Abdominal aortic aneurysm

Definition

An aneurysm is an abnormal bulging or swelling of a portion of a blood vessel. The aorta, which can develop these abnormal bulges, is the large blood vessel that carries oxygen-rich blood away from the heart to the rest of the body.

Description

The aorta carries oxygen-rich blood to the body, and is therefore called an artery. Because the aorta is an artery, its walls are made of up three layers; a thin inner layer, a muscular middle layer (that gives the vessel its flexibility under pressure from the filling blood), and a fiber-like outer layer that gives the vessel strength to not burst when the heart pumps blood to the body.

Aortic aneurysms occur when a weakness develops in part of the wall of the aorta; three basic types are usually found. If all three layers of the vessel are affected and weakness develops along an extended area of the vessel, the weakened area will appear as a large, bulging region of blood vessel; this is called a fusiform aneurysm. If weakness develops between the inner and outer layers of the aortic wall, a bulge results as blood from the interior of the vessel is pushed around the damaged region in the wall and collects between these layers. This is called a dissecting aneurysm because one layer is "dissected" or separated from another. If damage occurs to only the middle (muscular) layer of the vessel, a sack-like bulge can form; therefore, this is a saccular aneurysm.

Causes & symptoms

Aortic aneurysms occur in different portions of the aorta, which begins in the chest (at the heart) and travels downward through the abdomen. Aneurysms found in the region of the aorta within the chest are called thoracic aortic aneurysms. Aneurysms that occur in the part of the aorta within the abdomen are called abdominal aortic aneurysms.

Thoracic aortic aneurysms do not usually produce any noticeable symptoms. However, as the aneurysm becomes larger, chest, shoulder, neck, lower back, or abdominal pain can result. Abdominal aortic aneurysms occur more often in men, and these aneurysms can cause pain in the lower back, hips, and abdomen. A painful abdominal aortic aneurysm usually means that the aneurysm could burst very soon.

Most abdominal aortic aneurysms are caused by atherosclerosis, a condition caused when fat (mostly cholesterol) carried in the blood builds up in the inner wall of the aorta. As more and more fat attaches to the aortic wall, the wall itself becomes abnormally weak and often results in an aneurysm or bulge.

Aortic aneurysms are also caused by a breakdown of the muscular middle layer of the artery wall, by high blood pressure, by direct injury to the chest, and although rare, by bacteria that can infect the aorta.

Diagnosis

Silent, stable aneurysms are often detected when a person has an x ray as part of a routine examination or for other medical reasons. Otherwise, when chest, abdominal, or back pain is severe, aortic aneurysm is suspected and x-ray (radiographic) studies can confirm or rule out that condition.

Treatment

Aortic aneurysms are potentially life-threatening conditions. Small aneurysms should be monitored for their rate of growth and large aneurysms require consideration for a surgical repair. The most common method of surgical repair is to cut out the bulging section of artery wall and sew a Dacron fiber material into its place in the vessel wall.

Prognosis

Only 1-2% of people die from having surgical repair of an aortic aneurysm. However, if the aneurysm is untreated and eventually ruptures, less than half of the people with ruptured aneurysms will survive. The challenge for the physician is to decide when or if to do the preventive surgery.

Prevention

Aneuryms can develop in people with atherosclerosis. High blood pressure can also lead to this condition. Although no definite prevention exists, lifestyle and dietary changes that help lower blood pressure and the amount of fat in the blood stream may slow the development of aneurysms.

Key Terms

Atherosclerosis

The accumulation of fat on the inner wall of an artery. This fat is largely made up of cholesterol being carried in the blood.

Dacron

A synthetic polyester fiber used to surgically repair damaged sections of blood vessel walls.

Further Reading

For Your Information

Books

• "Aneurysms and Other Vascular Disorders." In Cardiovascular Diseases and Disorders Sourcebook, edited by Karen Bellenir and Peter D. Dresser. Detroit: Omnigraphics, Inc., 1995, 99-101.
• Dzau, Victor J. and Mark A.Creager. "Diseases of the Aorta." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw Hill, 1998, 1394-1395.
• Lindsay, Joseph L., Michael E. DeBakey, and Arthur C. Beall. "Diagnosis and Treatment of Diseases of the Aorta." In Hurst's The Heart, edited by Robert C. Schlant, et al. New York: McGraw Hill, 1994, 2166-2170.

  Periodicals

• van der Vleit, J. Adam and Albert P.M. Boll. "Abdominal Aortic Aneurysm." The Lancet 349 (March 22, 1997): 863.

  Organizations

• The American Heart Association. 7272 Greenville Ave., Dallas, TX 75231-4596. (800)787-8984. http://www.americanheart.org/.
• National Heart, Lung, and Blood Institute. P.O. Box 30105 Bethesda, MD 20892-2486. (301) 251-1222. http://www.nhlbi.nih.gov/nhlbi/nhlbi.htm.

Gale Encyclopedia of Medicine. Gale Research, 1999.