The aorta is the largest artery responsible for carrying oxygenated blood throughout the body.
If the aorta walls weaken, it can cause enlargement, an aneurysm, or aortic elongation.
Aortic elongation can form in any section of the aorta, but they are most common in the abdomen (abdominal aortic aneurysm) or the upper chest (thoracic aortic aneurysm).
There are reasons to be concerned if you have aortic elongation. If the vessel becomes too large, it could rupture, which is extremely dangerous because it can cause life-threatening bleeding.
Causes of an aortic elongation
Several factors can cause artery walls to weaken and lead to aortic enlargement.
Up to 80 percent of aortic elongations are caused by “hardening of the arteries” ( atherosclerosis ). Atherosclerosis can develop when cholesterol and fat build up inside the arteries.
Atherosclerosis accelerates the breakdown of collagen and elastin, two proteins that provide strength, structure, and elasticity to the aorta wall.
Over time, this causes the aorta walls to weaken and become damaged. High blood pressure through the aorta can cause the aortic wall to expand and swell.
High blood pressure ( hypertension ), smoking, family history, and age contribute to atherosclerosis.
Other less common disorders can also cause aortic enlargement to develop:
Inflammatory diseases, such as Takayasu’s arteritis, can block blood flow through the aorta and weaken the aortic wall.
Genetic connective tissue disorders
Disorders, such as Marfan syndrome or Ehler-Danlos syndrome, can also cause the aortic wall to weaken and possibly rupture or tear.
In Marfan syndrome, hereditary weakness in the blood vessel wall can contribute to aortic elongation.
Marfan syndrome is a genetic disorder that weakens the body’s connective tissue and can affect the function of the heart and blood vessels.
If Marfan syndrome affects the aorta, the body’s main blood supply, it can be life-threatening.
Aortic elongations can also be caused by physical trauma to the chest or abdomen.
Risk factors that could contribute to aortic elongation include:
- Age: Most cases of aortic extension occur in people over 65 years of age.
- Aortic valve problems: People born with a bicuspid aortic valve are at increased risk of aortic extension.
- Family history: People with a family history of aortic elongation tend to develop them at a younger age and are at higher risk of rupture.
- Infection: People who have had some diseases, such as syphilis or salmonella, that are not treated are prone to aortic enlargement.
Signs and symptoms of an aortic elongation
An aortic enlargement may grow slowly and have no symptoms. However, as it enlarges, aortic dilation can lead to symptoms like these:
- Pain in the chest or upper back. The pain can be profound, aching, gnawing, or throbbing, and can last for hours or days.
- Shortness of breath, a hoarse voice.
- Pain in the left shoulder or between the shoulder blades.
- Pain in the groin
Diagnosis of an aortic elongation
Early diagnosis is critical in the management of aortic elongation. To diagnose an aortic extension, you start with a medical history and perform a physical exam.
Advanced technology is then used to diagnose and inform the treatment, and the condition is carefully monitored. Standard diagnostic procedures may include:
- Abdominal ultrasound: During this test, sound waves are transmitted through the body tissues of the abdomen. The echoes of the sound waves are converted into video or photographic images.
- Angiogram: A thin tube (catheter) is inserted into a blood vessel, and contrast dye is injected to make the blood vessel visible during an X-ray. This can show any blood clots or other blood vessel problems.
- Chest X-ray – A standard imaging test of the lungs, heart, and aorta.
- CT scan: X-rays and computers create images of the aorta, compassion, and blood vessels. This provides a more detailed image than an ultrasound.
- Echocardiogram: This test uses ultrasound waves to take moving pictures of structures in the heart, such as chambers and valves.
- Magnetic Resonance Imaging (MRI): A large magnet, radio waves, and a computer are used to produce images of the heart and blood vessels.
Treatment for an aortic enlargement depends on its size, location, and the patient’s general health.
Once an aortic elongation is diagnosed, our goal is to develop an individualized plan to treat it so that it does not extend to a dangerous level and rupture. Depending on the size of the aortic elongation, treatment may include:
If the size of the aortic elongation or aneurysm is small, medications may be used to slow its growth rate.
It is imperative that blood pressure is controlled and that pressure medications are taken as prescribed.
A statin drug may also be prescribed, which lowers cholesterol and can help keep blood vessels healthy.
Regular tests are an essential way to monitor an aortic elongation closely.
Surgery is the most effective treatment for a larger, rapidly growing, or leaking aortic aneurysm or elongation.
Traditional open surgery or a less invasive procedure called endovascular surgery may be recommended for aortic enlargement repair.
The procedure recommended to you will depend on the location and appearance of the aortic elongation and your health.
During open surgery, the weakened section of the vessel will be removed and replaced with a graft.
Suppose the aortic elongation is close to the aortic valve (the valve regulating blood flow from the heart to the aorta). In that case, a valve replacement may also be recommended during the procedure.
During endovascular surgery, a stent is placed inside the diseased section of the aorta. The stent acts as a liner to divert blood flow from the aortic elongation.
If an aortic enlargement goes undiagnosed and treated, it could cause serious health problems. Those problems can include:
Rupture: Because the aorta is the main blood supply to the body, a break could cause life-threatening bleeding. This creates an emergency surgical situation.
Blood clots: Blood clots can weaken the heart and affect its ability to pump blood through the body. If a blood clot breaks loose, it could block a blood vessel anywhere in the body.
While some risk factors like age and heredity cannot be controlled, there are ways you can help prevent aortic enlargement:
- Practice good heart health: watch what you eat, exercise, and avoid smoking.
- Take medications as prescribed: If you have high blood pressure, high cholesterol, or diabetes, the patient should be sure to take the prescribed medicines as directed.
- Abdominal ultrasound examinations are recommended for men 65 years of age or older, men as young as 55 years of age with a family history of aortic enlargement, and women 65 years of age and older with a family history of aortic enlargement or who have smoked.
Prognosis of an aortic elongation
The prognosis is usually good when an aortic elongation is treated before it ruptures.
Aortic enlargements often have no symptoms; many are first discovered during an exam for another condition.
If an aortic elongation is pressing against nearby tissues, patients may notice deep, constant back, abdomen, or groin pain.
Aortic elongation or abdominal aortic aneurysms can also cause a shooting sensation in the abdomen.
If the aortic elongation continues to expand, it can rupture. The layers of the aortic wall can also separate (aortic dissection). This causes severe and tearing pain in the chest, back, or abdomen.
The potential for rupture is the most severe risk associated with an aortic elongation. A ruptured aortic extension can cause life-threatening internal bleeding and stroke.
Blood clots can also form within the walls of aortic enlargement. If part of a clot breaks off, it can travel to other arteries and block blood flow.