Aortic Aneurysm: Diagnosis and Treatment

An aortic aneurysm is a localized dilatation or widening of the aortic artery, from which the heart originates. It is a complication usually linked to age that produces a weakness in the wall of the artery.

What is aortic aneurysm and what factors cause its appearance?

The aorta is the largest artery in the human body, it originates in the heart, passes through the chest and reaches the abdomen. By aortic aneurysm we understand the localized or diffuse widening of this artery. This type of aneurysm occurs after the age of 60 years and its most frequent location is the abdominal aorta.

They are due to a weakness of the arterial wall secondary to a loss of collagen that confers the necessary strength to the artery. Although there is a genetic predisposition, there are other known risk factors that contribute to this structural alteration: age (people over 60 years of age), male sex, arterial hypertension and smoking. Less frequently, they can also be secondary to infection or trauma.

What techniques are used to detect it? What symptoms alert to its presence?

In recent years aneurysms are diagnosed early thanks to the use of modern diagnostic technologies such as abdominal Doppler ultrasound, CT angiography and MRI angiography. They are usually discovered in a medical check-up, hence the importance of good prevention by practicing regular vascular check-ups to those who have the risk factors described above.

Aneurysms are silent and do not cause symptoms until complications occur. If the aortic aneurysm is not treated, its natural evolution leads to progressive growth and finally to rupture of the artery, which causes severe internal bleeding. Sometimes they can also embolize into the legs causing a thrombus of the aortic wall.

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Mortality of aortic aneurysm complicated by rupture remains very high (30-60%), which emphasizes the need for early diagnosis and follow-up, as well as surgical repair before this serious complication occurs.

What surgical techniques can treat the aneurysm?

AAA can be treated safely and with low mortality with early diagnosis and elective treatment. The indication for repair of an aortic aneurysm (endovascular or conventional) is basically determined by its size. From 5.5 cm in diameter or in those with rapid growth, we know that the risk of spontaneous rupture is high and should therefore be repaired. Significant improvements in both surgical and anesthetic techniques in the last two decades have provided a clear improvement in the results of non-urgent elective treatment.

Two techniques are currently available for aortic aneurysm repair:

– Endovascular surgery (endoprosthesis): it consists of the introduction through the femoral arteries of an endoprosthesis (Stent or “spring” covered with a fiber), which is released and expands between the ends of the aneurysm with which the blood passes through its interior depressurizing the aneurysmal sac. It is not necessary to open the abdomen, so it is an ideal technique for elderly patients or those with an associated pathology.

– Conventional surgery: consists of resection of the affected aortic segment and its replacement by a tubular prosthesis (Dacron or PTFE) of the same size as the healthy aorta. It is a widely contrasted technique with excellent long-term results.

It is essential for the surgeon to master both techniques to perfection. The choice of one technique or the other must be personalized, based on two essential aspects: clinical criteria (age and associated pathology) and anatomical (aneurysm morphometry).

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Are the results of surgery definitive or can it be repeated?

Elective surgery (conventional or endovascular) of abdominal aortic aneurysm offers excellent results in terms of morbidity and mortality compared to emergency surgery. Therefore, early diagnosis and treatment of this pathology is essential. In this sense, vascular checkups, as in other diseases, play a fundamental role.