What are Aortic Aneurysm and Aortic Dissection? How Dangerous Are They?
Aortic Aneurysm and Aortic Dissection are conditions affecting the aorta, the main artery that carries blood from the heart to various parts of the body. These two conditions have different characteristics and severities as follows:
- Aortic Aneurysm is a condition where the wall of the aorta weakens and expands like a balloon, which may lead to complications as follows:
- Rupture of the aortic wall causes sudden internal bleeding, which can be life-threatening.
- Turbulent blood flow may occur in the aneurysm area, leading to blood clots that can dislodge and block blood vessels in the brain, causing stroke, or block vessels in the legs, potentially causing tissue death.
- If the aneurysm is large, it may press on nearby organs or nerves, causing symptoms such as difficulty breathing, hoarseness, back pain, or abdominal pain, depending on the location.
- Aortic Dissection is a condition where the inner layer of the aortic wall tears, allowing blood to flow between the layers of the wall, creating a new blood channel inside, which can cause complications as follows:
- The new blood channel from the dissection may compress the original blood flow, leading to insufficient blood supply to organs, causing conditions such as stroke, heart muscle ischemia, intestinal ischemia, or acute kidney failure.
- If the dissection occurs near the heart, blood may leak into the pericardial sac and compress the heart, preventing it from contracting normally.
- Dissection near the aortic valve may cause valve leakage, resulting in excessive backflow of blood into the left ventricle, potentially leading to acute heart failure.
- Rupture or tear of the aortic wall causes sudden internal bleeding and may lead to rapid death. Common sites for aortic aneurysm and dissection are:
Although aortic aneurysm and aortic dissection are less common than heart disease or stroke, they are severe and can be life-threatening if not diagnosed and treated promptly, especially in acute aortic dissection cases.
Both conditions can occur in the thoracic aorta and abdominal aorta. Risk factors include advanced age, high blood pressure, smoking, atherosclerosis, or genetic disorders affecting the blood vessel walls, such as Marfan syndrome.
Methods for Diagnosing Aortic Aneurysm and Aortic Dissection
Overall, the diagnosis of both aortic aneurysm and aortic dissection, whether in the chest or abdomen, relies on similar basic principles but with different details and tools as follows:
- Medical history The doctor will ask about symptoms, pain characteristics, and personal risk factors.
- Physical examination Blood pressure is measured in both arms to assess differences, which is an important and common sign in aortic dissection. The doctor will listen to the heart and blood vessels, palpate pulses in the arms, legs, and feet, feel for a pulsatile mass in the abdomen, assess for shock signs such as cold skin, sweating, low blood pressure, abnormal rapid heartbeat, and confusion, indicating severe blood loss or circulatory failure, and examine the nervous system for weakness, numbness, or changes in consciousness.
Differences in Diagnostic Tools for Thoracic and Abdominal Aorta
Examination of the thoracic aorta is usually performed in patients with chest pain or difficulty breathing. In addition to chest X-ray and ECG, important specialized tests include:
- CT Angiography (CTA) Chest with Aorta Protocol: The primary method for diagnosing thoracic aortic conditions, providing detailed 3D images from the neck down to the diaphragm, clearly and accurately showing aneurysms and dissections.
- Transesophageal Echocardiogram (TEE): A crucial method for detecting aortic dissection in the chest, especially Type A (near the heart), as it provides clear images and can be performed bedside in emergencies.
Examination of the abdominal aorta focuses on screening high-risk groups and monitoring aneurysm size. In addition to initial screening with abdominal ultrasound, important specialized tests include:
- CT Angiography (CTA) Abdomen and Pelvis: The main method for diagnosing abdominal and pelvic aortic conditions, providing detailed images covering the entire abdominal aorta and branches supplying the kidneys and intestines, important for treatment planning.
- Magnetic Resonance Angiography (MRA): Similar role to CTA in the abdomen but used for patients who cannot receive contrast agents, such as those with kidney failure or contrast allergies.
What are TEVAR and EVAR Treatments and How Do They Differ?
TEVAR (Thoracic Endovascular Aortic Repair) and EVAR (Endovascular Aortic Repair) are minimally invasive treatments for aortic aneurysm or dissection using catheter insertion instead of open surgery. These methods reduce injury, speed recovery, and lower complication risks. The difference lies in the location of the aorta treated as follows:
- TEVAR treats the thoracic aorta, especially the descending aorta in the chest behind the heart. The doctor inserts a catheter with a stent graft (a tube-like device supporting the vessel) through the femoral artery in the groin, advancing it to the affected area. Once in position, the stent is deployed to create a new blood channel inside the original vessel. The graft blocks blood from entering the aneurysm or tear, reducing pressure and the risk of rupture.
- EVAR treats the abdominal aorta, which supplies blood to vital organs such as the kidneys, intestines, and legs. The procedure is similar to TEVAR, with the catheter and stent graft inserted via the femoral artery and deployed at the problem site to create a new blood channel, block blood flow into the aneurysm or tear, reduce pressure, and lower rupture risk.
Preparation Before TEVAR and EVAR Procedures
Proper preparation before TEVAR and EVAR is crucial for safety and treatment effectiveness. Preparation includes:
- Health assessment such as underlying diseases, medications, drug allergies, food allergies, and contrast agent allergies.
- Stop smoking 3-6 weeks before the procedure to reduce circulatory system impact and complication risks.
- Fasting for at least 6-8 hours or as directed by the doctor to prevent aspiration during anesthesia.
- Skin preparation may include shaving the groin or incision area to reduce infection risk. In some cases, the doctor may advise a relative with the same blood type to donate blood in advance for emergency use.
- Plan to take at least 2-4 weeks off work or strenuous activities to allow full recovery after the procedure.
- Have a relative or companion on the procedure day for support and care.
Self-Care After TEVAR and EVAR Treatment
After TEVAR and EVAR, patients should properly care for themselves to promote recovery by following these guidelines:
- Keep the catheter insertion site dry by using waterproof dressings every time you shower.
- Start moving slowly as advised by the doctor, such as turning, sitting up, or light walking to stimulate blood circulation and reduce complication risks.
- Patients may feel fatigued during the first 1-2 weeks and should get adequate rest.
- Avoid driving for at least 2-3 weeks and avoid heavy physical activities, heavy lifting, or strenuous exercise for at least 3 months or until the doctor permits.
- Avoid high-fat, very sweet, and very salty foods, and limit alcohol consumption.
- Maintain a relaxed mind as stress can affect blood pressure, heart, and blood vessels.
- Take medications as prescribed and use pain relievers as recommended by the doctor.
- If abnormal symptoms occur, such as fever, severe wound pain, swelling, redness, or pus discharge, see a doctor immediately.
- Follow up regularly as complications like endoleak (continued blood flow into the aneurysm sac outside the stent graft) may be asymptomatic but detectable by CT scan or ultrasound for timely treatment.
Aortic aneurysm and aortic dissection often show no symptoms in early stages. Timely diagnosis and treatment with advanced technology can reduce dangerous complications and mortality.
At Phyathai Phaholyothin Hospital, there is a specialized cardiovascular medical team with advanced treatment technologies such as TEVAR and EVAR. Comprehensive services are provided from diagnosis, treatment planning, to close post-procedure care to ensure patient safety and restore quality of life.
Dr. Ongkarn Komsan
Cardiologist
Phyathai Phaholyothin Hospital
