More and more Thai people suffer from aortic aneurysm each year.

The walls of the aorta consist of three layers. When you get older, fat accumulates in the inner layer of the aortic walls, thereby causing the walls to lose their elasticity. Eventually, they might rupture with deep wounds expanding into the outer layers until another rupture occurs to the point that blood can flow out of the circulatory system, which is life-threatening. Degeneration in the middle layer of the aortic walls can also cause it to weaken and become distended and, upon rupture, can lead to rapid blood loss and death.

 

Furthermore, certain genetically-transmitted diseases contribute to the weakness of the aortic walls. These include Marfan Syndrome, which is transmitted by a dominant gene. This means that the gene, if acquired from a mother or father, can suppress the normal gene, irrespective of the patient’s sex, and both men and women are equally likely at acquiring it.

 

1. Patients less than 30 years old often have genetic causes and are less frequent than the other group.

2. Patients older than 50 years often have hypertension and experience weakening of the walls of their aorta.

 

 

1. Aortic aneurysm; and

2. Aortic dissection.

 

This group is divided according to the site of aneurysm, namely, between the chest and abdomen. The disease commonly occurs in elderly people. Bulging causes the aorta to gradually become enlarged, and the larger it becomes, the more quickly it bulges. Finally, the aortic walls tear and cause the aorta to rupture, leading to heavy loss of blood in a short time and the death of the patient.

 

Before the aorta becomes significantly enlarged, the patient will experience no symptoms. It is only when the aorta is about to burst or after it has ruptured that symptoms will occur, such as chest pain, back pain and abdominal pain, depending on the location of the aneurysm. The symptoms can result from pressure on adjacent organs such as on the bronchi, which can cause fatigue and loud breathing, or the esophagus, which causes swallowing difficulty and blood vomiting. In addition, pressure on the lungs can cause bloody coughs, and pressure on the spine can cause back pain and hip pain, while pressure on large veins can lead to swelling on both legs.

 

If there is an infection of the aorta, symptoms such as fever and chills might occur, along with blood infection. The condition can be diagnosed via chest x-ray, abdominal ultrasound and computer x-ray of the aortic aneurism.

 

Patients who experience an aneurysm that develops to a large size such as 5-6 centimeters or an aneurysm that grows more rapidly than 5 millimeters within 6 months should receive treatment even if they are asymptomatic, because they face greater risk of rupture, and treatment alternatives cannot certainly prevent rupture. If any of the symptoms occur, greater urgency is required to save the patient’s life. Patients with significant pain and low blood pressure need emergency treatment, while patients experiencing pain but who have normal blood pressure have to be hospitalized and treated for 1-2 days, due to the ever-present and unpredictable risk of rupture.

 

 

Cases where aortic dissection occurs are rupturing of the inner layer of the aortic walls. Although the causes of rupture remain uncertain, sometimes a rupture occurs following  injury during heart surgery. A common site of rupture is the section of the aorta that is connected to the heart, while another common site is the descending section of the aorta inside the chest cavity, usually occurring more on the left side than the right side of the chest.

 

Meanwhile, dissection by blood penetrating into the middle layer occurs along the length of the aorta from the heart descending down to the abdomen. Blood flowing along the walls might cause the outer layer to rupture, leading the patient to die as a result of bleeding through the circulatory system. Otherwise, the aorta might be subjected to pressure that prevents it to properly supply the body, or dissection can cause blockages at different branches of the aorta, leading to ischemia developing in the organs that receive blood supply from these arteries.

 

If it occurs at the heart, acute coronary syndrome can occur, leading to brain paralysis, ischemia in the small intestines and then necrosis of the intestines. It can cause rapid death in patients, with very low likelihood of survival due to the absence of warning symptoms, making screening very important.

 

Apparently, this disease has no warning symptoms. It occurs instantly and very quickly and causes intense pain and rapid fatality. Approximately 25% of patients die within the first 24 hours if they are undiagnosed and do not receive treatment in time.

 

Symptoms begin with intense pain in the chest and back that develops suddenly as if a tear has occurred in the body, spreading to the back, abdomen and both legs. The pain might be so intense that the patient loses consciousness. Diagnosis is performed by computer x-ray, and patients are divided into two major groups. The first group consists of patients who experience aortic rupturing at a site adjacent to the heart. This group experiences more severe symptoms and require open heart surgery for treatment by replacing the section of the aorta connected to the heart with an aortic replacement. Then the patient will be safe. As for the second group, tearing occurs in thoracic section of the aorta. Meanwhile, there is a third group that develops the condition in the descending section of the aorta, which is less severe, but it is still dangerous due to risk of aortic rupture or obstruction of blood supply to different organs. The treatment for this group involves insertion of an aortic replacement with stent via a femoral artery to expand them and seal the site of rupture of the inner wall. As a result, blood will no longer dissect the walls, and control of the disease will be achieved, thereby preventing additional tearing of the aortic walls. 

 

Today, aortic aneurysm can be treated by open surgery and by aortic stent graft.

 

This treatment can be performed on any location where the disease occurs. Although the surgical wound might be wide in the initial stages, and it might be necessary to open up the chest cavity along with the ribs and abdomen, with a longer operation time and more bleeding and possibility of complications, success is long lasting.

 

This treatment option is effective for the descending section of the aorta in the chest and the abdominal section of the aorta below the veins of the kidneys. The initial prognosis is good, with less risk for patient injury and faster recovery time, which allows the patient to return to normal living more quickly. However, the stent graft can move out of place, thus causing blood to potentially flow back to the site of the aneurysm, so the risk of rupture remains even after treatment. As a result, this treatment requires computer x-ray follow-ups by at least once each year for the rest of the patient’s life.

 

Accordingly, aortic replacements are made from durable synthetic materials that can last and remain usable with the patient lifelong, with few chances for infection and low risk of blood clots causing aortic obstruction, even when the patient is not taking an anticoagulant or antiplatelet medication.