Aortic aneurysm

The aorta is the largest vascular duct in the human body and has an additional role as a "secondary pump" during diastole, an important function that ensures coronary perfusion and more. The aorta is also involved in the control of systemic vascular resistance and heart rate through pressure receptors located in the aortic arch and descending segment.

What are aneurysms?

Aneurysms are permanent dilations of the vascular wall (in this case the aorta) that can affect any arterial segment (aortic root, aortic club, thoracic or abdominal aorta). Aortic aneurysms often develop asymptomatically, or with a poorly represented clinical picture, the manifestations becoming acute in the situation of rupture/dilatation frequently accompanied by the dissection of the artery.

What are the symptoms of aortic dilatation?

• Acute pulsatile pain with thoracic, abdominal or thoracoabdominal localization specific to the ascension of the ascending aorta / descending aorta;
• Cough with difficulty and painful swallowing in case of large thoracic aneurysms;
• Pain, discomfort and feeling full after eating small amounts in the case of large abdominal aortic aneurysms.

What are the causes of the disease

Risk factors for the development of aortic aneurysms include old age, uncontrolled hypertension, smoking, and poorly treated dyslipidemia.

Genetic diseases often cause aortic aneurysms but also have a wider involvement in the pathology of arterial vascularization. Marfan syndrome is the most common hereditary condition of the connective tissue with dominant transmission, involved in the occurrence of aortic aneurysms by mutation of a gene responsible for fibrillin synthesis (glycoprotein essential in the formation of elastin fibers of the aorta and connective tissue).

Treatment of aneurysms

The principles followed in the case of medical treatment of the disease are to keep under control the comorbidities frequently associated with aortic aneurysm: diabetes, high blood pressure, dyslipidemia, chronic coronary heart disease or chronic kidney disease.

The endovascular approach to the pathology is represented by TEVAR or the endovascular repair therapy of the thoracic vascular segment, through which the false aneurysm/lumen is removed following an aortic dissection, with the help of a stent.

From a surgical point of view, several methods have been devised to approach arterial dissection, including the technique of partial or complete bypass of the left heart in cases of descending aortic damage or the technique of reimplantation/remodelling by aortic annuloplasty in patients with aortic root aneurysm. Severe cases with extensive dissection of the thoracic and abdominal portion benefit from open surgical treatment with extensive aortic repair in an emergency.