aortic aneurysm

Aortic aneurysm refers to the local or generalized dilation of the aorta, with the diameter of the aorta being more than 50% larger than the normal diameter. Most aortic aneurysms occur below the level of the renal arteries. The main causes are atherosclerosis, trauma, infection, syphilis, congenital malformations, and aortitis. Aortic aneurysms are mostly solitary, with a very small number being multiple, and as the disease progresses, they can rupture, form abdominal wall thrombi, and lead to secondary infections.

Atherosclerosis

This is the most common cause and is more common in elderly males, with a male-to-female ratio of around 10:1. The main site is the abdominal aorta, especially between the origin of the renal artery and the bifurcation of the iliac artery.

Infection

Infection can be caused by common bacterial infections and specific bacterial infections such as tuberculosis, Brucella, etc. It often affects the thoracic aorta, and bacteremia from sepsis or endocarditis can lead to the spread of bacteria to the aorta.

Cystic Medial Necrosis

Cystic medial necrosis is a rare condition with an unknown cause. It involves the rupture of elastic fibers in the aortic media, replaced by acid mucopolysaccharides. It is mainly seen in ascending aortic aneurysms. Genetic diseases such as Marfan syndrome, Turner syndrome, etc., can also lead to cystic medial necrosis and the formation of a dissecting aneurysm.

Trauma

Penetrating trauma or direct impact on the aorta can cause aneurysms, which can occur at any site.

Congenital

Often due to genetic defects, congenital aneurysms mainly occur in the root of the aorta, and are more common in young and middle-aged individuals.

Others

Other causes include Behcet's syndrome, giant cell arteritis, and multiple aortitis.

Pain Symptoms: Pain symptoms are the result of nerve traction within the arterial wall due to its expansion, or due to the compression of surrounding tissues by the aneurysm. The nature of the pain varies, often being dull, but can also be severe and stabbing, and may be continuous or exacerbated by movement or breathing. The onset or exacerbation of pain indicates the expansion of the aortic aneurysm and an impending rupture.

Compression Symptoms: Compression symptoms are various functional disorders caused by the compression of various organs within the chest by the aneurysm.

In patients with thoracic aortic aneurysms, especially those with posterior wall or subclavian prominence, there is often some degree of dyspnea. Severe dyspnea may be due to compression of the trachea, bronchi (or superior vena cava). Improvements can be achieved by adopting a forward-leaning position of the chest. Coughing is a result of the stimulation of the trachea or bronchi due to compression. Severe compression can lead to partial or complete obstruction of the bronchi, causing bronchitis, bronchiectasis, lung collapse, or lung abscess.

Patients with aneurysms of the left subclavian artery may experience hoarseness or loss of voice due to compression of the vagus nerve.

Patients with aneurysms below the descending thoracic aorta may experience difficulty swallowing due to compression of the esophagus. In advanced cases, hemoptysis or hematemesis may occur, indicating that the aneurysm has ruptured into the respiratory or digestive tract. Such cases are often accompanied by severe shock and can lead to death if not promptly treated.

Patients with aneurysms of the descending thoracic aorta may experience numbness and tingling in the lower limbs, and even paralysis.

Aneurysms of the ascending aorta or aortic arch may lead to superior vena cava syndrome, compression of the trachea or main bronchi, esophagus, or recurrent laryngeal nerve.

Most patients with this condition can be cured. For those with milder conditions, timely diagnosis and standardized treatment can lead to a cure. However, for patients with large aortic aneurysms, complex anatomical conditions, or advanced age, surgical cure may not be possible.