic aneurysm because an aneurysm usually doesn’t cause any symptoms.
“Many patients come to us and have absolutely no symptoms,” Dr. Caranasos says. “An aortic aneurysm is usually discovered as part of a workup when your doctor is testing you for other issues.”
For example, a person with a cold and persistent cough might receive a chest X-ray that looks abnormal, with signs of a widening of the aorta. That might lead to a CT scan that reveals an aneurysm.
If aortic aneurysms run in your family, your doctor may screen you to check for one. Symptoms usually do not occur until an aneurysm bursts.
Symptoms of a ruptured aneurysm are sudden and can include:
- Rapid heart rate
- Sudden, severe chest, stomach or back pain
The symptoms of an aortic aneurysm can be confused with those of a heart attack. Both are emergencies. Seek immediate medical attention if you experience any of these warning signs. Call 911 or go straight to an emergency department.
How are aortic aneurysms treated?
If you have an aortic aneurysm, the goal is to keep it from bursting. Getting your blood pressure and cholesterol levels under control and quitting smoking can be very helpful.
There is no medical treatment to shrink or decrease the size of the aneurysm.
“While there are numerous clinical trials for this, there is nothing conclusive shown to change the course of the disease once it starts,” Dr. Ikonomidis says.
If you have an unruptured aortic aneurysm, your doctor will monitor your condition closely to see if it grows and may also recommend regular screenings.
“The typical way we follow patients is with CT scans every six months to a year to see how much it grows,” Dr. Caranasos says. “Many people live with them their entire lives with no change in size.”
If an aneurysm grows more than 1 centimeter in width in 12 months, that is an indication that it may be time for surgery. The decision to operate varies by patient, Dr. Ikonomidis says.
Surgery to repair an aortic aneurysm entails removing the diseased or damaged tissue and replacing it with a tube-shaped synthetic material called Dacron (polyethylene terephthalate).
“This is a very durable graft material that incorporates into the inside lining of the body tissue,” Dr. Caranasos says. “There is nothing foreign in the material that your body would reject, and it’s designed to be stretchy, so it mimics the bounciness of our own blood vessels. The procedure is simply to take out the old pipe and replace it with a new one.”
The UNC Health Aortic Network is made up of a multidisciplinary team of specialists who care for patients with aortic diseases such as aortic aneurysms. It also offers aortic aneurysm screening to high-risk patients older than 65.
“The Aortic Network is designed to make it easy, fast and reliable for patients to get their care here for aortic diseases,” Dr. Caranasos says. “The team is made up of the surgeons, vascular surgeons who are world-renowned in endovascular therapies, cardiologists who specialize in dealing with congenital heart disease, interventionalists who do the imaging that we need that’s necessary, and geneticists who will help us look into why certain patients have aneurysms.”
If you have been diagnosed with an aortic aneurysm, you should be monitored regularly. Talk to your doctor about referring you to the UNC Health Aortic Network or to a specialist who can monitor you. Need a doctor? Find one near you.