The aorta, which is the largest artery in the body, runs from the heart through the diaphragm and into the abdomen. It carries oxygen-rich blood from the heart to the rest of the body. The aorta is a lot like a garden hose, able to cope with small trickles of water just as well as the fast rush and pressure of the tap fully turned. And just like a hose, the aorta can become damaged or overstretched. Any weakness in the aorta can become filled with blood, causing a bulge that stretches the already thinned walls of the aorta. This bulge is called an aortic aneurysm, either a thoracic aortic aneurysm (if located in the chest) or an abdominal aortic aneurysm (if located in the abdomen). A rupture can cause serious bleeding.
How the aorta works
The aorta rises from the left ventricle of the heart, then arches upward and down behind the heart and through the chest and stomach. It branches off into iliac arteries, which provides blood to the legs and pelvis. The aorta’s job is to carry recycled oxygen-rich blood from the heart to the rest of the body. The aorta is elastic, to accommodate the changes in the flow of blood. When the heart beats faster, like after a workout or before an important presentation, more blood is pumped (more quickly) through the blood vessels. When we’re sleeping, less blood is sent through the various pipes that make up the circulatory system. Since the aorta is the largest artery in the body, it contains a lot of blood, and if you’ve seen an episode or two of “CSI” you’ll know that severing any artery can kill a person quickly. There is no treatment that will work fast enough if the mother of all arteries, the aorta, ruptures.
A chink in the armor
An aortic aneurysm occurs when there is a weak spot in the aorta, creating a bulge as blood collects against the fragile wall, just like a balloon slowly fills with water. If too much blood is in this stretched-out part of the aorta, it will burst, exactly like a water balloon that exceeds its capacity. But it’s not water that flows out of the aorta—it is the liquid essential to life: blood. Aortic aneurysms can be caused by the hardening of the arteries (atherosclerosis), preexisting genetic conditions (such as Marfan’s Syndrome or Ehlers-Danlos Syndrome), aging, infections in the lining of the heart (endocarditis), injury and inflammation. Abdominal aortic aneurysms are much more common than those in the thorax.
Reinforcing the walls of the aorta
As with most heart-related diseases, lifestyle changes are the first recommendation in treating aortic aneurysms. It is important to maintain a healthy weight with regular exercise, and to avoid smoking and being around people that do. Because higher blood pressure can cause the aneurysm to rupture, it is essential to maintain a healthy blood pressure, with the help of medication if necessary.
The last resort in the treatment of an aortic aneurysm is surgery, but because it carries so many risks, it is important to carefully weigh the pros and cons of the procedure. Often surgery is carried out if the risk of going without is higher than the operation itself, especially with an aneurysm that is quickly expanding or at risk of rupturing.
There are two types of surgery currently used to treat aortic aneurysms: traditional open-heart surgery or endovascular repair. In the traditional surgery the chest is opened, the diseased aorta is removed, and a replacement—usually a man-made graft--is attached. In the endovascular repair, a tube with a stent is inserted into the groin and up to the damaged aorta, creating a bridge between the healthy parts of the vessel. Though the latter method is less invasive, its long-term effects have not yet been studied.
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