Aorta is a large artery that carries oxygenated blood from the heart to supply various organs throughout the body. It starts from the heart’s base, ascends to the top of the chest, then curves backward alongside the spine in the thoracic cavity, passes through the diaphragm into the abdominal cavity, before branching into arteries that supply both legs and pelvic organs.
The importance of the aorta is comparable to a main water pipe that provides branches to supply vital organs such as the heart, brain, spinal cord, arms, legs, and abdominal organs including the liver, kidneys, and intestines. Therefore, any pathology or abnormality in the aorta can affect various organs. If the aorta aneurysm ruptures, it can be fatal.
Symptoms of Aortic Aneurysm
Many patients may have no symptoms beforehand and may only be incidentally detected through chest X-rays or by feeling a pulsatile mass in the abdomen. Patients with thoracic aortic aneurysms may experience symptoms from compression of adjacent organs, such as airway compression causing difficulty breathing, esophageal compression causing difficulty swallowing, or nerve compression supplying the vocal cords causing hoarseness.
Common symptoms also include chest tightness, back pain, dizziness, loss of consciousness, or coughing up blood. Any symptoms, whether pain or those caused by compression of adjacent organs by the aortic aneurysm, indicate that the aneurysm is about to rupture or has already ruptured, which has a mortality rate of nearly 100 percent. Those with risk factors such as high blood pressure, heavy smoking, and emphysema are all factors that accelerate aneurysm growth and eventual rupture.
Diagnosis of Aortic Aneurysm
Doctors diagnose by taking a history, physical examination, and additional investigations such as chest or abdominal X-rays, ultrasound, and computed tomography (CT Scan).
Treatment Guidelines
Regarding treatment, since aortic rupture can result in a mortality rate of 50 to 90%, the risk of rupture is related to the size of the aorta. The larger the artery, the higher the risk of rupture. High blood pressure increases this risk. Therefore, treatment begins with blood pressure control, smoking cessation, avoiding straining during bowel movements, and may include surgical intervention.
Currently, there is an innovative non-surgical treatment by inserting a stent graft to replace the aneurysmal aorta in the chest or abdomen (TEVAR + EVAR). This is a stent graft with a coil that is inserted through the femoral arteries on both sides up to the aneurysmal aorta and then expanded to keep blood flow from contacting the diseased artery wall, preventing rupture. This is a new option for patients at high risk for major surgery, reducing wound size, mortality, and surgical complications.
Assoc. Prof. Dr. Kittichai Luangtaweeboon
Cardiovascular and Thoracic Specialist
Heart Center, Phyathai 1 Hospital
