Causes
An aneurysm occurs due to a weakening of the blood vessel wall. The exact mechanism of development is often unclear, but there are several risk factors that can negatively affect the condition of the aortic wall and consequently increase the likelihood of an aortic aneurysm.
Risk Factors:
1. Modifiable Risk Factors
These are risk factors that can still be influenced, allowing you to reduce the risk of cardiovascular diseases.
- Atherosclerosis (caused by factors such as high blood pressure, LDL cholesterol, diabetes, and smoking) is the most common cause of an aortic aneurysm.
- Excessive alcohol consumption
- Unhealthy diet (high in fats and sugars)
- Overweight (obesity)
- Lack of physical activity
2. Non-modifiable Risk Factors
These are risk factors that you cannot change yourself.
- Age and Gender: As you age, the likelihood of developing an aortic aneurysm increases. From the age of 65, the risk of an aneurysm is higher in men than in women.
- Diseases
- Hereditary connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome) can affect the aortic wall.
- Congenital heart defects such as a bicuspid aortic valve (an aortic valve with two instead of three leaflets) or a narrowing of the aorta (coarctation of the aorta).
- Aortitis is an inflammation of the aorta caused by an infection (e.g., salmonella, HIV) or an autoimmune disease (e.g., rheumatoid arthritis, psoriasis).
- Family history: A family history of aneurysms in first-degree relatives increases your risk of developing an aortic condition.
Symptoms
An aortic aneurysm often develops unnoticed and does not cause symptoms in most people. As a result, it is often discovered by chance (e.g., during a CT scan or chest X-ray). In some cases, vague symptoms may appear when the aneurysm becomes very large and presses against surrounding structures such as nerves or organs.
Examples include:
- Hoarseness (if the aneurysm compresses the nerve to the larynx)
- Shortness of breath (if the aneurysm presses against the trachea)
- Difficulty swallowing (if the aneurysm pushes against the esophagus)
- Pain or a pulsating sensation in the back or abdomen
- Sudden coldness, pain, or numbness in the foot or leg (claudication intermittens)
Treatment
Indication
International guidelines and studies indicate that surgery for an aortic aneurysm is recommended once a certain diameter is reached. This threshold depends on the location of the aneurysm, gender, age, and any underlying conditions.
Surgery is performed to prevent major complications (e.g., aortic rupture or dissection), but it is never without risk. Therefore, the risk of not operating must always be weighed against the surgical risk.
Surgery is more likely to be considered if:
- The patient experiences symptoms.
- The aortic aneurysm is growing rapidly.
- The aneurysm is asymmetrical or sac-shaped (saccular).
- Vascular or heart surgery is already planned (e.g., aortic valve replacement). In such cases, the aneurysm can be treated simultaneously.
- An underlying disease (e.g., Marfan syndrome, bicuspid aortic valve) increases the risk of complications such as aortic rupture.
- There is a family history of aortic diseases or sudden death.
- The patient has a desire for pregnancy.