Ascending aortic aneurysm: What you need to know

Thousands of Americans are affected with ascending aortic aneurysms each year, and if not treated, they can be fatal.

An aneurysm is a blood vessel that has expanded or bulged to more than 1.5 times its usual size. Aneurysms can form in the aorta, the body’s main artery responsible for transporting oxygen-rich blood away from the heart.

An ascending aortic aneurysm is a kind of aneurysm that arises in the ascending aorta, a segment of the artery near the heart that starts at the base of the left ventricle.

Causes

cough

Anything that weakens the aortic walls might produce aneurysms. An ascending aortic aneurysm, as well as other types of aneurysms, can be caused by a number of reasons, including:

Atherosclerosis

This condition develops when plaque builds up on the artery walls, making them rigid and inflexible, increasing the risk of the artery walls weakening and bulging.

High cholesterol and high blood pressure are two risk factors for atherosclerosis.

Medical conditions and infection

Aneurysms in the thoracic area are hypothesized to be caused by genetic abnormalities and inflammatory diseases.

The following genetic disorders may play a role:

  • Marfan syndrome: A condition that affects the connective tissue in the body and can lead to aortic wall weakening.
  • Ehlers-Danlos: A category of uncommon diseases affecting the connective tissue that supports blood vessels, bones, skin, and other organs and tissues.
  • Loeys-Dietz: A condition related to Marfan syndrome that damages the body’s connective tissue as well as causing aorta enlargement.

Giant cell arteritis and Takayasu arteritis are two inflammatory disorders that can enhance the development of thoracic aortic aneurysms.

Untreated infection, such as salmonella poisoning, is a rare cause of a mycotic aneurysm, which is an aneurysm in the aorta.

Aortic valve issues

Ascending aortic aneurysms are more common in people who have difficulties with their aortic valve. For example, persons born with a bicuspid aortic valve, which has just two rather than three cusps, may suffer increased pressure on the artery walls.

Symptoms

Symptoms of ascending aortic aneurysms are not usually present, especially in the early stages and when they are small.

Thoracic aortic aneurysms can create issues as they grow in size, such as:

  • hoarseness
  • shortness of breath
  • cough
  • chest pain
  • back pain
  • tenderness in the thoracic region

Even when the bulge is significant, not everyone with an ascending aortic aneurysm will develop symptoms.

An aneurysm that has ruptured, on the other hand, is a medical emergency. Among the signs and symptoms are:

  • low blood pressure
  • rapid heart rate
  • clamminess
  • sudden and intense pain in the chest or back
  • weakness or paralysis on one side of the body
  • difficulty breathing
  • difficulty swallowing
  • dizziness
  • light-headedness
  • loss of consciousness

Types
The following are the different forms of aortic aneurysms:

Thoracic aortic aneurysms

Thoracic aneurysms are aneurysms that form above the diaphragm in the chest and can be ascending or descending. Aortic aneurysms in the rear of the chest cavity are called descending aneurysms.

Abdominal aortic aneurysms

Abdominal aortic aneurysms are aneurysms that form in the lower section of the aorta. Abdominal aortic aneurysms are more prevalent than thoracic aortic aneurysms, accounting for more than 75% of all aortic aneurysms.

Other types of aneurysm

  • Peripheral aneurysms occur in the large arteries of the legs and arms.
  • Cerebral aneurysms develop in an artery in the brain.
  • Thoracoabdominal aneurysms forms between the upper and lower parts of the aorta.

Risk factors

Other variables that raise the chances of an ascending aortic aneurysm include:

  • Age: With age, both atherosclerosis and thoracic aortic aneurysms become more likely.
  • Sex: An ascending aortic aneurysm affects males 2 to 4 times more frequently than women.
  • Family background: Aortic aneurysm is frequently connected to a family history of the condition.
  • General health: Hardening of the arteries, a risk factor for ascending aortic aneurysm, is more likely in people who have high blood pressure and high cholesterol.
  • Smoking: The use of tobacco products, such as cigarettes, is a major risk factor for the development of an aortic aneurysm.

Diagnosis

If a clinician suspects an aortic aneurysm, one or more of the tests listed below may be used to confirm the diagnosis:

  • magnetic resonance angiography (MRA)
  • CT scan
  • echocardiogram

Because most ascending aortic aneurysms don’t cause symptoms, they go unnoticed until they’re identified during a doctor’s visit or medical check-up.

Treatment

Small aneurysms are commonly treated with beta-blockers, a kind of blood pressure medicine. Regular testing will be needed to track the aneurysm’s development.

Large or fast developing aneurysms will necessitate surgery. Surgical procedures include:

Open surgery

During this operation, doctors create a chest incision. They remove the injured aorta and replace it with a graft, which is a synthetic tube. Following surgery, you can expect to be out of commission for at least four weeks.

Endovascular surgery

Endovascular surgery is a less intrusive type of surgery that includes passing a tiny catheter through an artery in the leg to the aorta. The catheter is then used to place a stent in the aneurysm, lowering blood pressure in the artery. This technique keeps the aneurysm from becoming larger, lowering wall tension and lowering the chance of rupture.

Emergency surgery

An ascending aortic aneurysm will necessitate emergency surgery if it ruptures. While the aorta can be repaired, the risks are high, and the patient is more prone to develop problems.

Complications

An ascending aortic aneurysm is a potentially fatal condition. It may burst, resulting in life-threatening internal hemorrhage. The greater the size of the aneurysm, the higher the danger of rupture.

Aortic dissection, a life-threatening medical emergency characterized by ripping of the aortic layers, can also be caused by bigger aneurysms.

Smaller aneurysms can lead to:

  • a build up of atherosclerotic plaque at the site
  • the formation of clots around the aneurysm, which increases the risk of stroke

Prevention

A change in lifestyle can enhance general health and reduce the chance of an ascending aortic aneurysm or another form of aortic aneurysm.

The following are some preventative measures to take:

  • engaging in regular cardiovascular activity
  • managing stress levels
  • reducing intake of foods high in fat, sugar, and sodium
  • treating medical conditions that can raise the risk of an aortic aneurysm
  • stopping smoking
  • keeping blood pressure within the healthy range
  • maintaining a healthy weight
  • keeping cholesterol levels within the healthy range

People who have a higher risk of having an aortic aneurysm, such as those who have a family history of the condition, should see their doctor for routine screening tests to check for aneurysm formation.

Conclusion

The outlook for people who have an ascending aortic aneurysm is determined by a number of circumstances, including the prevalence of co-existing illnesses including heart disease, high blood pressure, and high cholesterol.

Treatment for these conditions, as well as monitoring existing aneurysms, are critical for rehabilitation and avoiding complications.

Sources:

  • http://www.uwhealth.org/heart-cardiovascular/types-of-aortic-aneurysms/10973
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334714/
  • https://www.medicalnewstoday.com/articles/319547
  • https://my.clevelandclinic.org/health/articles/thoracic-aortic-aneurysm
  • https://vascular.org/patient-resources/vascular-conditions/thoracic-aortic-aneurysm