Aortic disease is a form of peripheral artery disease that affects the aorta, the largest artery in the body. The most common problem in the aorta is called an aortic aneurysm. An aneurysm is a bulging out of the artery wall, caused by a weakened or diseased artery that stretches like a balloon under the pressure of blood pumped from the heart. Over time, these bulges grow in size, and without treatment, they may eventually rupture, causing massive internal bleeding that usually results in death.
Treatment for an aortic aneurysm depends on how large your aneurysm is and how quickly it is growing – indications of how likely it is to burst. Women with small aneurysms may simply be monitored to make sure the aneurysm is not becoming too large. Large or fast-growing aneurysms require immediate treatment to prevent a potentially fatal rupture.
Small Aortic Aneurysms
Small, slow-growing aneurysms that are not causing symptoms are unlikely to burst, and usually do not require immediate treatment. Instead, your doctor may recommend regular tests to monitor the aneurysm's size and see how quickly it is growing. This is often done if your aneurysm is smaller than 1.8 inches/4.5 cm in diameter in women (2 inches/5 cm in men).
Because not all aneurysms will ever become large enough to require repair, regular testing can avoid unnecessary procedures and keep you safe by detecting aneurysms that are at risk of bursting. See Monitoring an Aortic Aneurysm to learn more about what tests are used to monitor a small aortic aneurysm, and how often you should have them.
In the meantime, you will need to make healthy lifestyle changes and take medications to control your risk factors and slow the growth of the aneurysm. Steps you should take include:
- Working with your doctor to get your blood pressure under control – for most women, this will include treatment with high blood pressure medications.
- Working with your doctor to get your cholesterol under control. Your doctor may recommend cholesterol-lowering drugs such as statins.
- Eating a heart-healthy diet low in saturated fat and cholesterol. Get plenty of whole grains, fruits, and vegetables.
- Getting regular exercise – 30 minutes a day most days of the week. Talk to your doctor about how much physical activity is safe for you before starting an exercise regimen.
- If you smoke, get the help you need to quit. Avoid exposure to second-hand smoke.
- Maintaining a healthy weight, and losing weight if you are overweight or obese.
Large or Fast-Growing Aneurysms
If your aneurysm is causing symptoms, or if it is larger than 2.2 inches (5.5 cm) or expanding more than 0.4 inches (1 cm) a year, you will probably need a procedure to repair the aneurysm and prevent it from bursting. Because women tend to have smaller aortas than men do, a procedure may also be considered in women with aneurysms 1.8 inches (4.5 cm) or larger. These procedures can also be performed in an emergency in someone whose aneurysm has already burst, but a ruptured aortic aneurysm is often fatal.
If you need a procedure to repair an aortic aneurysm and prevent it from bursting, your main options are:
Also called "open" aneurysm repair, surgical aneurysm repair has long been the standard treatment to prevent aneurysms from bursting. During the procedure, an incision is made in your abdomen to reach the aneurysm. The surgeon will put a clamp above the aneurysm to stop blood flow, then open the aneurysm and remove any blood clots and fatty deposits. The diseased part of the aorta is then removed and replaced with an artificial graft that is the same size and shape as your healthy artery.
Endovascular Aneurysm Repair
A newer alternative to surgical repair, endovascular aneurysm repair is a less-invasive procedure that does not remove the aneurysm, but instead uses a stent graft to strengthen the artery wall from the inside. The stent graft is a fabric tube with a wire mesh skeleton that is placed in the aorta and seals to the walls above and below the aneurysm. As blood flows through the aorta, the pressure is absorbed by the stent graft, instead of pressing on the aneurysm and causing it to enlarge or burst. Over time, the aneurysm usually shrinks.
To learn much more about aneurysm repair procedures, including who should have them, how to decide which procedure is best for you, and what the procedure involves, see Aortic Aneurysm Repair.