Abdominal aortic aneurysm | Pathologies of Blood, heart and circulation

• Abdominal aortic aneurysm
• Abdominal aortic aneurysm repair - open
• Abdominal aortic aneurysm repair - open - discharge
• Abdominal CT scan
• Abdominal ultrasound
• Aortic aneurysm repair - endovascular
• Aortic aneurysm repair - endovascular - discharge
• Aortic angiography
• Aortic dissection
• Chest MRI
• Magnetic resonance angiography
• Thoracic aortic aneurysm

Abdominal aortic aneurysm

The aorta is the main blood vessel that supplies blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes very large or balloons out.

Causes

The exact cause of the condition is unknown. Factors that can increase your risk of developing the problem include:
• Smoking
• High blood pressure
• Male gender
• Genetic factors
An abdominal aortic aneurysm is most often seen in males over age 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to break open. This can be life-threatening.

Symptoms

Aneurysms can develop slowly over many years, often with no symptoms. Symptoms may come on quickly if the aneurysm expands rapidly, tears open or leaks blood within the wall of the vessel (aortic dissection).
Symptoms of rupture include:
• Pain in the abdomen or back. The pain may be severe, sudden, persistent, or constant. It may spread to the groin, buttocks, or legs.
• Passing out
• Clammy skin
• Dizziness
• Nausea and vomiting
• Rapid heart rate
• Shock

Exams and Tests

Your doctor will examine your abdomen and feel the pulses in your legs. The doctor may find:
• A lump (mass) in the abdomen
• Pulsating sensation in the abdomen
• Stiff or rigid abdomen
You may have an abdominal aortic aneurysm that is not causing any symptoms. Your doctor may find this problem by doing the following tests:
• Ultrasound of the abdomen when the abdominal aneurysm is first suspected
• CT scan of the abdomen to confirm the size of the aneurysm
• CTA (computed tomographic angiogram) to help with surgical planning
Any one of these tests may be done when you're having symptoms.

Treatment

If you have bleeding inside your body from an aortic aneurysm, you will need abdominal aortic aneurysm repair.
If the aneurysm is small and there are no symptoms:
• Surgery is rarely done.
• You and your doctor must decide if the risk of having surgery is smaller than the risk of bleeding if you do not have surgery.
• Your doctor may want to check the size of the aneurysm with ultrasound tests every 6 months.
Most of the time, surgery is done if the aneurysm is bigger than 2 inches (5.5 cm) across or growing quickly. The goal is to do surgery before complications develop.
There are two types of surgery:
• Traditional (open) repair. A large cut is made in your abdomen. The abnormal vessel is replaced with a graft made of man-made material.
• Endovascular stent grafting. This procedure can be done without making a large cut in your abdomen, so you may recover more quickly. This may be a safer approach if you have certain other medical problems. Endovascular repair can sometimes be done for a leaking or bleeding aneurysm.

Outlook (Prognosis)

The outcome is often good if you have surgery to repair the aneurysm before it ruptures.
When an abdominal aortic aneurysm begins to tear or ruptures, it is a medical emergency. Only about 1 in 5 patients survive a ruptured abdominal aneurysm.

When to Contact a Medical Professional

Go to the emergency room or call 911 if you have pain in your belly or back that is very bad or does not go away.

Prevention

To reduce the risk of aneurysms:
• Eat a heart-healthy diet, exercise, stop smoking (if you smoke), and reduce stress.
• If you have high blood pressure or diabetes, take your medicines as your doctor has told you.
People over age 65 who have ever smoked should have a screening ultrasound done once.

Alternative Names

Aneurysm - aortic; AAA

References

Tracci MC, Cherry KJ. The aorta. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery
Lewiss RE, Egan DJ, Shreves A. Vascular abdominal emergencies.Emerg Med Clin North Am
Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm.N Engl J Med
Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med
Braverman AC, Thompson RW, Sanchez LA. Diseases of the aorta. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds.Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine

Abdominal aortic aneurysm repair - open

Open abdominal aortic aneurysm repair is surgery to fix a widened part in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your belly (abdomen), pelvis, and legs.
An aortic aneurysm is when part of this artery becomes too large or balloons outward.

Description

The surgery will take place in an operating room. You will be given general anesthesia (you will be asleep and pain-free).
Your surgeon opens up your belly and replaces the aortic aneurysm with a man-made, cloth-like material.
Here is how it can be done:
• In one approach, you will lie on your back. The surgeon will make a cut in the middle of your belly, from just below the breastbone to below the belly button. Rarely, the cut goes across the belly.
• In another approach, you will lie slightly tilted on your right side. The surgeon will make a 5- to 6-inch cut from the left side of your belly, ending a little below your belly button.
• Your surgeon will replace the aneurysm with a long tube made of man-made (synthetic) cloth. It is sewn in with stitches.
• In some cases, the ends of this tube (or graft) will be moved through blood vessels in each groin and attached to those in the leg.
• Once the surgery is done, your legs will be examined to make sure that there is a pulse.
• The cut is closed with sutures or staples.
Surgery for aortic aneurysm replacement may take 2 to 4 hours. Most people recover in the intensive care unit (ICU) after the surgery.

Why the Procedure is Performed

Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency procedure when there is bleeding inside your body from the aneurysm.
You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your health care provider may have found the problem after you had an ultrasound or CT scan done for another reason. There is a risk that this aneurysm may suddenly break open (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky, depending on your overall health.
You and your provider must decide whether the risk of having this surgery is smaller than the risk of rupture. Surgery is more likely to be recommended if the aneurysm is:
• Larger (about 2 inches or 5 cm)
• Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)

Risks

The risks for this surgery are higher if you have:
• Heart disease
• Kidney failure
• Lung disease
• Past stroke
• Other serious medical problems
Risks of problems or complications are also higher for older people.
Risks for any surgery are:
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Infection, including in the lungs (pneumonia), urinary tract, and belly
• Reactions to medicines
Risks for this surgery are:
• Bleeding before or after surgery
• Damage to a nerve, causing pain or numbness in the leg
• Damage to your intestines or other nearby organs
• Infection of the graft
• Injury to the ureter, the tube that carries urine from your kidneys to your bladder
• Lower sex drive or inability to get an erection
• Poor blood supply to your legs, your kidneys, or other organs
• Spinal cord injury
• Wound breaks open
• Wound infections

Before the Procedure

Your will have a physical exam and get tests before you have surgery.
Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
If you are a smoker, you should stop smoking at least 4 weeks before your surgery. Your provider can help.
During the 2 weeks before your surgery:
You will have visits with your provider to make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are well treated.
• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
• Ask which drugs you should still take on the day of your surgery.
• Always tell your provider if you have a cold, flu, fever, herpes breakout, or other illness before your surgery.
DO NOT drink anything after midnight the day before your surgery, including water.
On the day of your surgery:
• Take the drugs you were told to take with a small sip of water.
• You will be told when to arrive at the hospital.

After the Procedure

Most people stay in the hospital for 5 to 10 days. During a hospital stay, you will:
• Be in the intensive care unit (ICU), where you will be monitored very closely right after surgery. You may need a breathing machine during the first day.
• Have a urinary catheter
• Have a tube that goes through your nose into your stomach to help drain fluids for 1 or 2 days. You will then slowly begin drinking, then eating.
• Receive medicine to keep your blood thin
• Be encouraged to sit on the side of the bed and then walk
• Wear special stockings to prevent blood clots in your legs
• Be asked to use a breathing machine to help clear your lungs
• Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)

Outlook (Prognosis)

Full recovery for open surgery to repair an aortic aneurysm may take 2 or 3 months. Most people make a full recovery from this surgery.
Most people who have an aneurysm repaired before it breaks open (ruptures) have a good outlook.

Alternative Names

AAA - open; Repair - aortic aneurysm - open

References

De Bruin JL, Baas AF, Buth J, Brinssen M, Verhoeven EL, Cuypers PW, et al: DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.N Engl J Medwww.ncbi.nlm.nih.gov/pubmed/20484396
Tracci MC, Cherry JR KJ. The Aorta. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery
United Kingdom EVAR Trial Investigators, Grenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm.N Engl J Medwww.ncbi.nlm.nih.gov/pubmed/20382983

Abdominal aortic aneurysm repair - open - discharge

AAA - open - discharge; Repair - aortic aneurysm - open - discharge

When you were in the hospital

You had open aortic aneurysm surgery to repair an aneurysm (a widened part) in your aorta, the large artery that carries blood to your belly (abdomen), pelvis, and legs.
You have a long incision (cut) either in the middle of your belly or on the left side of your belly. Your surgeon repaired your aorta through this incision. After spending 1 to 3 days in the intensive care unit (ICU), you spent more time recovering in a regular hospital room.

What to expect at home

Plan to have someone drive you home from the hospital. Do not drive yourself home.
You should be able to do most of your regular activities in 4 to 8 weeks. Before that:
• Do not lift anything heavier than 10 to 15 pounds until you see your doctor.
• Avoid all strenuous activity, including heavy exercising, weightlifting, and other activities that make you breathe hard or strain.
• Short walks and using stairs are OK.
• Light housework is OK.
• Don't push yourself too hard.
• Increase how much you exercise slowly.

Managing pain

Your doctor will prescribe pain medicines for you to use at home. If you are taking pain pills 3 or 4 times a day, try taking them at the same times each day for 3 to 4 days. They may be more effective this way.
Get up and move around if you are having some pain in your belly. This may ease your pain.
Press a pillow over your incision when you cough or sneeze to ease discomfort and protect your incision.
Make sure your home is safe as you are recovering.

Wound care

Change the dressing over your surgical wound once a day, or sooner if it becomes soiled. Your doctor will tell you when you do not need to keep your wound covered. Keep the wound area clean. You may wash it with mild soap and water if your doctor says you can.
You may remove the wound dressings and take showers if sutures, staples, or glue were used to close your skin, or if your doctor says you can.
If tape strips (Steri-strips) were used to close your incision, cover the incision with plastic wrap before showering for the first week. Do not try to wash off the Steri-strips or glue.
Do not soak in a bathtub or hot tub, or go swimming, until your doctor tells you it is OK.

Lifestyle changes

Surgery will not cure the cause of your aneurysm. Your arteries may become widened again, or you may have this problem in another artery. You will need to make lifestyle changes to try to prevent the problem from coming back.
• Eat a heart-healthy diet.
• Exercise.
• Stop smoking, if you smoke.
• Reduce stress to help lower your chances of having a blocked artery again.
Your health care provider may give you medicine to help lower your cholesterol. If you are given medicines for blood pressure or diabetes, take them as your doctor has asked you to.

When to call the doctor

Call your doctor or nurse if:
• You have pain in your belly or back that does not go away or is very bad
• Your legs are swelling
• You have chest pain or shortness of breath that does not go away with rest
• You experience dizziness, fainting, or you are very tired
• You are coughing up blood or yellow or green mucus
• You have chills or a fever over 100.5 °F
• Your belly hurts or feels distended
• You have blood in your stool
• You are not able to move your legs
Also call your doctor or nurse if there are changes in your surgical incision, such as:
• The edges are pulling apart
• You have green or yellow drainage
• You have more redness, pain, warmth, or swelling
• Your bandage is soaked with blood

References

De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, van Sambeek MR, Balm R, Grobbee DE, Blankensteijn JD; DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.N Engl J Med
Gloviczki P, Ricotta JJ II. Aneurysmal vascular disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery
Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm.N Engl J Med
Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med

Abdominal CT scan

An abdominal CT scan is an imaging method that uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomography.

How the Test is Performed

You will lie on a narrow table that slides into the center of the CT scanner. Most often, you will lie on your back with your arms raised above the head.
Once you are inside the scanner, the machine's x-ray beam rotates around you. Modern "spiral" scanners can perform the exam without stopping.
A computer creates separate images of the belly area, called slices. These images can be stored, viewed on a monitor, or printed on film. Three-dimensional models of the belly area can be made by stacking the slices together.
You must be still during the exam, because movement causes blurred images. You may be told to hold your breath for short periods of time.
The scan should take less than 30 minutes.

How to Prepare for the Test

You need to have a special dye, called contrast, put into your body before some exams. Contrast helps certain areas show up better on the x-rays.
• Contrast can be given through a vein (IV) in your hand or forearm. If contrast is used, you may also be asked not to eat or drink anything for 4-6 hours before the test.
• You may have to drink the contrast before the exam. When you drink it will depend on the type of exam being done. Contrast has a chalky taste although some have flavors so that they taste a little better.
• The contrast will pass out of your body through your stools.
• Let your doctor know if you have ever had a reaction to contrast. You may need to take medicines before the test in order to safely receive this substance.
• Before receiving the contrast, tell your health care provider if you take the diabetes medication metformin(Glucophage). People taking this medicine may have to stop taking it for a while before the test.
Too much weight can damage the scanner. Find out if the CT machine has a weight limit if you weigh more than 300 pounds.
You will need to take off your jewelry and wear a hospital gown during the study.

How the Test Will Feel

Lying on the hard table may be a little bit uncomfortable.
If you have contrast through a vein (IV), you may have:
• Slight burning sensation
• Metallic taste in the mouth
• Warm flushing of the body
These feelings are normal and go away within a few seconds.

Why the Test is Performed

An abdominal CT scan makes detailed pictures of the structures inside your belly (abdomen) very quickly.
This test may be used to look for:
• Cause of abdominal pain or swelling
• Hernia
• Cause of a fever
• Masses and tumors, including cancer
• Infections or injury
• Kidney stones
• Appendicitis

What Abnormal Results Mean

The abdominal CT scan may show some cancers, including:
• Breast cancer
• Cancer of the renal pelvis or ureter
• Colon cancer
• Hepatocellular carcinoma
• Lymphoma
• Melanoma
• Ovarian cancer
• Pancreatic cancer
• Pheochromocytoma
• Renal cell carcinoma (kidney cancer)
• Testicular cancer
The abdominal CT scan may show problems with the gallbladder, liver, or pancreas, including:
• Acute cholecystitis
• Alcoholic liver disease
• Cholelithiasis
• Pancreatic abscess
• Pancreatic pseudocyst
• Pancreatitis
• Sclerosing cholangitis
The abdominal CT scan may reveal the following kidney problems:
• Acute bilateral obstructive uropathy
• Acute unilateral obstructive uropathy
• Chronic bilateral obstructive uropathy
• Chronic unilateral obstructive uropathy
• Complicated UTI (pyelonephritis)
• Kidney stones
• Kidney swelling (hydronephrosis)
• Kidney or ureter damage
• Polycystic kidney disease
• Ureterocele
Abnormal results may also be due to:
• Abdominal aortic aneurysm
• Abscesses
• Appendicitis
• Bowel wall thickening
• Retroperitoneal fibrosis
• Renal artery stenosis
• Renal vein thrombosis

Risks

Risks of CT scans include:
• Allergy to contrast dye
• Exposure to radiation
CT scans expose you to more radiation than regular x-rays. Many x-rays or CT scans over time may increase your risk for cancer. However, the risk from any one scan is small. Talk to your doctor about this risk and the benefit of the test for getting a correct diagnosis of your medical problem.
Some people have allergies to contrast dye. Let your doctor know if you have ever had an allergic reaction to injected contrast dye.
• The most common type of contrast given into a vein contains iodine. If you have an iodine allergy, you may have nausea or vomiting,sneezing, itching,or hives if you get this type of contrast.
• If you must be given such contrast, your doctor may give you antihistamines (such as Benadryl) or steroids before the test.
• Your kidneys help remove iodine out of the body. You may need extra fluids after the test to help flush the iodine out of the body if you have kidney disease or diabetes.
Rarely, the dye may cause a life-threatening allergic response called anaphylaxis. Tell the scanner operator right away if you have any trouble breathing during the test.. Scanners come with an intercom and speakers, so the operator can hear you at all times.

Alternative Names

Computed tomography scan - abdomen; CT scan - abdomen; CAT scan - abdomen

References

Kim DH, Pickhardt PJ. Diagnostic imaging procedures in gastroenterology. In: Goldman L, Schafer AI, eds.Cecil Medicine.
Shaw AS, Dixon AK. Multidetector computed tomography. In: Adam A, Dixon AK, eds.Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging

Abdominal ultrasound

Abdominal ultrasound is an type of imaging test. It is used to examine organs in the abdomen including the liver, gallbladder, spleen, pancreas, and kidneys. The blood vessels that lead to some of these organs can also be looked at with ultrasound.

How the Test is Performed

An ultrasound machine makes images of organs and structures inside the body. The machine sends out high-frequency sound waves that reflect off body structures. A computer receives these waves and uses them to create a picture. Unlike with x-rays or CT scans, this test does not expose you to ionizing radiation.
You will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the abdomen. This helps with the transmission of the sound waves. A handheld probe called a transducer is then moved over the abdomen.
You may need to change position so that the health care provider can look at different areas. You may also need to hold your breath for short periods during the exam.
Most of the time, the test takes less than 30 minutes.

How to Prepare for the Test

Preparation steps vary depending on the problem. Most of the time, people are asked not to eat or drink for several hours before the exam. Your health care provider will go over what you need to do.

How the Test Will Feel

There is little discomfort. The conducting gel may feel a little cold and wet.

Why the Test is Performed

You may have this test to:
• Find the cause of abdominal pain
• Find the cause of kidney infections
• Diagnose a hernia
• Diagnose and monitor tumors and cancers
• Diagnose or treat ascites
• Learn why there is swelling of an abdominal organ
• Look for damage after an injury
• Look for stones in the gallbladder or kidney
• Look for the cause of abnormal blood tests such as liver function tests or kidney tests
• Look for the cause of a fever
The reason for the test will depend on your symptoms.

Normal Results

The organs examined appear normal.

What Abnormal Results Mean

The meaning of abnormal results depends on the organ being examined and the type of problem. Talk to your health care provider if you have any questions or concerns.
An abdominal ultrasound can indicate conditions such as:
• Abdominal aortic aneurysm
• Abscess
• Appendicitis
• Cholecystitis
• Gallstones
• Hydronephrosis
• Kidney stones
• Pancreatitis (inflammation in pancreas)
• Spleen enlargement (splenomegaly)

Risks

There is no known risk. You are not exposed to ionizing radiation.

Alternative Names

Ultrasound - abdomen; Abdominal sonogram

References

Cosgrove DO, Meire HB, Lim A, Eckersley RJ. Ultrasound: general principles. In: Adam A, Dixon AK, eds.Grainger & Allisonn's Diagnostic Radiology: A Textbook of Medical Imaging
Kim DH, Pickhardt PJ. Diagnostic imaging procedures in gastroenterology. In: Goldman L, Ausiello D, eds.Cecil Medicine

Aortic aneurysm repair - endovascular

Endovascular abdominal aortic aneurysm repair is surgery to repair a widened area in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your belly, pelvis, and legs.
An aortic aneurysm is when a part of this artery becomes too large or balloons outward. It occurs due to weakness in the wall of the artery.

Description

This procedure is done in an operating room, in the radiology department of the hospital, or in a catheterization lab. You will lie on a padded table. You may receive general anesthesia (you are asleep and pain-free) or epidural or spinal anesthesia.
• Your doctor will make a small surgical cut near the groin, to find the femoral artery. Then your doctor will insert a stent (a metal coil) and a manmade (synthetic) graft through the cut into the artery.
• The doctor uses x-rays to guide the stent graft up into your aorta, to where the aneurysm is located. The doctor will open the stent using a spring-like mechanism and attach it to the walls of the aorta. Your aneurysm will eventually shrink around it.
• The doctor will then use x-rays again to make sure the stent is in the right place and your aneurysm is not bleeding inside your body.

Why the Procedure is Performed

Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding.
You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem when you had an ultrasound or CT scan for another reason. There is a risk that this aneurysm may open up (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky. In such cases, endovascular repair is an option.
You and your doctor must decide whether the risk of having this surgery is smaller than the risk of rupture if you do not have surgery to repair the problem. The doctor is more likely to recommend that you have surgery if the aneurysm is:
• Larger (about 2 inches or 5 cm)
• Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)
Endovascular repair has a lower risk of complications compared to open surgery. Your doctor is more likely to suggest this type of repair if you have other serious medical problems or are elderly.

Risks

Risks for any surgery are:
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs, urinary tract, and belly
• Heart attack or stroke
• Reactions to medicines
Risks for this surgery are:
• Bleeding around the graft that needs more surgery
• Bleeding before or after procedure
• Blockage of the stent
• Damage to a nerve, causing weakness, pain, or numbness in the leg
• Kidney failure
• Poor blood supply to your legs, your kidneys, or other organs
• Problems getting or keeping an erection
• Surgery is not successful and you need open surgery
• The stent slips

Before the Procedure

Your health care provider will examine you and order tests before you have surgery.
Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
If you are a smoker, you should stop. Your provider can help. Here are other things you will need to do before your surgery:
• About two weeks before your surgery, you will visit your provider to make sure any medical problems, such as diabetes, high blood pressure, and heart or lung problems, are well treated.
• You also may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and naprosyn (Aleve, Naproxen).
• Ask which drugs you should still take on the day of your surgery.
• Always tell your provider if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.
The evening before your surgery:
• DO NOT drink anything after midnight, including water.
On the day of your surgery:
• Take any medicines your doctor told you to take with a small sip of water.
• You will be told when to arrive at the hospital.

After the Procedure

Most people stay in the hospital for 3 to 5 days after this surgery, depending on the type of procedure they had. Most often, the recovery from this procedure is faster and with less pain than with open surgery. Also, you will most likely be able to go home sooner.
During a hospital stay, you may:
• Be in the intensive care unit (ICU), where you will be watched very closely at first
• Have a urinary catheter
• Be given medicines to thin your blood
• Be encouraged to sit on the side of your bed and then walk
• Wear special stockings to prevent blood clots in your legs
• Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)

Outlook (Prognosis)

Recovery after endovascular repair is quick in most cases.
You will need to be watched and checked regularly to make sure your repaired aortic aneurysm is not leaking blood.

Alternative Names

EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular

References

Braverman AC. Diseases of the aorta. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds.Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine
Lederle FA, Freischlag JA, Kyriakides TC, Matsumura JS, Padberg FT Jr, Kohler TR, et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm.N Engl J Medwww.ncbi.nlm.nih.gov/pubmed/23171095
Tracci MC, Cherry JR KJ. The Aorta. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery

Aortic aneurysm repair - endovascular - discharge

AAA repair - endovascular - discharge; Repair - aortic aneurysm - endovascular - discharge; EVAR - discharge; Endovascular aneurysm repair - discharge

When you were in the hospital

You had endovascular aortic surgery repair for an aneurysm (a widened part) of the large artery that carries blood to your lower body (aorta).
To perform the procedure:
• Your doctor made a small incision (cut) near your groin to find your femoral artery.
• Your doctor inserted a stent and a man-made (synthetic) graft through the incision into the artery.
• X-rays were used to guide the stent and graft into your aorta where the aneurysm was located.
• The graft and stent were opened up and attached to the walls of the aorta.

What to expect at home

The cut in your groin may be sore for several days. You should be able to walk farther now without needing to rest. But you should take it easy at first. It may take 6 to 8 weeks to fully recover.

Self-care

You will need to increase your activity slowly while the incision heals.
• Walking short distances on a flat surface is OK. Try to walk a little, 3 or 4 times a day. Slowly increase how far you walk each time.
• Limit going up and down stairs to about 2 times a day for the first 2 to 3 days after the procedure.
• Do not do yard work, drive, or play sports for at least 2 days, or for the number of days your doctor tells you to wait.
You will need to take care of your incision.
• Your doctor or nurse will tell you how often to change your dressing.
• If your incision bleeds or swells, lie down and put pressure on it for 30 minutes.
When you are resting, try keeping your legs raised above the level of your heart. Place pillows or blankets under your legs to raise them.
Ask your doctor about follow-up x-rays you will need to have to check if your new graft is OK.
Your doctor may ask you to take aspirin or another medicine called clopidogrel (Plavix) when you go home. These medicines are anti-platelet agents. They prevent the platelets in your blood from clumping together and forming clots in your arteries or stent. Do not stop taking them without talking with your doctor first.

Lifestyle changes

Endovascular surgery does not cure the cause of your aneurysm. Your arteries may become wide again. To prevent the aneurysm from coming back:
• Eat a heart-healthy diet.
• Exercise.
• Stop smoking (if you smoke).
• Reduce stress to help lower your chances of having a blocked artery again.
Your health care provider may give you medicine to help lower your cholesterol. If you are given medicines for blood pressure or diabetes, take them as your doctor has asked you to.

When to call the doctor

Call your doctor or nurse if:
• You have pain in your belly or back that does not go away or is very bad
• There is bleeding at the catheter insertion site that does not stop when pressure is applied
• There is swelling at the catheter site
• Your leg or arm below where the catheter was inserted changes color, becomes cool to the touch, pale, or numb
• The small incision for your catheter becomes red or painful
• Yellow or green discharge is draining from the incision for your catheter
• Your legs are swelling
• You have chest pain or shortness of breath that does not go away with rest
• You have dizziness or fainting, or you are very tired
• You are coughing up blood, or yellow or green mucus
• You have chills or a fever over 101 °F
• You have blood in your stool
• You are not able to move your legs
• Your belly starts to swell and is painful

References

Hammond CJ, Nicholson AA. Aortic Intervention. In: Adam A, Dixon AK, Gillard JH, et al. eds.Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging
De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, van Sambeek MR, Balm R, Grobbee DE, Blankensteijn JD; DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.N Engl J Med
Tracci MC, Cherry KJ. The aorta. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery
Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm.N Engl J Med
Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med

Aortic angiography

Aortic angiography is a procedure that uses a special dye and x-rays to see how blood flows through the aorta. The aorta is the major artery leading out of the heart, and through your abdomen or belly.
Angiography uses x-rays and a special dye to see inside the arteries. Arteries are blood vessels that carry blood away from the heart.

How the Test is Performed

This test is done at a hospital. Before the test starts, you will be given a mild sedative to help you relax.
• An area of your body, most often in your arm or groin area, is cleaned and numbed with a local numbing medicine (anesthetic).
• A radiologist or cardiologist will place a needle into the groin blood vessel. A guidewire and a long tube (catheter) will be passed through this needle.
• The catheter is moved into the aorta. The doctor can see live images of the aorta on a TV-like monitor, and x-rays are used to guide the catheter to the correct position.
• Once the catheter is in place, dye is injected into it. X-ray images are taken to see how the dye moves through the aorta. The dye helps detect any blockages in blood flow.
After the x-rays or treatments are finished, the catheter is removed. Pressure is applied to the puncture site for 20 to 45 minutes to stop the bleeding. After that time, the area is checked and a tight bandage is applied. The leg is most often kept straight for another 6 hours after the procedure.

How to Prepare for the Test

You will not eat or drink anything for 6 to 8 hours before the test.
You will wear a hospital gown and sign a consent form for the procedure. Remove jewelry from the area being studied.
Tell your health care provider:
• If you are pregnant
• If you have ever had any allergic reactions to x-ray contrast material or iodine substances
• If you are allergic to any medicines
• Which medicines you are taking (including any herbal preparations)
• If you have ever had any bleeding problems

How the Test Will Feel

You will be awake during the test. You may feel a sting as the numbing medicine is given and some pressure as the catheter is inserted. You may feel a warm flushing when the contrast dye flows through the catheter. This is normal and most often goes away in a few seconds.
You may have some discomfort from lying on the hospital table and staying still for a long time.
In most cases, you can resume normal activity the day after the procedure.

Why the Test is Performed

Your provider may ask for this test if there are signs or symptoms of a problem with the aorta or its branches, including:
• Aortic aneurysm
• Aortic dissection
• Congenital (present from birth) problems
• AV malformation
• Double aortic arch
• Coarctation of the aorta
• Vascular ring
• Injury to the aorta
• Takayasu's arteritis

What Abnormal Results Mean

Abnormal results may be due to:
• Abdominal aortic aneurysm
• Aortic dissection
• Aortic regurgitation
• Aortic stenosis
• Congenital (present from birth) problems
• Double aortic arch
• Coarction of the aorta
• Vascular ring
• Injury to the aorta
• Mesenteric ischemia
• Peripheral artery disease
• Renal artery stenosis
• Takayasu's arteritis

Risks

Risks of aortic angiography include:
• Allergic reaction to the contrast dye
• Blockage of the artery
• Blood clot that travels to the lungs
• Bruising at the site of catheter insertion
• Damage to the blood vessel where the needle and catheter are inserted
• Excessive bleeding or a blood clot where the catheter is inserted, which can reduce blood flow to the leg
• Heart attack or stroke
• Hematoma, a collection of blood at the site of the needle puncture
• Infection
• Injury to the nerves at the needle puncture site
• Kidney damage from the dye

Considerations

This procedure may be combined with left heart catheterization to look for coronary artery disease.
Aortic angiography has been mostly replaced by computed tomography (CT) or magnetic resonance (MR) angiography.

Alternative Names

Angiography - aorta; Aortography; Abdominal aorta angiogram; Aortic arteriogram

References

Fattori R, Lovato L. The thortic aortica. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds.Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging
Jackson JE, Meaney JFM. Angiography. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds.Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging

Aortic dissection

Aortic dissection is a serious condition in which there is a tear in the wall of the major artery carrying blood out of the heart (aorta). As the tear extends along the wall of the aorta, blood can flow in between the layers of the blood vessel wall (dissection). This can lead to aortic rupture or decreased blood flow (ischemia) to organs.

Causes

When it leaves the heart, the aorta first moves up through the chest towards the head (the ascending aorta). It then bends or arches, and finally moves down through the chest and abdomen (the descending aorta).
Aortic dissection most often happens because of a tear or damage to the inner wall of the aorta. This very often occurs in the chest (thoracic) part of the artery, but it may also occur in the abdominal aorta.
When a tear occurs, it creates two channels:
• One in which blood continues to travel
• Another where blood stays still
If the channel with non-traveling blood gets bigger, it can push on other branches of the aorta. This can narrow the other branches and reduce blood flow through them.
An aortic dissection may also cause abnormal widening or ballooning of the aorta (aneurysm).
The exact cause is unknown, but more common risks include:
• Aging
• Atherosclerosis
• Blunt trauma to the chest, such as hitting the steering wheel of a car during an accident
• High blood pressure
Other risk factors and conditions linked to aortic dissection include:
• Bicuspid aortic valve
• Coarctation (narrowing) of the aorta
• Connective tissue disorders (such as Marfan syndrome and Ehlers-Danlos syndrome) and rare genetic disorders
• Heart surgery or procedures
• Pregnancy
• Swelling of the blood vessels due to conditions such as arteritis and syphilis
Aortic dissection occurs in about 2 out of every 10,000 people. It can affect anyone, but is most often seen in men ages 40 to 70.

Symptoms

In most cases, the symptoms begin suddenly, and include severe chest pain. The pain may feel like a heart attack and it:
• Can be described as sharp, stabbing, tearing, or ripping
• Is felt below the chest bone, then moves under the shoulder blades or to the back
• Can move to the shoulder, neck, arm, jaw, abdomen, or hips
• Changes position, often moving to the arms and legs as the aortic dissection gets worse
Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:
• Anxiety and a feeling of doom
• Fainting or dizziness
• Heavy sweating (clammy skin)
• Nausea and vomiting
• Pale skin (pallor)
• Rapid, weak pulse
• Shortness of breath and trouble breathing when lying flat (orthopnea)
Other symptoms may include:
• Pain in the abdomen
• Stroke symptoms
• Swallowing difficulties from pressure on the esophagus

Exams and Tests

The health care provider will take your family history and listen to your heart, lungs, and abdomen with a stethoscope. The exam may find:
• A "blowing" murmur over the aorta, heart murmur, or other abnormal sound
• A difference in blood pressure between the right and left arms, or between the arms and legs
• Low blood pressure
• Signs resembling a heart attack
• Signs of shock, but with normal blood pressure
Aortic dissection or aortic aneurysm may be seen on:
• Aortic angiography
• Chest x-ray
• Chest MRI
• CT scan of chest with dye
• Doppler ultrasonography (occasionally performed)
• Echocardiogram
• Transesophageal echocardiogram (TEE)
Blood work to rule out a heart attack is needed.

Treatment

Aortic dissection is a life-threatening condition and needs to be treated right away.
• Dissections that occur in the part of the aorta that is leaving the heart (ascending) are treated with surgery.
• Dissections that occur in other parts of the aorta (descending) may be managed with surgery or medicines.
Two techniques may be used for surgery:
• Standard, open surgery. This requires a surgical incision that is made in the chest or abdomen.
• Endovascuar aortic repair. This surgery is done without any major surgical incisions.
Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Beta-blockers are the first drugs of choice. Strong pain relievers are very often needed.
If the aortic valve is damaged, valve replacement is needed. If the heart arteries are involved, a coronary bypass is also performed.

Outlook (Prognosis)

Aortic dissection is life threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than half of people with a ruptured aorta survive.
Those who survive will need lifelong, aggressive treatment of high blood pressure. They will need to be followed up with CT scans every few months to monitor the aorta.

Possible Complications

Aortic dissection may decrease or stop the blood flow to many different parts of the body. This may result in short-term or long-term problems, or damage to the:
• Brain
• Heart
• Intestines or bowels
• Kidneys
• Legs

When to Contact a Medical Professional

If you have symptoms of an aortic dissection or severe chest pain, call 911 or your local emergency number, or go to the emergency room as quickly as possible.

Prevention

Many cases of aortic dissection cannot be prevented.
Things you can do to reduce your risk include:
• Treating and controlling hardening of the arteries (atherosclerosis)
• Keeping high blood pressure under control, especially if you are at risk for dissection
• Taking safety precautions to prevent injuries that can cause dissections
• If you have been diagnosed with Marfan or Ehlers-Danlos syndrome, making sure you regularly follow-up with your doctor

Alternative Names

Aortic aneurysm - dissecting

References

Isselbacher EM. Diseases of the aorta. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

Chest MRI

A chest MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnetic fields and radio waves to create pictures of the chest (thoracic area). It does not use radiation (x-rays).

How the Test is Performed

The test is done in the following way:
• You may be asked to wear a hospital gown or clothing without metal fasteners (such as sweatpants and a t-shirt). Certain types of metal can cause blurry images or be dangerous to have on in the scanner room.
• You lie on a narrow table, which slides into the large tunnel-shaped scanner.
• You must be still during the exam, because movement causes blurred images.
Some exams require a special dye called contrast. The dye is usually given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly. A blood test to measure your kidney function may be done before the test. This is to make sure your kidneys are healthy enough to filter the contrast.
During the MRI, the person who operates the machine will watch you from another room. The test most often lasts 30 - 60 minutes, but it may take longer.

How to Prepare for the Test

You may be asked not to eat or drink anything for 4 to 6 hours before the scan.
Tell your doctor if you are claustrophobic (afraid of closed spaces). You may be given a medicine to help you feel sleepy and less anxious. Your doctor may suggest an "open" MRI, in which the machine is not as close to your body.
Before the test, tell your health care provider if you have:
• Brain aneurysm clips
• Certain types of artificial heart valves
• Heart defibrillator or pacemaker
• Inner ear (cochlear) implants
• Kidney disease or are on dialysis (you may not be able to receive contrast)
• Recently placed artificial joints
• Certain types of vascular stents
• Worked with sheet metal in the past (you may need tests to check for metal pieces in your eyes)
The MRI contains strong magnets, so metal objects are not allowed into the room with the MRI scanner. This is because there is a risk that they will be drawn from your body toward the scanner. Examples of metal objects you will need to remove are:
• Pens, pocket knives, and eyeglasses
• Items such as jewelry, watches, credit cards, and hearing aids
• Pins, hairpins, and metal zippers
• Removable dental work

How the Test will Feel

An MRI exam causes no pain. If you have trouble lying still or are very nervous, you may be given medicine to relax you. Too much movement can blur MRI images and cause errors when the doctor looks at the images.
The table may be hard or cold, but you can ask for a blanket or pillow. The machine produces loud thumping and humming noises when turned on. You can wear ear plugs to help reduce the noise.
An intercom in the room allows you to speak to someone at any time. Some MRIs have televisions and special headphones that you can use to help the time pass.
There is no recovery time, unless you were given a medicine to relax. After an MRI scan, you can resume your normal diet, activity, and medications.

Why the Test is Performed

A chest MRI provides detailed pictures of tissues within the chest area.
A chest MRI may be done to:
• Provide an alternative to angiography, or avoid repeated exposure to radiation
• Clarify findings from earlier x-rays or CT scans
• Diagnose abnormal growths in the chest
• Evaluate blood flow
• Show lymph nodes and blood vessels
• Show the structures of the chest from many angles
• See if cancer in the chest has spread to other areas of the body (this is called staging -- it helps guide future treatment and follow-up, and gives you an idea of what to expect in the future)
• Detect tumors

Normal Results

A normal result means your chest area appears normal.

What Abnormal Results Mean

An abnormal chest MRI may be due to:
• Abnormal blood vessels in the lungs (pulmonary vessels)
• Abnormal lymph nodes
• Aortic dissection
• Aortic stenosis
• Atrial myxoma
• Atrial septal defect
• Bronchial abnormalities
• Bronchiectasis
• Cardiac tamponade
• Chronic obstructive pulmonary disease (COPD)
• Coarctation of the aorta
• Constrictive pericarditis
• Cystic lung lesions
• Esophageal tumor
• Ischemic cardiomyopathy
• Lung tumors
• Mitral regurgitation - acute
• Mitral regurgitation - chronic
• Mitral valve prolapse
• Other masses or tumors of the chest
• Pericardial effusion
• Pericarditis
• Pleural abnormalities, including thickening or pleural effusion
• Pulmonary edema
• Restrictive cardiomyopathy
• Superior vena cava (SVC) obstruction
• Thoracic aortic aneurysm
• Thymus tumor
• Tumors of the chest
Consult your health care provider with any questions or concerns.

Risks

MRI uses no radiation. To date, no side effects from the magnetic fields and radio waves have been reported.
The most common type of contrast (dye) used is gadolinium. It is very safe. Allergic reactions to the substance rarely occur. However, gadolinium can be harmful to patients with kidney problems who need dialysis. If you have kidney problems, tell your health care provider before the test.
The strong magnetic fields created during an MRI can cause heart pacemakers and other implants not to work as well. It can also cause a piece of metal inside your body to move or shift.

Considerations

Currently, MRI is not considered a valuable tool for spotting or monitoring slight changes in lung tissue. The lungs contain mostly air and are hard to image. CT scan tends to be better for monitoring these changes.
Disadvantages of MRI include:
• High cost
• Long length of the scan
• Sensitivity to movement

Alternative Names

Nuclear magnetic resonance - chest; Magnetic resonance imaging - chest; NMR - chest; MRI of the thorax; Thoracic MRI

References

Gotway MB, Elicker BM. Radiographic techniques. In: Mason RJ, Broaddus CV, Martin TR, et al., eds.Murray & Nadel's Textbook of Respiratory Medicine
Stark P. Imaging in pulmonary disease. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

Magnetic resonance angiography

Magnetic resonance angiography is an MRI exam of the blood vessels. Unlike traditional angiography that involves placing a tube (catheter) into the body, MRA is noninvasive.

How the Test is Performed

You may be asked to wear a hospital gown or clothing without metal fasteners (such as sweatpants and a t-shirt). Certain types of metal can cause blurry images.
You will lie on a narrow table, which slides into a large tunnel-shaped scanner.
Some exams require a special dye (contrast). Most often, the dye is given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly.
During the MRI, the person who operates the machine will watch you from another room. The test may take 1 hour or more.

How to Prepare for the Test

You may be asked not to eat or drink anything for 4 - 6 hours before the scan.
Tell your doctor if you are afraid of close spaces (have claustrophobia). You may be given a medicine to help you feel sleepy and less anxious, or your doctor may suggest an "open" MRI, in which the machine is not as close to the body.
Before the test, tell your health care provider if you have:
• Brain aneurysm clips
• Artificial heart valve
• Heart defibrillator or pacemaker
• Inner ear (cochlear) implants
• Insulin or chemotherapy port
• Intrauterine device (IUD)
• Kidney disease or dialysis (you may not be able to receive contrast)
• Neurostimulator
• Recently placed artificial joints
• Vascular stent
• Worked with sheet metal in the past (you may need tests to check for metal pieces in your eyes)
Because the MRI contains strong magnets, metal objects are not allowed into the room with the MRI scanner:
• Pens, pocketknives, and eyeglasses may fly across the room.
• Items such as jewelry, watches, credit cards, and hearing aids can be damaged.
• Pins, hairpins, metal zippers, and similar metallic items can distort the images.
• Removable dental work should be taken out just before the scan.

How the Test will Feel

An MRA exam causes no pain. If you have problems lying still or are very nervous, you may be given a medicine (sedative) to relax you. Moving too much can blur images and cause errors.
The table may be hard or cold, but you can ask for a blanket or pillow. The machine produces loud thumping and humming noises when turned on. You can wear ear plugs to help reduce the noise.
An intercom in the room allows you to speak to someone at any time. Some scanners have televisions and special headphones that you can use to help the time pass.
There is no recovery time, unless you were given a medicine to relax.

Why the Test is Performed

MRA is used to look at the blood vessels in all parts of the body, including the head, heart, abdomen, lungs, kidneys, and legs.
It may be used to diagnose or evaluate conditions such as:
• Arterial aneurysm
• Aortic coarctation
• Aortic dissection
• Stroke
• Carotid artery disease
• Atherosclerosis of the arms or legs
• Heart disease, including congenital heart disease
• Mesenteric artery ischemia
• Renal artery stenosis (narrowing of the blood vessels in the kidneys)

Normal Results

A normal result means the blood vessels do not show any signs of narrowing or blockage.

What Abnormal Results Mean

An abnormal exam suggests a problem with one or more blood vessels. This may suggest atherosclerosis, trauma, a congenital disease, or other vascular condition.

Risks

MR angiography is generally safe. It uses no radiation. To date, no side effects from the magnetic fields and radio waves have been reported.
The most common type of contrast (dye) used contains gadolinium. It is very safe. Allergic reactions to the substance rarely occur. However, gadolinium can be harmful to patients with kidney problems who require dialysis. If you have kidney problems, please tell your health care provider before the test.
The strong magnetic fields created during an MRI can cause heart pacemakers and other implants to not work as well. They can also cause a piece of metal inside your body to move or shift.

Alternative Names

MRA; Angiography - magnetic resonance

References

Kwong RY. Cardiovascular Magnetic Resonance Imaging. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds.Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine
Jackson J, Allison DJ, Meaney J. Angiography: principles, techniques, and complications. In: Grainger RC, Allison D, Adam A, Dixon AK, eds.Diagnostic Radiology: A Textbook of Medical Imaging

Thoracic aortic aneurysm

An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.
A thoracic aortic aneurysm occurs in the part of the body's largest artery (the aorta) that passes through the chest.

Causes

The most common cause of a thoracic aortic aneurysm is hardening of the arteries (atherosclerosis). This condition is more common in people with high cholesterol, long-term high blood pressure, or who smoke.
Other risk factors for a thoracic aneurysm include:
• Changes caused by age
• Connective tissue disorders such as Marfan or Ehlers-Danlos syndrome
• Inflammation of the aorta
• Injury from falls or motor vehicle accidents
• Syphilis

Symptoms

Aneurysms develop slowly over many years. Most people have no symptoms until the aneurysm begins to leak or expand.
Symptoms often begin suddenly when:
• The aneurysm grows quickly
• The aneurysm tears open (called a rupture)
• Blood leaks along the wall of the aorta (aortic dissection)
If the aneurysm presses on nearby structures, the following symptoms may occur:
• Hoarseness
• Swallowing problems
• High-pitched breathing (stridor)
• Swelling in the neck
Other symptoms may include:
• Chest or upper back pain
• Clammy skin
• Nausea and vomiting
• Rapid heart rate
• Sense of impending doom

Exams and Tests

The physical exam is often normal unless a rupture or leak has occurred.
Most thoracic aortic aneurysms are detected on imaging tests performed for other reasons. These tests include chest x-ray, echocardiogram, or chest CT scan or MRI. A chest CT scan shows the size of the aorta and the exact location of the aneurysm.
An aortogram (a special set of x-ray images made when dye is injected into the aorta) can identify the aneurysm and any branches of the aorta that may be involved.

Treatment

There is a risk that the aneurysm may open up (rupture) if you do not have surgery to repair it.
The treatment depends on the location of the aneurysm. The aorta is made of three parts:
• The first part moves upward toward the head. It is called the ascending aorta.
• The middle part is curved. It is called the aortic arch.
• The last part moves downward, toward the feet. It is called the descending aorta.
For patients with aneurysms of the ascending aorta or aortic arch:
• Surgery to replace the aorta is recommended if an aneurysm is larger than 5 - 6 centimeters.
• A cut is made in the middle of the chest bone.
• The aorta is replaced with a plastic or fabric graft.
• This is major surgery that requires a heart-lung machine.
For patients with aneurysms of the descending thoracic aorta:
• Major surgery is done to replace the aorta with a fabric graft if the aneurysm is larger than 6 centimeters.
• This surgery is done through a cut on the left side of the chest, which may reach to the abdomen.
• Endovascular stenting is a less invasive option. A stent is a tiny metal or plastic tube that is used to hold an artery open. Stents can be placed into the body without cutting the chest. Not all people with descending thoracic aneurysms are candidates for stenting, however.

Outlook (Prognosis)

The long-term outlook for patients with thoracic aortic aneurysm depends on other medical problems, such as heart disease, high blood pressure, and diabetes. These problems may have caused or contributed to the condition.

Possible Complications

Serious complications after aortic surgery can include:
• Bleeding
• Graft infection
• Heart attack
• Irregular heartbeat
• Kidney damage
• Paralysis
• Stroke
Death soon after the operation occurs in 5 - 10% of patients.
Complications after aneurysm stenting include damage to the blood vessels supplying the leg, which may require another operation.

When to Contact a Medical Professional

Tell your doctor if you have:
• A family history of connective tissue disorders (such as Marfan or Ehlers-Danlos syndrome)
• Chest or back discomfort

Prevention

To prevent atherosclerosis:
• Control your blood pressure and blood lipid levels.
• Do not smoke.
• Eat a healthy diet.
• Exercise regularly.

Alternative Names

Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic

References

Tracci MC, Cherry KJ. The aorta. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL.Sabiston Textbook of Surgery
Cheng D, Martin J, Shennib H, et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease: a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol
Isselbacher EM. Diseases of the aorta. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

Published for educational purposes from the website: MedlinePlus
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.