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Introduction[edit | edit source]
Aortic aneurysm is a focal or diffuse dilatation of the aorta involving all three layers of the aortic wall. Most of the aneurysms are caused by atherosclerosis whilst trauma, infection and genetic syndromes are other causes.
Aortic aneurysms can happen anywhere along the length of the aorta, but they are most common in the lower part. This is called an abdominal aortic aneurysm. When they happen in the upper part of the aorta, in the chest, it is called a thoracic aortic aneurysm.
The bulge in the aorta happens when part of the blood vessel grows weak and expands under pressure. Aneurysms usually start small and then grow bigger as the pressure increases. They usually grow very slowly.
Sometimes aneurysms burst and cause bleeding inside the body. Because the aorta is such a large blood vessel, this can be very dangerous and is often fatal.
Risk Factors[edit | edit source]
You may have an increased risk of developing an aortic aneurysm because of
1. Age - The risk for aortic aneurysms goes up as you age. Abdominal aortic aneurysms are most common in adults after age 65
2. Family history and Genetics - Several familial or genetic conditions increase the risk for a thoracic aortic aneurysm. These include:
- Ehlers–Danlos syndrome
- Loeys–Dietz syndrome
- Marfan syndrome
- Turner syndrome
- Familial thoracic aortic aneurysms
- Bicuspid aortic valve (BAV), which is an abnormal aortic valve
- Abdominal aortic aneurysms also run in families.
3. Lifestyle habits - Some lifestyle habits increase the risk of having an aortic aneurysm. These include: Cigarette smoking; Using stimulants eg cocaine; Weight lifting.
4. Medical conditions - Medical conditions that are risk factors for aortic aneurysms include:
- Aneurysms of blood vessels in other parts of your body
- Chronic obstructive pulmonary disease (COPD)
- Cardiovascular conditions eg atherosclerosis, coronary artery disease, and peripheral artery disease
- High blood cholesterol
- Infection, a risk factor for thoracic aortic aneurysms.
- Kidney conditions eg chronic renal insufficiency, chronic kidney disease, and polycystic kidney disease
- Pheochromocytomaexternal link, a rare tumor of the adrenal gland that can lead to high blood pressure
- Trauma eg car accidents or falls.
Sex - Men are more likely than women to develop aortic aneurysms. However, an existing aneurysm is more likely to rupture at a smaller size in women than in men.
Clinical Presentation[edit | edit source]
An aortic aneurysm may not cause any signs or symptoms until the aneurysm ruptures or dissects. The types of symptoms that occur before a rupture will depend on the location of the aneurysm and whether it has become large enough to affect other parts of your body.
Image 2: Abdominal Aorta
An aneurysm that ruptures or dissects is life-threatening. Signs of a possible aortic aneurysm in the chest include:
- Pain in the chest or back
- Difficulty swallowing
- Difficulty breathing
- Coughing or being hoarse
If the aneurysm is in the abdomen, signs can include:
- Pain in the back Note: Low back pain is most commonly caused by a mechanical dysfunction, however, 1-2% of cases of low back pain are caused by non-mechanical spinal disorders or visceral diseases eg abdominal aortic aneurysm. 
- Deep pain on the side of the abdomen
- Throbbing feeling near the belly button
Diagnosis[edit | edit source]
Image 3: A ruptured AAA as seen on CTThere is no screening in Australia for aortic aneurysms. Often they are found when people see their doctor for something else, such as prostate problems or gallstones.
Different types of imaging studies may be used to diagnose an aortic aneurysm. The doctor may order some of the following imaging tests to confirm or diagnose an aortic aneurysm:
- Computed tomography (CT) to provide information about the location, size and shape of an aneurysm.
- Echocardiography to provide information about the size of the aortic aneurysm and about the thoracic aorta, which is close to heart.
- MRI to provide information about the size, shape, and location of the aneurysm
- Ultrasound to provide information about the size of the abdominal aortic aneurysm. In the cases of abdominal or back pain, an ultrasound can check for an abdominal aortic aneurysm or other possible causes the pain.
Treatment[edit | edit source]
Small aneurysms less than 5.5 cm across usually do not need treatment. This is a very scary diagnosis, and it certainly should be taken seriously, but the truth is that for most patients these aneurysms have been growing for quite some time – years in fact. So it’s important to relax, stay calm, avoid extreme stress, have regular checks.
Aneurysms larger than 5.5 cm across will probably need surgery because they are more likely to burst or if the aneurysm is smaller but growing quickly or causing other problems.
Until recently, the only treatment for an aortic aneurysm was open surgery, a major operation that replaces the faulty part of the aorta with an artificial blood vessel. Patients usually stay in hospital for 7 to 10 days and will spend some time in intensive care.
Some people may be able to have a stent inserted into the aneurysm through small cuts in the groin to strengthen the wall of the aorta (endovascular surgery). It is not suitable for all types of aortic aneurysm. Another possibility is to repair the aortic aneurysm via keyhole surgery.
Prevention[edit | edit source]
It is not possible to prevent an aortic aneurysm, but it is possible to stop it from growing. Persons with an aortic aneurysm should stop smoking and follow the doctor’s advice for keeping blood pressure down and treating hardening of the arteries.
Physical Therapy Management[edit | edit source]
Remember - Aortic aneurysm is the forgotten red flag of low back pain.
There is currently no conservative management to affect the progression of an aortic aneuryms but a physical therapist can provide education on risk factor reduction eg
- Avoiding stimulants, such as cocaine
- Heart-healthy eating
- Managing stress, which can help lower high blood pressure
- Quitting smoking, especially cigarette smoking, which is a leading risk factor for developing an aortic aneurysm
- Reduction of cardiovascular risk factors - eg improve cardiovascular fitness exercise (treadmill, cycle ergometer, stair climbing, elliptical training
Pre-operative physical therapy has also shown promising effects to decrease post aortic aneurysm surgery complication risks, but is still unclear why and requires further research.
Physical therapy with post surgical patients should focus on incisional site inspection and bronchial hygiene techniques to decrease incidence of pulmonary complications
Although an exercise test is typically not required before starting a low-intensity (<40% of heart rate [HR] reserve or o2peak) exercise program such as walking, for sedentary patients with aortic aneurysm interested in moderate- (40-59%) or vigorous-intensity (≥60%) exercise (brisk walking and jogging) it is prudent to receive medical clearance before engaging in such, which might include completion of an exercise stress test.
Cardiac rehabilitation (CR) programs have been broadening their referral base in recent years to include patients other than those with coronary heart disease. Patients with concurrent AAA or TAA, diagnosed or undiagnosed, participate in CR to an unknown degree. Patients with isolated small AAA or TAA are good candidates for CR programs.
References[edit | edit source]
- ↑ Radiopedia Aortic Aneurysm Available: https://radiopaedia.org/articles/aortic-aneurysm-1 (accessed 19.9.2021)
- ↑ 2.0 2.1 2.2 2.3 Health direct Aortic Aneurysm Available:https://www.healthdirect.gov.au/aortic-aneurysm (accessed 19.9.2021)
- ↑ 3.0 3.1 3.2 NIH Aortic Aneurysm Available: https://www.nhlbi.nih.gov/health-topics/aneurysm (accessed 19.9.2021)
- ↑ https://www.physio-pedia.com/Low_Back_Pain_or_a_silent_killer_(AAA)-_A_case_Study?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal
- ↑ Heart Valve Surgery Surgeon Q&A: Top 6 Facts About Aortic Aneurysms & Heart Valve Disease Available:https://www.heart-valve-surgery.com/heart-surgery-blog/2017/09/28/top-facts-aortic-aneurysms-eric-weiss-dr/ (accessed 19.9.2021)
- ↑ Slide share Aortic aneurysm and low back pain ... The forgotten red flag Available: https://www.slideshare.net/TaylorAlanJ/aortic-aneurysm-and-low-back-pain (accessed 19.9.2021)
- ↑ Physiopedia Abdominal Aortic Aneurysm Available: Abdominal Aortic Aneurysm (accessed 19.9.2021)
- ↑ Ehrman JK, Fernandez AB, Myers J, Oh P, Thompson PD, Keteyian SJ. Aortic Aneurysm: Diagnosis , management, exercise testing and training Journal of Cardiopulmonary Rehabilitation and Prevention. 2020 Jul 1;40(4):215-23.Available: https://journals.lww.com/jcrjournal/Fulltext/2020/07000/Aortic_Aneurysm__DIAGNOSIS,_MANAGEMENT,_EXERCISE.3.aspx (accessed 19.9.2021)