Aortic Aneurysm

2025/08/07

What is Aortic Aneurysm?

Aorta is the largest blood vessel in the body that channels oxygen-rich blood from the heart to the organs and tissues, and also the largest blood vessel connecting the heart to the rest of the human body.

An Aortic Aneurysm is a bulge or ballooning in a weakened area of the aorta. It can occur in the thoracic aorta (the part of the aorta in the chest) or the abdominal aorta (the part in the abdomen). This can be due to many factors, including high blood pressure, genetic conditions and aortic valve issues.

Often underdiagnosed or delayed in diagnosis, Aortic Aneurysm is often referred to as a "silent killer" because the enlargement of the aorta can occur over time without symptoms, leading to rapid and life-threatening blood loss if it ruptures.

What are the symptoms?

Aortic Aneurysm often do not cause symptoms until they become too large or when they rupture. When symptoms are present, they can include:

Pain in the chest, abdomen or back, which may be severe
Tenderness or pain in the abdomen when the doctor presses or touches it
Shortness of breath due to pressure on the lungs
Hoarseness of voice if the aneurysm affects the nerves around the aorta
Coughing or difficulty swallowing if the aneurysm presses on the airways or the esophagus.

How is it diagnosed?

Aortic Aneurysm is usually diagnosed through imaging tests. These may include ultrasound, Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI) and others, to determine the size and location of the aneurysm.

1. Abdominal Ultrasound

What is it? Abdominal ultrasound is a non-invasive imaging test that uses high-frequency sound waves to create images of the aorta.
Why is it done? It is performed to diagnose and monitor the size and shape of an Aortic Aneurysm.
Does it hurt? This test is generally painless, with no known discomfort.
Potential risks or complications? There are no significant risks associated with abdominal ultrasound.

2. Computed Tomography (CT) Scan

What is it? A CT scan involves taking X-ray images from different angles to create detailed cross-sectional images of the aorta.
Why is it done? It provides a more detailed view of the aorta, helping to diagnose and assess the aneurysm's size, location, and risk of rupture.
Does it hurt? The CT scan itself is painless, but the contrast dye injection may cause temporary discomfort or allergic reactions in some individuals.
Potential risks or complications? Risks may include the exposure to ionizing radiation and allergic reactions to the contrast dye.

3. Magnetic Resonance Imaging (MRI)

What is it? MRI uses strong magnetic fields and radio waves to create detailed images of the aorta without using X-rays.
Why is it done? It provides a clear view of the aorta and helps in assessing aneurysm characteristics.
Does it hurt? MRI is generally painless, but some individuals may experience mild discomfort from being inside the machine.
Potential risks or complications? There are usually no significant risks with MRI.

4. Blood Tests

What is it? Blood tests are administered to check for specific markers, like D-dimer, to assess the risk of an aneurysm.
Why is it done? These tests can help identify inflammation or clot formation, which could indicate the presence of an aneurysm.
Does it hurt? Blood tests are typically painless, involving a simple blood draw.
Potential risks or complications? Blood tests are generally low risk, with minimal potential for complications.

What are the treatment options for Aortic Aneurysm?

1. Personalised External Aortic Root Support (PEARS)

What is it? The Personalised External Aortic Root Support (PEARS) is a pre-emptive operation to halt an expansion of the aortic root (located at the beginning of the aorta and contains the aortic valve). This procedure prevents an increase in size of the aortic root, which may lead to an Aortic Aneurysm and other further complications.

As the aortic root contains the aortic valve, PEARS can also assist in preventing aortic valve dysfunctions – another complication related to aneurysms and seen in many conditions including Marfan syndrome, congenitally deformed aortic valve and genetic aortic wall weakness. The controlling of aortic root size by the implementation of PEARS maintains optimal aortic root dimensions, which in turn reduces the stress on the aortic valve. This stabilization helps to ensure that the valve functions properly, minimizing the risk of valve leaking or becoming too narrow – issues that can arise from abnormal aortic root enlargement.

What to expect? A custom-made, open mesh 3D sleeve is manufactured to resemble the shape of the patient’s ascending aorta. Applied when a patient’s aorta has only just increased in size or is mildly aneurysmal, the support sleeve acts as a protective “glove” around the vessel to decrease the aortic size or prevent further expansion, thus significantly reducing the risk of a rupture.

What are the potential benefits compared to existing treatment procedures?

The benefits of PEARS include a shorter surgical procedural time with the need for cardiopulmonary bypass eliminated, a lower risk of surgery and a minimised need for lifetime blood-thinning therapy.
The PEARS implant also allows the possibility for conventional aortic root replacement surgery to be avoided, where the diseased or enlarged portion of the aortic root is removed and replaced with a synthetic graft or a biological valve.

Key advantages of PEARS over the conventional root replacement surgery:

• The PEARS implant can be placed before the aorta reaches a size at which a root replacement is deemed mandatory by established criteria – thus offering the patient a peace of mind and an earlier reduction of the risk of aortic rupture.
• The aortic valve is spared and the architecture of the aortic valve is maintained, reducing the risk of aortic regurgitation.
• The PEARS procedure is shorter than that for root replacement surgery (typically 2-3 hours rather than 5-6).
• There is usually no requirement for cardiopulmonary bypass during PEARS.
• There is no requirement for lifetime blood-thinning therapy for PEARS.
• The material in the reinforced aorta reverts to a structure like that of a normal aorta to support the patient’s own valve, thus minimizing adverse effects on the native aortic function, and further surgery is unlikely to be necessary.

2. Endovascular Aneurysm Repair (EVAR)

What is it? EVAR is a minimally invasive procedure to treat aortic aneurysms.
What to expect? During EVAR, a stent graft is placed inside the aneurysm to reinforce the weakened aortic wall and prevent further expansion. The procedure is typically performed under general anesthesia.
What to prepare? Patients should prepare for pre-operative evaluations and post-operative care, which may include hospitalization.
Success rates? High for appropriately selected patients. EVAR effectively prevents rupture and reduces risk of death.
Potential risks and complications? Endovascular leaks, device migration, or kidney problems. Close post-op monitoring is essential.

3. Open Surgical Aneurysm Repair

What is it? Open surgery involving the removal of the damaged portion of the aorta and replacing it with a synthetic graft.
What to expect? This is a major surgical procedure requiring general anesthesia and a longer recovery period.
What to prepare? Patients should prepare for hospital stay, recovery process, and rehabilitation.
Success rates? Open surgery is highly effective in treating aneurysms, with a lower risk of long-term complications.
Potential risks and complications? Risks include bleeding, infection, and complications associated with major surgery.

4. Medication Management

What is it? Medications, such as beta-blockers and statins, are often prescribed to reduce blood pressure or blood cholesterol, and manage an aortic aneurysm.
What to expect? Medications aim to lower blood pressure and reduce the risk of aneurysm growth and complications.
What to prepare? Patients should be prepared to take prescribed medications consistently and attend regular follow-up appointments with their doctor.
Success rates? Dependent on individual patient factors and the size and location of the aneurysm. Medication can help slow the growth of smaller aneurysms.
Potential risks and complications? Medication management is generally safe, but side effects may include dizziness, fatigue, and muscle pain. There is no guarantee that medication alone will prevent aneurysm progression.

What do I do post-treatment?

Home care if any: After treatment, patients may need to follow specific guidelines, such as avoiding heavy lifting and maintaining a healthy lifestyle with regular check-ups.

When to call the doctor: Patients should contact their healthcare provider if they experience severe pain, shortness of breath, signs of infection, or other concerning symptoms.