Understanding Aortic Aneurysms: Causes, Symptoms, and Treatment Options

An aortic aneurysm can be defined as follows: An aortic aneurysm is a bulging of the main artery of various types and locations that can burst and lead to fatal internal bleeding. Causes, classification, symptoms and treatment are discussed below.

Aortic aneurysm: causes and forms

Aneurysms are bulges in the arterial vessels that occur at certain points and primarily affect the main artery. There are basically three different types:

• True aneurysm
• Aneurysm dissection
• Spurious aneurysm

True aneurysm

The “true” or “correct” aneurysm verum (verum = Latin true) is the most common of the three types of aneurysm. It is characterized by an increasing bulge at a certain point in the vascular strand and is thus similar to a rubber bladder on a water hose. Despite the bulging, the vessel wall remains intact overall.

In most cases, the verum aneurysm is due to  vascular calcification of the  aorta, which damages the vessel wall and promotes its bulging. Elevated blood pressure is an important risk factor both for the development of vascular calcification and for the increasing expansion of the aneurysm. Once an aneurysm has formed, it is inflated further and further by the blood flow pulsating at high pressure.

In rarer cases, a congenital weakness of the vessel wall or a chronic syphilis or fungal infection can also trigger a verum aneurysm.

Aneurysm dissection

In the case of aneurysm dissecans (dissecare = Latin to cut in), which occurs in about 25 percent of cases of an aortic aneurysm, the inner lining of the vessel typically tears at a specific point in a longitudinal or transverse direction. The blood that is pressed into the aorta at high pressure can dig into the vessel wall as a result and cause the aorta to bulge. In contrast to a verum aneurysm, congenital defects in the vessel wall are the predominant cause, compared to which atherosclerosis takes a back seat.

Spurious aneurysm

The aneurysm spurium (spurius = Latin false) has a special position in that it corresponds less to an aneurysm than to a small tear in the vessel through which blood can escape. Clotted blood finally surrounds the resulting vascular defect like a plug and thus prevents further bleeding in most cases. The aneurysm spurium occurs mainly as a complication after operations or punctures on arterial vessels.

Aortic aneurysm: symptoms and signs

The  aneurysm verum  of the  aorta  is usually found in the abdominal area and can also   be palpated there as a large pulsating nodule centrally below the costal arch, at least in slim patients. While this so-called abdominal aortic aneurysm mainly leads to abdominal pain,  flatulence , irregular bowel movements or sometimes an increased  urge to urinate , back pain is the main  problem with an aneurysm verum in the chest area   .

The pressure of the pulsating aortic aneurysm on surrounding structures can also lead to  hoarseness ,  shortness of breath ,  difficulty swallowing  and circulatory disorders in the arms or head.

A similar symptom can also be caused by the rarer  aneurysm dissecans  , which usually begins immediately above the aortic valve and can involve the entire aorta and into the abdominal cavity. The  aneurysm spurium  is rarely as large as the other two types of aneurysms, but can produce similar symptoms depending on the location.

Aortic aneurysm: course

The decisive criterion for assessing the danger of a  verum aneurysm  is the diameter of the bulge. This value can vary between 3 cm and in extreme cases up to 8 or 9 cm, with a critical diameter of 5 to 6 cm there is a risk that the sac will burst and life-threatening internal bleeding will occur.

From a purely statistical point of view, abdominal aortic aneurysms with a diameter of 5 to 6 cm, for example, burst in up to 40 percent of cases within 2 years.

The situation with  aneurysm dissecans is even more dangerous than with aneurysm verum  , in which the already weakened and additionally torn vessel wall often cannot withstand the pressure of the blood flow for long. If the first internal tear in the wall of the aorta, which is accompanied by severe chest or abdominal pain, is survived, the repeated tear in the damaged vessel wall, this time outwards, often leads to fatal internal bleeding.

Aortic aneurysm: diagnostics and diagnostics

Diagnosis of an aneurysm is made either by ultrasonography,  computed tomography ,  or direct vascular imaging with X-ray contrast media. With the latter method, the vascular tree with all its irregularities, bottlenecks and bulges can be seen directly in the X-ray image.