DR MILES DALBY
MBBS BSc MD FRCP FESC
Arterial disease usually causes narrowing (stenosis) of arteries due to atherosclerosis. Arteries can also bulge or dilate causing enlargement (aneurysm). Aneurysms of the aorta which is the main artery in the chest and abdomen can occur in a number of locations. They are often small, slow growing and can be managed conservatively in the first instance. If they become large however they can carry a risk of rupture and death. It is important therefore that if aortic aneurysms are discovered incidentally or through a screening program that appropriate investigations, treatment and follow up are put in place.
Aortic Root Aneurysm
This is a specific kind of aortic aneurysm in the chest which occurs at the base of the aorta-just above the aortic valve of the heart. Like other aortic aneurysms if it becomes large it may need intervention.
Although aortic root aneurysms are not routinely screened for, they are sometimes found incidentally during a cardiac ultrasound (echocardiogram) cardiac CT scan or MRI scans.
National Heart Lung and Blood Institute
Ascending, Arch and Descending thoracic aortic aneurysms
Above the aortic root the aorta extends upwards toward the neck then forms an arch, giving off blood vessels to the head and then descends back toward the diaphragm and into the abdomen. Aneurysms in this part of the aorta do occur and can sometimes involve major side-branches. Although ascending, arch and descending thoracic aortic aneurysms are not routinely screened for, they are sometimes found incidentally during CT scan or MRI scans.
Abdominal aortic aneurysm
Abdominal aortic aneurysm (AAA) is a bulging of the main artery in the abdomen. As with other aneurysms AAA develops over many years and if found through screening it can be monitored and often managed conservatively. Screening for AAA has been shown to be of benefit in certain patient groups and as such forms an important part of an overall cardiovascular screening program. The abdominal aorta can be scanned in detail using ‘body scans’ such as CT and MRI which give a very accurate assessment however AAA can also be screened for using simple abdominal ultrasound.
Management of aortic aneurysm
The risk posed by aortic aneurysm depends on a number of factors, including location, size, rate of growth, family history, abnormalities of the connective tissue and blood pressure. Once such an aneurysm is identified an assessment will usually involve a clinical assessment with CT or MRI scan and sometimes cardiac ultrasound if they have not already been done. An ongoing management plan will include optimal blood pressure control, serial imaging and sometimes genetic tests. In some cases, physical intervention will be recommended to treat the aneurysm with either a transcatheter technique such as stenting or an open surgical approach.
Dr Dalby will discuss these tests, their implications and any subsequent tests, treatment or follow up with you so that you may reach a mutually agreeable management plan.