Aortic Aneurysms: How to Detect and Treat

An aortic aneurysm is a dilatation maintained over time and located in a specific area of the aortic artery. The dilatation of the aortic diameter should be at least 50% greater than that expected for the patient’s gender or size or that observed in immediately bordering sectors (above or below). The aorta is the main blood transport route in the human body. It has branches that go to the main organs, its flow and pressure is very high so that its rupture is a catastrophic situation for those who suffer from it.

The dilation of this “Great pipe” of the body leads to the weakening of its wall and therefore the possibility of its rupture. There is statistical agreement that the risk of rupture begins to be important from 6 cm in thoracic aortic aneurysms and from 5.5 cm in abdominal aortic aneurysms.

They appear more frequently in men, after 50 years of age and with the usual cardiovascular risk factors almost always present: smoking, hypertension, hypercholesterolemia.

Detection and diagnosis of aortic aneurysm

Physical examination including abdominal palpation should never be forgotten in patients belonging to the at-risk population but ultrasound is the test that offers the best performance when detecting and measuring them. If the aneurysm does not have a size that exceeds the limits, the patient should undergo periodic follow-up to evaluate its evolution and the possible need for intervention to prevent its rupture.

In the event that they are detected with a size that already meets treatment criteria, they should be assessed by Computerized Axial Tomography (CT) to accurately establish their measurements and those of the bordering healthy sectors in order to establish the best treatment strategy.

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How to treat aortic aneurysms

Detected in time and with the wall intact, there are two main possibilities:

1.-Conventional surgery: in which the affected sector is replaced by a synthetic material prosthesis suturing it to the healthy proximal and distal areas, with normal caliber. It requires an open surgery, aggressive, but with very good results in the long term.

Endovascular surgery: accessing generally through the femoral artery, a device is introduced into the aorta that deploys a stent (a metallic spring coated with a prosthesis) that will rest on the healthy areas proximal and distal to the dilatation, preventing the flow from breaking the weakened wall. It is a much less aggressive procedure, more indicated in high-risk or elderly patients, although its durability is not yet sufficiently proven.

If the aneurysm is ruptured and there is an extremely serious clinical situation the two options remain but open surgery is probably more indicated, although it will depend on multiple clinical circumstances.