medic Al
Q&A
Aortic Aneurism
Q
:
I have a friend who nearly died from an aortic aneurism that burst. She was only 31. What are the major risk factors for
Dr. phil
parker
aortic disease? Is it different from heart disease? Can someone know
they have it before disaster strikes? And how is the FAA going to treat you after a repair
is done (if you are lucky enough to have a tear or aneurism diagnosed before it kills you)?
I’m glad you asked as this will give me a chance to address
one of the most common, but difficult questions in medicine,
The aorta is the main artery through
which blood is pumped out of the heart
to the rest of the body. It arches up out
of the heart and then down through the
abdomen splitting off to both legs. A
number of branches come off to supply
the brain, organs, and rest of the body.
Aneurysm is simply a weakness in the
wall of the aorta allowing it to balloon
out much like an old water hose. If that
ballooning gets large enough, there
is increased risk for potentially cata-
strophic rupture and internal bleeding.
In general, most people are concerned with either dilation of
the aorta as it exits the heart, known as ascending aortic an-
eurysm, or with dilation of the aorta in the abdomen, also
known as abdominal aortic aneurysm.
Ascending aortic aneurysms are more common in males,
those over 55 years of age, those with hypertension, smok-
ers, and those with inherited diseases causing weakness of
the blood vessels such as Marfan’s Syndrome. We typically
see these detected during evaluation for murmur with associ-
ated aortic valve disease, but can be caused by trauma or de-
generation of the aorta wall. One such type of degeneration
called cystic medial necrosis (CMN) may lead to additional
problems even after repair. As such, the FAA has been resis-
tant to waiver aircrew that have CMN confirmed during their
aortic aneurysm repair.
I suspect your question is actually in regards to the more
common abdominal aortic aneurysm (AAA) which occurs
seven times more often in men than women and mostly in
those older than 65 years of age, those who have other vas-
cular disease, those who have first-degree relatives with an
AAA. It is often associated with a history of smoking, high
blood pressure, or chronic obstructive pulmonary disease
(COPD), and has been estimated as the thirteenth leading
cause of death in the U.S. AAA is esti-
mated to occur in two to four percent
of the population, with a much smaller
number who end up eventually needing
surgery. Most people with AAA do not
have symptoms unless the aneurysm
expands or ruptures, resulting in rapid,
severe back, flank, abdominal or groin
pain. Physical exam by your physician
is not reliable, but the condition can
be detected by imaging such as ultra-
sound, CT, or MRI.
There is a direct risk
from some diagnostic
testing such as
radiation exposure
or perhaps
contrast reaction to
imaging such as
CT scans and x-rays.
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