Aortic aneurysm

Methodist Heart and Lung Institute Aortic Center, a facility of Methodist Healthcare located within Methodist Plaza, offers advanced specialty heart services for patients throughout Greater San Antonio with an aortic aneurysm. Our cardiologists perform the most current heart and vascular surgeries and offer comprehensive treatments for both abdominal and thoracic aortic aneurysms.

To learn more about treatments we offer for vascular conditions, call Methodist Healthcare at (210) 575-5506.

An aortic aneurysm is an abnormal enlargement of the wall of the aorta that causes the walls to weaken. Aneurysms can occur anywhere along the aorta, and fall into two categories:

• Abdominal aortic aneurysm — This type of aneurysm occurs through the portion of the aorta that passes through the abdomen.
• Thoracic aortic aneurysm — This type of aneurysm occurs through any portion of the aorta that runs the entire length of the chest, which supplies blood to structures in the chest. The aneurysm usually grows slowly and does not present with symptoms, which can make it very challenging to detect.

The wall of the aorta can continue to enlarge or remain unchanged. It is important to monitor aortic aneurysms closely. If the bulge continues to grow, the wall can become weakened and cause tearing, or dissection, and life-threatening bleeding.

Because aortic aneurysms take a long time to develop, symptoms are rarely felt until they become serious health concerns. Symptoms usually manifest when the aneurysm compresses on surrounding structures and can cause:

• Back pain
• Chest pain
• Cough
• Difficulty breathing
• Difficulty swallowing
• Hoarseness

You may be experiencing a tearing of the aorta if you are experiencing:

• Dizzy or generally feeling unwell
• Nausea and vomiting
• Pain in the jaw and neck
• Raising heartbeat
• Sudden chest pain or back pain

Other signs and symptoms that suggests aneurysm rupture, or burst, include:

• Loss of consciousness
• Low blood pressure
• Signs of stroke
• Weakness/difficulty speaking

If you are experiencing symptoms related to tearing or rupturing of an aneurysm, call 911 and seek medical care at your nearest emergency room.

Due to its lack of definitive symptoms, many aortic aneurysms are found during an examination of a different condition. For example, an aortic aneurysm may be found during a chest X-ray or an ultrasound of the heart. If your doctor suspects you may have an aortic aneurysm forming, specific diagnostic tests can be performed for confirmation, including:

• Abdominal ultrasound
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)

The goal of treatment is to prevent an aneurysm from growing or rupturing. Medication and monitoring are important interventions prior to surgical repair. Monitoring may require regular imaging studies to detect the rate of growth of the aneurysm. A CT scan or magnetic resonance angiogram (MRA) should be conducted every six months depending on cause, size and rate of growth of the aneurysm. Medications may be prescribed to help control blood pressure and reduce cholesterol levels.

Surgery is recommended based on the size and location of the aneurysm and its rate of growth. Surgical repair is generally recommended if your thoracic aortic aneurysm is between five or six centimeters or larger. Patients with Marfan syndrome or other connective tissue diseases, who have a higher risk of having an aortic dissection, may need to undergo repair for smaller-sized aneurysms.

Surgical treatments may include:

• Endovascular aneurysm repair (EVAR) — Sometimes, a vascular surgeon will suggest that you get a stent graft for your aneurysm if it has not ruptured. An endovascular stent graft is a tube composed of fabric supported by metal mesh that strengthens the weakened section of your artery. This allows blood to flow normally through the artery without putting pressure on the bulge, eliminating the risk of the aneurysm rupturing.
• Open-abdominal procedure — This procedure involves making an incision above the aneurysm site and temporarily clamping the artery above the aneurysm to stop blood from flowing through the enlarged area. The surgeon then carefully opens up the aneurysm and removes the clotted blood and plaque deposits. After drainage is complete, the surgeon may insert an organic or man-made graft to strengthen the artery wall.

The Methodist Heart and Lung Institute Aortic Center offers serves all of South Texas by providing patients treatment plans from critical to advanced therapy measures to those who have been diagnosed with an aortic aneurysm to reduce the need for surgery.

Each patient will have a specific treatment plan provided based upon their stage of aneurysm and their medical history. It will take on average about two to three months to achieve full recovery after undergoing ascending aortic aneurysm/dissection or arch surgery. Your surgeon will advise you to plan to be away from work for six to eight weeks with some post-operative restrictions for activities. We encourage participation in a cardiac rehabilitation program during your recovery period. Arrangements can be made for these services prior to your discharge home.

Remember to make lifestyle changes even after surgery such as eating well and subscribing to a healthy diet, smoking cessation and engaging in moderate physical activity. There are no medications to prevent the development of an aortic aneurysm but controlling blood pressure and cholesterol levels may reduce the risk of complications from an aortic aneurysm.

The surgeon will follow up with you three, six and nine months after your surgery, then decrease visits and have your primary care physician or cardiologist continue the follow-up care. Postoperative restrictions will differ from person to person, but your surgeon will advise you on any restrictions before discharge. Some lifestyle choices that are typically recommended include:

• Cardiac rehabilitation
• Daily walking
• Eating healthy, including incorporating fruits, vegetables and whole grains
• Eliminating smoking and alcohol usage