from the aneurysm.
The diagnosis, again remember that most of
them are below the renal artery. Sometimes
they can be found on physical exam, with a
careful abdominal physical exam you may feel
a pulsating mass enlargement of the aorta
although that is often not seen and the best
way is usually to do some form of imaging.
Sometimes, if the patient is quite thin, you
can estimate, you can feel the aorta by pressing
deep into the abdomen. You can estimate how
many centimetres wide it is and feel if it
has in fact widened but generally the best
technique is using some non-invasive technique
to image the aneurysm. Aneurysms may be calcified.
And as I mentioned the potentially fatal complication
is when the aneurysm breaks and blood hemorrhages
out into the abdominal cavity or the chest
cavity depending upon where the aneurysm is
located. Again the diagnosis is made with
either an ultrasound examination of the abdomen
or the chest or with an echocardiogram looking
at the heart and ascending aorta or with CT
scans or MRI imaging and the figure that you
see here shows an ascending aortic aneurysm
labelled ‘A’, big wide dilated aorta.
This is an ascending aortic thoracic aneurysm.
The diagnosis again is almost always confirmed
even if you suspect it on your physical exam
with an ultrasound examination, with echocardiography
for thoracic aneurysms, and for abdominal
aneurysms usually a CT scan or an MRI. In
the US usually it's a CT scan that is simpler,
takes less time, and gives a very good picture
of the aorta and shows you how wide the aneurysm
is and often patients who have an aortic abdominal
aneurysm are followed every year with a CT
scan to see if it is enlarging. And when it
gets up around 4 cm or a little bit more those
patients are referred either for surgery or
for angioplasty because the risk for rupture
increases at that size.
Therapy, well if you see an aortic aneurysm
starting, then of course one attempts to reduce
all of the atherosclerotic risk factors. Smoking
cessation is very important and particularly
in very elderly patients where repair is unlikely
to improve the life expectancy, it is important
to do as much as you can to control blood
pressure, to reduce lipids with statin drugs
for example, and of course to get patients
away from smoking. We often try and hold the
blood pressure down, even lower than the usual
level, to put less stress on the aneurysm
and to decrease its chance of enlarging.
One can repair them as we have mentioned before
either with angioplasty, with stents, or with
a surgical repair where the section of the
aorta is removed or opened and a graft is
sewn in, usually are made from Dacron,
an artificial plastic substance so that then
there is no risk of rupture because the aneurysm
is no longer in the circulation.