Aortic aneurysm, a potentially life-threatening heart condition, may now be treated with a safer and less invasive surgery method.

An aortic aneurysm is an abnormal, balloon-like swelling in the aorta, the body’s largest artery. The aorta runs from the heart to the abdomen and down to supply blood to the legs.

A large, fast-growing aortic aneurysm may rupture and cause massive bleeding into the chest or the abdomen. This bleeding can send the body into severe shock which can be fatal.

Traditional open surgery to treat​ the aortic aneurysm before it ruptures is associated with significant risks of morbidity and death. It is also not suitable for high-risk patients with diabetes and heart conditions – as it is simply too risky.

“About 30 to 40 per cent of patients seeking treatment for aortic aneurysm are not suitable for open surgery due to the high cardiac risks involved,” say doctors from the Department of General Surgery​, Singapore Gene​ral Hospital​ (SGH), a member of the SingHealth group.

In the past, these patients faced a possibility of death should the aortic aneurysm rupture suddenly. Fortunately, with a newer, safer and minimally invasive surgical technique called endovascular aortic repair, chances of repairing the an​eu​​​​rysm are good.

Endovascular aortic repair, also called endovascular stent grafting, is ideal for large aortic aneurysms. It is also suitable for​ elderly patients with chronic medical conditions such as diabetes, high blood pressure and coronary heart disease.

Symptoms of an aortic aneurysm

An aortic aneurysm is usually asymptomatic but some patients may experience:

  1. Throbbing sensations in the abdomen
  2. ​Abdominal pain or deep, diffuse chest pain
  3. Lower back pain
  4. Difficulty in swallowing
  5. Hoarseness of voice
  6. Headache

Causes of aortic aneurysm

The exact cause is unknown but normal ageing and chronic health conditions can lead to a weakening of the aortic wall, which can then bulge under the pressure of blood flowing through the aorta. These chronic conditions include:​

  1. Atherosclerosis (hardening of the arteries) due to diabetes, high blood cholesterol or lipids, chronic smoking
  2. Infection or inflammation in the aorta
  3. High blood pressure
  4. Genetic conditions (e.g. Marfan’s syndrome, a connective tissue disorder)

An aortic aneurysm usually occurs in the middle-aged and elderly (aged 50 and above). Smokers too, bear a significantly higher risk. Screening for abdominal aortic aneurysms is recommended for current or past male smokers over the age of 65.

An aortic aneurysm can be diagnosed with the help ​of an ultrasound, computed tomography scan (CT scan) or magnetic resonance imaging scan (MRI scan) of the chest or abdomen. If it’s large enough, an aortic aneurysm in the abdomen can be detected by clinical examination. These investigations are also used to monitor the size of the aneurysm over time to assess the risk of rupture and the timing of surgery.

See​​​ next to learn about the benefits of endovascular aortic repair​.

Ref: O17