An aortic aneurysm generally doesn’t cause symptoms until a patient has a significant problem. Most aortic aneurysms are detected by chance — for example, through an imaging test that was ordered to rule out other health concerns.
This is why it’s so important to know your health history. Does someone in your family have an aneurysm? Has a family member died from an aneurysm or experienced a catastrophic event due to an aneurysm? If so, these are indications that you and members of your family should be tested. The key is to know your risk(s) for an aortic aneurysm to reduce your chances of stroke or sudden death.
How does an aneurysm develop?
Your aorta is the largest artery in your body. It carries oxygen-rich blood from the heart to your entire body. The aortic wall can weaken over time secondary to hereditary or environmental factors. If this happens, the wall expands because of the constant pressure of blood flowing against it and may bulge or balloon out. This condition is called an aortic aneurysm. Aortic aneurysms generally measure more than 4.0 centimeters and can occur in your chest (thoracic aortic aneurysm), abdomen (abdominal aortic aneurysm) or a combination of the chest and abdomen (thoracoabdominal aortic aneurysm).
Know the risk factors
In addition to a family history, individuals with certain conditions are also at a much higher risk of an aortic aneurysm. These conditions include:
- Loeys-Dietz syndrome
- Marfan syndrome
- Bicuspid aortic valve
- Uncontrolled hypertension
In determining treatment, cardiovascular physicians look at the individual patient and a series of factors, including:
- How large is the aneurysm?
- Is the aneurysm stable or growing?
- What is the patient’s underlying pathology (Loeys-Dietz syndrome, Marfan syndrome, bicuspid aortic valve, atherosclerosis, family history)?
- Where in the aorta is the aneurysm located?
- Is the patient feeling chest pressure?
- Is the patient’s blood pressure under control?
- Does the patient smoke?
- What is the patient’s overall lifestyle/occupation?
Weighing the treatment options
A patient’s treatment plan is based on the above factors. Some patients are put on medication such as beta-blockers or angiotensin receptor blockers with careful monitoring of the aneurysm via ultrasound, CT scan or MRI. Other patients require open surgery or a minimally invasive procedure to insert a stent.
When surgery is recommended
Surgery for an aortic aneurysm is determined by the above factors and what role they play in the health of each individual patient. For example, a person with a 5.0 cm aneurysm and a bicuspid aortic valve is more at risk than a person with a 5.0 cm aneurysm with no underlying conditions. Anyone with an aneurysm that measures more than 4.0 cm should be seen and screened by his or her doctor.
Here are some basic guidelines for patient conditions that likely require surgical intervention:
- Loeys-Dietz syndrome with an aneurysm measuring 4.0+ cm
- Marfan syndrome with an aneurysm measuring 4.5+ cm
- Bicuspid aortic valve with an aneurysm measuring 5.0-6.0+ cm
- Atherosclerosis with an aneurysm measuring 5.5+
- Family history with an aneurysm measuring 5.0+ cm
Take the next step:
- Find out why one couple from Egypt chose U-M for aortic aneurysm surgery.
- Read about Frank Korany’s fenestrated abdominal aortic endograft procedure.
Dr. George Michael Deeb is a leader in building the University of Michigan into a powerhouse for heart/lung transplantation and is widely recognized as a leader in this field. He is also highly skilled in the area of aortic surgery and has the largest practice treating aortic aneurysmal disease and aortic valve repair in the United States. He consistently has one of the highest operative volumes in the U-M Department of Surgery as well as exemplary outcomes.
The University of Michigan Samuel and Jean Frankel Cardiovascular Center is a top ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at umcvc.org.