aortic aneurysm
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Introduction
Dilation of a segment of the aorta.
Etiology
- atherosclerosis*
- cystic medial degeneration
- Marfan's syndrome
- Ehlers-Danlos syndrome
- idiopathic
- most common cause of ascending thoracic aortic aneurysms
- vasculitis
- spondyloarthropathy
- congenital anomalies
- bicuspid aortic valve (cystic medial degeneration)
- coarctation of the aorta
- aneurysm of the sinuses of Valsalva
- infection
- trauma
* factors that contribute to atherosclerosis, i.e. cigarette smoking, hypertension, hypercholesterolemia may be primary causes of aortic aneurysms
Epidemiology
- 0.28% above age 80
- 4-fold more common in men than women
- 0.046-0.055% of men
- 0.007-0.012% of women
- more prevalent among whites than among blacks, Asians, & Hispanics
Pathology
- altered expression & synthesis of types 1 & 3 procollagen
- destruction of matrix by cytokine-induced matrix metallo- proteinases
- medial neovascularization
- fragmentation of elastin
- increased collagen content
- aorta becomes less distensible
- increased tension of the aortic wall leads to progressive dilation
Genetics
- see dilated aorta
Clinical manifestations
- depend upon location & size of aneurysm
- thoracic aortic aneurysms
- symptoms related to compression or erosion of adjacent structures
- dyspnea
- dysphagia
- hoarseness
- cough
- risk of rupture is directly related to size
Laboratory
- thrombocytopenia may be observed secondary to consumption of platelets by thrombi in aneurysm
- genetic testing (see dilated aorta)
Diagnostic procedures
- ultrasound
- angiography/aortography
- 12-lead EKG prior to repair[4]
Radiology
Management
- pharmacologic agents to treat hypertension (acute)
- beta blockers
- vasodilators
- calcium channel blockers
- nifedipine: 10 mg SL; 10-40 mg PO q8h
- nitrates
- ACE inhibitors
- calcium channel blockers
- chronic pharmaceutical management
- surgery (aortic aneurysm repair)
- see thoracic aortic aneurysm &/or abdominal aortic aneurysm
- open surgery
- endovascular stent-graft via femoral arteriotomy
- diagnostic imaging every 6-12 months to assess progression & need for surgery
- prophylaxis for bacterial endocarditis if aortic prosthesis used in repair[4]
- prevention:
- regular exercise & a favorable diet (i.e., adequate intake of fruit, vegetables, & nuts)
More general terms
More specific terms
- abdominal aortic aneurysm (AAA)
- dissecting aortic aneurysm; aortic dissection (acute aortic syndrome)
- familial aortic aneurysm
- ruptured aortic aneurysm
- thoracic aortic aneurysm
Additional terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 865
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006.
- ↑ Journal Watch, Mass Med Soc 20(1):7 (Jan 1) 2000
- ↑ 4.0 4.1 4.2 Abdominal Aortic Aneurysm. Society for Vascular Surgery In: Anello J, Feinberg B, Heinegg J et al New Clinical Practice Guidelines, February 2018. Medscape. February 07, 2018 https://reference.medscape.com/viewarticle/892328
Glovicki P, Lawrence PF, Forbes TL. Update of the Society for Vascular Surgery abdominal aortic aneurysm guidelines. J Vasc Surg. 2018 Jan;67(1):1. http://www.jvascsurg.org/article/S0741-5214(17)32369-8/fulltext - ↑ Isselbacher EM, Preventza O, Hamilton Black J 3rd et al 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Dec 13;146(24):e334-e482. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36322642 PMCID: PMC9876736 (available on 2023-12-13)