What You Might Want to Know about an Aortic Aneurysm

One of the greatest difficulties in diagnosing an aortic aneurysm is it's either often asymptomatic or only manifests at an advanced stage. However, precision medicine and advances in genetics have opened a window of hope for the early detection of this problem.
What You Might Want to Know about an Aortic Aneurysm

Last update: 29 September, 2021

Generally, an aortic aneurysm is an anomaly in the artery that could lead to death. It occurs when there’s an abnormal widening of the blood vessel, which implies a growth in its diameter of about 40% or more.

One of the complex parts of an aortic aneurysm is it’s usually slow developing and asymptomatic. Thus, hard to detect early on. In fact, people usually find out about it when they have to consult a doctor for another reason.

There’s no definite way to prevent this anomaly. However, a healthy lifestyle coupled with a healthy diet, such as the Mediterranean, and no smoking, is usually a good way to keep it at bay. The greatest risk of an aortic aneurysm is rupture because it could be fatal.

What’s an aortic aneurysm?

An aortic aneurysm is a localized dilatation at a defined point in the aortic artery. It arises and remains over time. In general, it appears after there’s been a thinning and weakening of the blood vessel.

This anomaly can appear in any area of the artery but most commonly in the abdominal aorta. Furthermore, this condition is more common in men over 60 years of age with a family history of aneurysm, smoking, and risk factors for heart disease.

The aneurysm weakens the artery to the point of rupture. Consequently, it becomes a life-threatening emergency when it does. Only 20% of patients survive such an event.

An artery straight from the heart.
Aortic aneurysm carries the risk of rupture in which the mortality is 20%.

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Types of aneurysm and symptoms

There are three types of aortic aneurysms:

  • The abdominal aortic aneurysm happens in the aorta of the abdomen and usually measures over three inches; it’s the most likely to rupture.
  • The thoracic aneurysm crosses the thorax and appears in the part of the artery that comes out of the heart.
  • Dissecting aneurysm (or aortic dissection) is a clinical modality in which the aorta is torn on the inside but remains intact on the outside. Moreover, it lifts the middle layer of the artery when blood enters the tear and creates a new channel in the artery wall.

The symptoms vary:

  • A mass in the abdomen that seems to throb is the main characteristic of the abdominal aortic aneurysm. It becomes intensely painful later on, mainly in the back, which subsides when changing position.
  • A thoracic aneurysm causes severe pain in the upper back, as well as coughing and wheezing. It sometimes causes pain in the arms or chest, and people might mistake it for a heart attack. Some cases are asymptomatic.
  • Finally, a dissecting aneurysm most commonly manifests with sudden and intense back pain in the area between the shoulder blades.

The causes of an aortic aneurysm

Currently, available research suggests that an aortic aneurysm has a genetic component. A large-scale genome-wide association study (GWAS), conducted by scientists at the Cardiovascular Research Network (RECAVA) in 2010, found that an abnormality in the DAB2IP gene is present in up to 40% of people with this condition.

Likewise, preliminary research, presented at the Vascular Discovery From Genes to Medicine Scientific Sessions 2020, indicated that there are at least 29 mutations that can increase the risk of developing it.

In addition, diseases such as atherosclerosis are also known to weaken the aortic wall and become a major risk factor for developing an aneurysm. Similarly, inflammatory diseases of the aorta, as well as hypertension, high cholesterol, and smoking increase the risk.

Arteries with arteriosclerosis.
Arteriosclerosis is an important risk factor in the development of aneurysms.

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Diagnosis and treatment

Pain is usually the first sign of this problem, either because it occurs spontaneously or because it triggers during a clinical examination. A doctor can confirm a diagnosis by conducting an X-ray or an ultrasound of the abdomen.

Precision medicine, by examining the genetic map of individuals, will be able to predict the risk of this disease well in advance. In fact, it’ll lead to an early diagnosis and improve the prognosis.

The treatment for an aortic aneurysm is surgery. This typically occurs when the size of the aneurysm exceeds 2 inches if it is abdominal, or 3 inches if it’s thoracic. The doctor will prescribe drugs in the case of a dissecting aneurysm and resort to surgery only as a last option. This intervention entails significant risks in all three kinds of aneurysms.

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