An aortic aneurysm is an enlargement of the aorta. This can occur in all areas of the aorta. A distinction is made between aneurysms of the thoracic aorta (thoracic aortic aneurysm, TAA) and aneurysms of the abdominal aorta (abdominal aortic aneurysm, BAA).
The risk of an aortic aneurysm increases with age. Common causes are vascular calcification (arteriosclerosis), high blood pressure (hypertension), smoking and diabetes mellitus. In rare cases, bacterial infections or inflammatory changes in the vessel wall can be involved in the development of an aneurysm.
Congenital diseases such as Marfan syndrome or Ehlers-Danlos syndrome can also lead to an aortic aneurysm as a result of a congenital weakness of the connective tissue.
The greater the enlargement of the aorta, the greater the risk of a rupture. If left untreated, this is almost always fatal due to internal haemorrhaging.
Symptoms
In most cases, an aortic aneurysm does not cause any symptoms. It is therefore often an incidental finding during a routine examination. However, if the aneurysm becomes so large that it presses on surrounding structures, symptoms may occur.
An aortic aneurysm in the chest area can lead to chest pain, coughing, hoarseness, difficulty swallowing or shortness of breath, among other things.
An aortic aneurysm in the abdominal area can lead to diffuse abdominal and/or back pain radiating into the legs as well as digestive problems.
If the aneurysm ruptures, there is usually acute pain of destruction with radiating pain in the chest or abdomen, which can radiate into the back. Internal haemorrhage can quickly lead to circulatory failure and even unconsciousness.
Diagnosis
In slim people, a larger aneurysm of the abdominal aorta may be palpable as a pulsating lump under the abdominal wall.
Imaging techniques provide details about the size and shape of the aortic aneurysm.
An ultrasound examination can usually show the size of an aneurysm and possibly the rate of growth. Initially, an ultrasound examination is performed every 3 to 6 months. The further course depends on whether the aneurysm enlarges.
Computer tomography with contrast medium (CT angiography) is considered the gold standard for visualising the spatial extent of the aneurysm and for planning the operation.
Therapy
The treatment of an aortic aneurysm depends primarily on its size.
If an aortic aneurysm of the abdominal aorta reaches a diameter of more than 5.5 cm, the risk of the vessel wall tearing increases. In this case, the patient benefits from a planned operation. In the case of rapid growth in size, symptoms such as back or abdominal pain or spherical enlargement, an operation may be advisable even if the diameter is smaller.
There are basically two treatment methods for an abdominal aortic aneurysm. Which one is used depends on many factors, including the age and general condition of the patient as well as the anatomy of the aorta and the aneurysm. In an open surgical procedure, the dilated part of the aorta is removed under general anaesthetic via an abdominal or flank incision and replaced with a replacement vessel made of artificial tissue (tubular prosthesis/Y prosthesis).
In the minimally invasive (endovascular) procedure, access to the vessels is also created under general anaesthetic via incisions in the groin area. A tube (catheter) containing the folded stent prosthesis is inserted into the abdominal aorta via this access and placed inside the aneurysm under X-ray control. The stent prosthesis is then deployed, stabilising the vessel from the inside and bridging the aortic aneurysm.
For aortic aneurysms that do not currently require surgery, it is important that the blood pressure is set in the lower normal range (130/80 mm Hg).
Other risk factors for an aortic aneurysm such as lipometabolic disorders, diabetes mellitus or nicotine consumption should also be optimally treated or avoided.
Depending on the treatment method, the inpatient stay is approx. 5-10 days.
