Frequently asked questions
What is an aortic aneurysm and what should I know about it?
The aorta is the main vessel that carries blood from the heart to all parts of your body. The aorta ascends from the heart, arches in the chest, travels downwards through the abdomen, and then divides in your pelvis to supply your lower extremities.
The most common aortic problem is an aneurysm, which essentially is a ballooning of the vessel. While the walls of the aorta are very elastic and adjust to blood flow, conditions like high cholesterol, hypertension, and atherosclerosis can weaken the artery. Due to this thinning and weakening of the vessel wall, the artery may begin to bulge and enlarge, thus increasing risk for rupture. These aneurysms may occur in the chest, which are known as “Thoracic Aortic Aneurysms,” or, more commonly, may develop in the abdomen, which are known as “Abdominal Aortic Aneurysms.”
How are aortic aneurysms detected and what are some symptoms I should be aware of?
Abdominal aortic aneurysms (AAA) are typically screened for by your primary care physician. The United States Preventative Services Task Force currently recommends one-time screening for abdominal aortic aneurysms with ultrasound in men ages 65 to 75 years who have ever smoked. In most cases, AAAs cause no symptoms and may be discovered when you are being evaluated for another medical condition. If you have a family history of AAA and feel a sudden, severe pain in your back or abdomen, you should seek immediate care. This may indicate that you have developed an AAA and it is possibly in the process of rupturing.
Thoracic aortic aneurysms tend to develop and expand slowly over time. They rarely cause any symptoms and are often discovered when you are tested for other reasons. However, if a thoracic aortic aneurysm grows large enough it can compress nearby structures and lead to hoarseness and difficulty swallowing. Rarely do they cause pain; however, when a thoracic aneurysm grows quickly, ruptures or develops a tear, it may cause a sharp searing pain between the shoulder blades.
When is surgery necessary?
Small aortic aneurysms often can be managed medically and are periodically monitored for change. However, larger aortic aneurysms usually require treatment. Some of the indications for surgery are: aneurysm size >5cm, growth of the aneurysm more than 0.5cm over one year, risk of rupture outweighs risk of surgery, or if the patient develops serious, life-threatening bleeding.
How are aortic aneurysms treated?
There are two types of surgery that are often used to repair aortic aneurysms.
- Open surgery is an option where the surgeon will make a larger incision in the patient’s abdomen or chest to expose the aorta and repair the aneurysm with a graft. Open procedures are more invasive and utilized in emergent situations or when the anatomy is not amenable to minimally invasive options.
- Endovascular repair is the minimally invasive option where the surgeon will make a small incision, typically in the groin of the patient, and use catheters to guide surgical instruments through the aorta to deploy stents and grafts that repair the aneurysm.
What puts Tufts Medical Center at the forefront of endovascular treatment?
Here at Tufts Medical Center, we have the ability to repair both abdominal and thoracic aortic aneurysms through a minimally invasive approach or a hybrid approach (which includes a combination of an open surgery and endovascular technique) to minimize risk and to expedite recovery. Thoracic aneurysms were traditionally difficult to treat because of their complex anatomy and because they involved aortic branches that provide blood to the brain and upper extremities. At Tufts Medical Center, we have the expertise and the resources to bring you customized endovascular stent grafts that can treat complex aneurysms for which the standard stent grafts would not work. By utilizing sophisticated imaging technology and fostering a collaborative environment between surgeons and interventional radiologists, we are able to generate complex 3D images that allow us treat aneurysms that would have previously required risky, open procedures and prolonged hospitalization.
What are some preventative measures I can take to avoid an aortic aneurysm or a rupture?
The best way to keep an aneurysm from growing or rupturing is to reduce the risk factors that contribute to its development. This includes maintaining a healthy diet, exercising regularly, managing hypertension, and reducing cholesterol. In addition to improving overall cardiovascular health, if you smoke, one of the most important things you can do is try to quit.