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Aortic Arch Aneurysm

What is an aneurysm?

An aneurysm is an abnormal dilatation of the wall of a blood vessel that is  50% greater than the artery's normal diameter (width). An aneurysm may be located in many areas of the body, such as the blood vessels of the brain, the aorta (the largest artery in the body), the intestines, the kidneys, the spleen, and the vessels in the legs.

What is an aortic aneurysm?

The most common location of an aneurysm is the aorta.  They may occur in any part of the aorta:

The aorta extends upward from the top of the left ventricle of the heart in the chest area (ascending thoracic aorta), then curves like a candy cane (aortic arch) downward through the chest area (descending thoracic aorta) into the abdomen (abdominal aorta). The aorta delivers oxygenated blood pumped from the heart to the rest of the body.

An aneurysm can be characterized by its location, shape, and cause. A thoracic aortic aneurysm is located in the chest area. The thoracic aorta can be divided into segments: ascending aorta, aortic arch, and descending aorta, as described above. An aneurysm may be located in one of these areas and/or may be continuous throughout the aorta. An aneurysm called a thoracoabdominal aneurysm involves a thoracic aortic aneurysm extending down to the abdominal aorta.  An abdominal aortic aneurysm is located in the abdomen area. 

The shape of an aneurysm is described as being fusiform or saccular, which helps to identify a true aneurysm. The more common fusiform-shaped aneurysm bulges or balloons out on all sides of the blood vessel. A saccular-shaped aneurysm bulges or balloons out only on one side.

Because an aneurysm may continue to increase in size, along with progressive weakening of the artery wall, surgical intervention may be needed. Preventing rupture of an aneurysm is one of the goals of therapy. The larger an aneurysm becomes, the greater the risk of rupture (bursting). With rupture, life-threatening hemorrhage (uncontrolled bleeding) may result. 
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Ascending Aortic Aneurysm
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Descending Thoracic Aortic Aneurysm
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Abdominal Aortic Aneurysm

What are the causes of aortic aneurysms?

Thoracic aortic arch  aneurysms may be caused by different disease processes:
  • Takayasu's arteritis: a type of vasculitis that causes inflammation of the arteries
  • atherosclerosis
  • continuation of an ascending and/or descending aortic aneurysm
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What are the symptoms of an aneurysm?

Aortic disease is often insidious. Most people with aortic aneurysms experience no symptoms, unless they are extremely large or an aortic dissection occurs. For most people, their aortic condition is discovered incidentally while being tested for other reasons.  

When present, symptoms may occur with different types of aneurysms may include, but are not limited to, the following pain in the jaw, neck, chest and/or back; wheezing, coughing or shortness of breath; hoarseness or difficulty swallowing. 
The symptoms of an aneurysm may resemble other medical conditions or problems, including heart attacks, pneumonia, and digestive conditions. Always consult your physician for more information.

How are aneurysms diagnosed?

For most people, their aortic condition is discovered incidentally while being tested for other reasons.  For patients suspected to have aortic disease, selection of a type of diagnostic examination is related to the location of the aneurysm. In addition to a complete medical history and physical examination, diagnostic procedures for an aneurysm may include any, or a combination, of the following:
  • computed tomography scan (also called a CT or CAT scan): a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices). A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. 
  • magnetic resonance imaging (MRI): a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
  • echocardiogram (also called echo): a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves.
  • arteriogram (angiogram): A dye (contrast) will be injected through a thin flexible tube placed in an artery. This dye will make the blood vessels visible on the X-ray.
  • ultrasound: uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. An ultrasound is used to view internal organs as they function, and to assess blood flow through various vessels.
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Aortic Root Aneurysm and Asceneding Aortic Aneurysm on CT Scan
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Aortic Root Aneurysm and Ascending Aortic Aneurysm on CT Reconstruction
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Aortic root aneurysm on echocardiogram

What are the possible treatment for aortic aneurysms?

Treatment options for an amort aneurysm may include one or more of the following:
  • Controlling or modifying risk factors steps such as: 
        -- quitting smoking, 
        -- controlling blood sugar in those with diabetics, 
        -- weight loss if those overweight or obese and 
        -- controlling dietary fat intake 
  • Medication: to control factors such as: 
        -- hyperlipidemia (elevated levels of fats in the blood) and/or 
        -- high blood pressure
  • Surgery, typically the diseased area of the aorta is replaced with a fabric graft
  • Stent graft or endograft which is comprised of a layer of impermeable reinforcement material enclosed by a self-expanding metal support mesh and is placed across the aneurysm site 

Specific treatment will be determined by your physician based on:
  • age, overall health and medical history
  • size and extent of the disease
  • signs and symptoms
  • tolerance of specific medications, procedures or therapies
  • expectations for the course of the disease
  • patient preference

Location of the aneurysm also impacts treatment options:

How do I prevent an aortic dissection and/or further growth of my aneurysm?

Here are a few tips:

  • Control your blood pressure. If you have high blood pressure, get a home blood pressure measuring device to help you monitor and keep your blood pressure well controlled.
  • Don't smoke. Or, if you do, take steps to stop.
  • Maintain an ideal weight. Follow a low-salt diet, low fat, high fiber diet, and exercise regularly.
  • Watch your cholesterol. Keep your cholesterol levels within a range that is recommended by your doctor.
  • Continue low-impact exercise (eg brisk walking).  If you have an aneurysm or are predisposed, avoid high-impact exercise that significantly increases your blood pressure (eg weight training)
  • Wear a seat belt. This reduces the risk of traumatic injury to your chest area.
  • Keep your doctor well-informed. If you have a family history of aortic dissection, let your doctor know.

For more info on lifestyle recommendation visit IRAD online