Disease Description (Causes and Symptoms)
- Definition and pathophysiology
- An aortic aneurysm is a condition in which part of the aorta expands to approximately 1.5 times or more its normal diameter. A thrombus (clotted blood mass) may form inside an aortic aneurysm, creating a risk of embolism and rupture.
- Main causes
- Atherosclerosis — the most common cause
- Vascular risk factors such as smoking, hypertension, hyperlipidemia, and diabetes
- Genetic defects (e.g., Marfan syndrome and other connective tissue disorders)
- Inflammatory or infectious causes (arteritis, syphilis, fungi, etc.) and trauma
- Main symptoms
- Usually asymptomatic (particularly, 70–80% of abdominal aortic aneurysms are asymptomatic)
- Abdominal, flank, or back pain; a pulsatile mass palpable in the abdomen
- Fullness, nausea and vomiting when surrounding organs are compressed; urinary symptoms due to ureteral compression, etc.
- Coldness and pain in the lower extremities in cases of thromboembolism
- Sudden, severe pain and shock if rupture occurs — an emergency and potentially fatal
- Diagnostic tests (main methods)
- Abdominal ultrasonography (useful for screening and follow-up monitoring)
- CT angiography — standard when planning surgery
- MRI / MR angiography
- Conventional angiography (if necessary)
Treatment Methods
- Basic principles
- Treatment is determined according to the risk of rupture, the patient’s condition, the location and size of the aortic aneurysm, and its growth rate.
- Treatment options: conservative treatment (observation and medication) vs. open surgery (aneurysm resection followed by prosthetic graft replacement) vs. endovascular surgery (EVAR/TEVAR)
- Conservative and medical treatment
- Blood pressure control (especially maintaining an appropriate systolic blood pressure) — antihypertensive drugs (e.g., beta blockers, ACE inhibitors/ARBs, etc.)
- Lipid management (statins) and blood glucose control
- Smoking cessation (the most important lifestyle modification)
- Regular imaging follow-up (monitoring size and growth rate)
- Criteria for surgical treatment (general guidelines; individualization is necessary)
- Ascending aortic aneurysm: Surgery is considered when symptoms are present or complications such as aortic valve regurgitation occur. Even if asymptomatic, surgery is generally considered at a diameter of 5.5–6.0 cm (the threshold is lower when a hereditary disease is present: for example, 5.0 cm or a growth rate of 0.5 cm/year or more may indicate surgery).
- Descending and thoracoabdominal aortic aneurysms: Immediate surgery is indicated when symptoms are present; surgery is generally considered at a diameter of 5.5 cm or more or with rapid annual growth (e.g., >1.0 cm/year).
- Abdominal aortic aneurysm (AAA): Elective surgery is generally considered at 5.5 cm or more (with differences according to sex and clinical condition).
- Procedural options
- Open surgery: Aneurysm resection followed by prosthetic graft replacement — excellent long-term durability
- Endovascular treatment (EVAR/TEVAR): Stent-graft insertion — faster recovery and shorter hospitalization, but there is a need for repeat procedures and anatomical limitations
- Complications and precautions (related to treatment)
- Surgical complications: myocardial infarction, bleeding, renal failure, intestinal or ureteral injury, spinal cord ischemia (risk of paralysis), lower-extremity ischemia or embolism, prosthetic graft infection, etc.
- The mortality rate is high in cases of rupture (an emergency situation)
- Smoking cessation and management of underlying cardiovascular disease are important (the risk of cardiovascular complications is high)
Checklist Before an Outpatient Visit (Including Example Questions)
- Items to prepare and information to confirm
- List of medications currently being taken (including prescription drugs, OTC medications, and anticoagulants)
- Medical history: hypertension, coronary artery disease, history of interventions or surgery, and whether a connective tissue disorder (e.g., Marfan syndrome) is present
- Family history: whether there is a history of aortic aneurysm or rupture
- CDs or reports of recent imaging studies (ultrasound, CT, or MRI), if possible including the original images
- Record of symptom changes: location, intensity, and onset of pain; newly developed shortness of breath, fainting, etc.
- Lifestyle information: smoking status (duration and number of cigarettes per day), weight, exercise, and diet
- Allergies (including contrast medium allergy) and kidney function (recent blood test results)
- Examples of questions to ask during an outpatient visit (questions that can be used directly during the consultation)
- "I can show you my recent images and results. What are the current size and growth rate of my aortic aneurysm?"
- "Has the time come for surgery, or is my condition one that requires surgery immediately?"
- "If I choose monitoring instead of surgery, how often should I have follow-up examinations?"
Examples of General Questions to Ask the Doctor
- What are the main side effects of this medication (or treatment plan)?
- What are the current size and annual growth rate of my aortic aneurysm? What is the prognosis?
- What are the advantages and disadvantages of surgery (or EVAR), and what is my individual surgical risk?
- Besides quitting smoking, are there any activities I should particularly avoid in daily life (such as lifting heavy objects)?
- How is the interval for follow-up examinations (imaging) determined?
Examples of Disease-Specific Questions
- How many centimeters is my aortic aneurysm, and based on the current criteria, do you recommend surgery (or EVAR)? (Taking the growth rate and risk of complications into account)
- I am a smoker. When I start quitting, how will the growth rate or risk of rupture of my aortic aneurysm change? Are there any additional medications or supportive treatments you recommend?