103 of 126
Aortic Aneurysms (AA)
Clinical Presentation: Often asymptomatic Patient may be aware of a pulsatile mass (especially if abdominal aorta is involved) Patient may have symptoms caused by compression of other structures by the aneurysm…examples:
Back pain (erosion of the vertebrae by large abdominal aneurysm)
Dysphagia/hemoptysis/respiratory problems (esophagus or trachea compressed by thoracic aneurysm)
Hoarseness (stretching of the left recurrent laryngeal due to aortic aneurysm)
Heart failure (aortic regurgitation from dilation of the aortic ring by aneurysm of the ascending thoracic aorta)
Physical Findings: Aneurysms of the abdominal aorta may be discovered by careful abdominal palpation – one would feel a large, pulsatile mass.
Aortic aneurysms most often seen incidentally on chest or abdominal x-rays, especially if the aneurysm’s walls are calcified.
Etiology and Pathogenesis: Atherosclerosis is implicated in approximately 90% of abdominal aortic aneurysms.
Atherosclerosis more common in descending aorta than ascending portion.
Atherosclerotic aneurysms rarely develop before age 50 and are more common in men
development is accelerated by smoking, hypertension, dyslipidemia (and other factors that predispose to
atherosclerosis in general)
Ascending aortic aneurysms are uncommonly atherosclerotic; instead they are related to cystic medial degeneration.
cystic medial degeneration (aka cystic medial necrosis) involves degeneration and fragmentation of elastic
fibers – w/ later accumulation of collagenous and mucoid material in the medial layer.
This condition affects ascending aorta due to greatest pulsatile expansions happening there
Medial degeneration can also happen with connective tissue disorders:
Medial degeneration can happen in response to hypertension and aging.
Pseudoaneurysm: may develop at sites of vessel injury caused by infection or trauma (puncture of vessel during surgery or percutaneous catheterization)
Vessel wall can also be weakened by the likes of: syphilis, TB, staph, strep, salmonella, inflammatory diseases, genetic defects of connective tissue fibers (approx 5-10% of patients have an affected first-degree relative)