Aortic aneurysm: symptoms and therapies

The aortic aneurysm must be monitored and, if necessary, treated to avoid the risk of dissection and rupture.

  • The symptoms to recognize
  • The therapies
    The aortic aneurysm must be monitored and, if necessary, treated to avoid the risk of dissection and rupture.

The aorta – the main blood vessel that conveys blood from the heart to the rest of the body – is the most common form of aneurysm, or the dilation of an artery wall.

It can be caused by trauma or damage to the aorta, such as those associated with smoking, high blood pressure and atherosclerosis , or conditions of genetic origin that cause this blood vessel to no longer be able to withstand the forces exerted on its wall.

With the passage of time the dilation can increase up to cause an aortic dissection (that is the laceration of one of the layers of the artery wall) or even its rupture.

The symptoms to recognize

The symptoms depend on the type of aneurysm and its location, which can be abdominal or thoracic depending on the portion of the aorta affected.

Generally abdominal aortic aneurysms develop slowly, often without causing symptoms until rupture occurs; in some cases they can trigger a sensation of pulsation in the abdominal area, deep pain in the back or on the side or a constant abdominal discomfort that can last hours or days.

In case of breakage there is a strong and sudden pain in the lower part of the abdomen and back, nausea , vomiting, constipation, problems with urination, sweating, dizziness and acceleration of the heartbeat in an upright position.

Thoracic aortic aneurysms may instead be associated with pain in the jaw, neck, back or chest, as well as symptoms (such as cough or hoarseness, shortness of breath and difficulty in breathing or swallowing) that can be caused by compression of the surrounding structures.

However, even in this case, the symptoms may be absent until the situation worsens with increased dilation or aortic rupture, which can trigger bleeding associated with severe and sudden pain that can extend from the chest to ‘abdomen or arms.

The differences between the two situations are summarized in the following table:

 

Abdominal aorta Thoracic aorta
Symptoms preceding the rupture Abdominal pulsation sensation

Deep pain in the back or
side

Constant abdominal discomfort that
can last hours or days

Pain in the jaw, neck, back or chest

Cough or hoarseness

Shortness of breath

Difficulty breathing or swallowing

Symptoms in case of breakage Strong and sudden pain in the
lower abdomen and back

Nausea, vomiting

Constipation

Urination problems

Sweating and dizziness

Acceleration of the heartbeat in
an upright position

Strong and sudden pain that
can extend from the chest to the abdomen or arms

 

The therapies

If you suspect an aneurysm rupture or dissection of the aorta it is a good idea to ask a doctor immediately, because you risk a real shock, a condition in which the blood pressure is lowered until it guarantees plus an adequate blood supply to vital organs such as the brain and kidneys.

Furthermore, breakages and dissections can be avoided thanks to an early diagnosis, a careful monitoring of the situation and, if necessary, appropriate treatments.

In general, in the case of an aortic aneurysm less than 5 cm not associated with symptoms, doctors prescribe regular checks to make sure that it is not increasing in size.

Aneurysms greater than 5 cm may instead require the taking of drugs to lower blood pressure, relax blood vessels and reduce the risk of rupture, such as beta-blockers and calcium- antagonists.

If the size of the aneurysm should increase rapidly or if there is a real risk of dissection or rupture, surgery may be needed instead.

In general, an incision is made at the level of the abdomen or chest and the aneurysm is removed, and then the damaged section of the aorta is replaced; however in some cases it is sufficient to use a prosthesis to strengthen the aorta, positioned thanks to the use of catheters inserted at the inguinal level (endovascular repair of the aneurysm).

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