Aortic aneurysm

Disease Description (Causes and Symptoms)

• Definition: A condition in which part of the aorta expands to at least 1.5 times its normal diameter (aneurysm). Abdominal aortic aneurysms (AAA) account for approximately 75% of all cases, and thoracic aortic aneurysms account for approximately 25%; most abdominal aortic aneurysms occur below the renal arteries (distal to the transition point).
• Main causes: Atherosclerosis (most common), trauma, genetic defects (e.g., Marfan syndrome), arteritis, infection (e.g., syphilis and fungal infection), and congenital abnormalities.
• Pathophysiology: Structural weakening of the aortic wall causes localized expansion of the vessel due to blood-flow pressure. A thrombus (continuous protrusion) may form inside the aneurysm and cause an embolism; as the aneurysm continues to expand, the risk of rupture increases.
• Main symptoms
  • Usually asymptomatic (incidentally discovered during routine checkups or other examinations).
  • Abdominal, flank, or back pain; a pulsatile mass palpable in the abdomen.
  • Early satiety, nausea, urinary tract symptoms due to ureteral compression, and other symptoms when surrounding organs are compressed.
  • Coldness, pain, and ischemic symptoms in the lower extremities caused by thromboembolism.
  • If rupture occurs, sudden severe abdominal or chest pain may develop, followed by syncope and shock, and it can be fatal.

Treatment Methods

• Risk-factor management (prevention and slowing progression)
  • Smoking cessation (most important), management of blood pressure, diabetes, and lipids, weight and dietary control, and regular exercise.
  • Treatment of atherosclerotic risk factors, such as with statins, is recommended.
• Medication treatment
  • Medication cannot remove the aneurysm itself. Medications such as antihypertensive drugs and statins are used to manage symptoms and cardiovascular risks before and after surgery.
  • In hereditary defects (e.g., Marfan syndrome), beta blockers or ARBs (e.g., losartan) may be considered to inhibit aortic enlargement, at the specialist’s discretion.
• Surgical treatment (definitive treatment)
  • Resection of the aortic aneurysm and replacement with an artificial blood vessel through thoracotomy or laparotomy (open surgery).
  • If the anatomical conditions are suitable, insertion of an endovascular stent graft (percutaneous/endovascular treatment, EVAR/TEVAR) is possible — the hospitalization and recovery periods are shorter, but it cannot be applied to all lesions.
• Timing of surgery (general recommendations)
  • Abdominal aortic aneurysm: Surgery is generally considered when the inner diameter is at least 5.5 cm (adjusted according to the individual’s condition and comorbidities). Surgery is indicated when the annual increase is ≥0.5 cm/year or when symptoms occur.
  • Thoracic (ascending) aortic aneurysm: The criteria vary depending on the presence of symptoms and the cause. Surgery is considered when symptoms are present or the diameter is at least 6.0 cm; a lower threshold (e.g., 5.0 cm) is applied when a hereditary disease is present.
  • Descending and thoracoabdominal aortic aneurysms: Surgery is generally considered at ≥5.5 cm or in cases of rapid growth (≥1.0 cm annually).
• Follow-up observation
  • Monitoring with regular imaging tests (ultrasound, CT/CTA, MRI, etc.) according to the size and growth rate.

Checklist Before an Outpatient Visit (Including Preparation and Example Questions)

• Items and information to prepare
  • A list of medications currently being taken (prescription drugs, over-the-counter drugs, and supplements).
  • Records of previous surgeries and hospitalizations, and information about underlying diseases (hypertension, coronary artery disease, diabetes, etc.).
  • Results of previous imaging tests (ultrasound, CT, MRI), if possible including the images or reports.
  • A record of changes in symptoms (location, intensity, and onset of pain; syncope, dizziness, etc.).
  • Smoking history and family history (aortic disease, rupture, etc.).
• Items the doctor is likely to ask about during the outpatient visit (answers that are useful to prepare in advance)
  • The nature of the pain (whether it started suddenly, whether it is continuous, and whether it improves with rest).
  • Recent weight changes, presence of fever (suspected infection), and abnormalities in bowel movements or urination.
  • Exercise capacity, shortness of breath, and history of syncope.
• Precautions before testing
  • Kidney function testing (blood tests) may be necessary in preparation for the possible use of contrast media.
  • Be sure to inform the medical staff whether you are currently taking blood-thinning medications (anticoagulants or antiplatelet drugs).

Examples of General Questions to Ask the Doctor

• "What are the size and location of my aortic aneurysm, and how high is the risk of rupture?"
• "When will surgery (or stent insertion) be necessary, and what are the advantages and disadvantages of the surgery?"
• "Are there any medications I need to start immediately for treatment? What are their side effects?"
• "What will the interval between future imaging follow-ups be?"
• "What lifestyle factors should I pay particular attention to, such as exercise, smoking, or medications?"

Examples of Disease-Specific Questions

• "What are the diameter and annual growth rate of the aortic aneurysm on my imaging, and am I currently in a condition for which surgery is recommended?"
• "Is my anatomical structure (neck location and relationship to arterial branches) suitable for endoscopic or endovascular treatment (EVAR/TEVAR), and if so, what are the expected complications and the likelihood of requiring reintervention?"