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 is
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.
Now the diagnosis again
is almost always confirmed even if
you suspect it on your physical exam
with an ultrasound examination,
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
5.5 cm or a little bit more
those patients are referred either
for surgery or for angioplasty
because the risk for rupture
is 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.
is very important
and particularly in very
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 issewn
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.