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The human body is a fascinating and complex machine, with various organs and systems working together to ensure our well-being. One such essential organ is the aorta. In this article, we will explore the intricacies of the aorta, its functions, and the potentially dangerous condition known as aortic aneurysm. We'll delve into the meaning of aortic aneurysm, its classification according to the International Classification of Diseases (ICD 10), and discuss what an aneurysm in the aorta entails. So, let's dive in and discover more about this vital component of our cardiovascular system.

What Is an Aorta? Understanding the Body's Main Artery

The aorta is the largest artery in the human body, originating from the left ventricle of the heart. It plays a crucial role in distributing oxygen-rich blood to all parts of the body. The aorta emerges from the heart's upper section, arches over the organ, and descends through the chest and abdomen. By branching into various smaller arteries, it ensures an adequate blood supply to every organ and tissue.

The Anatomy of the Aorta

To understand the importance of the aorta, let's examine its anatomy. The aorta consists of several segments, each serving a specific region of the body. The primary divisions of the aorta are:

  • - Ascending Aorta
  • - Aortic Arch
  • - Descending Aorta
  • - Thoracic Aorta
  • - Abdominal Aorta

The ascending aorta arises from the heart's left ventricle and carries oxygenated blood to the aortic arch. From there, the aortic arch branches out to supply blood to the head, neck, and upper extremities. Subsequently, the descending aorta continues downward, supplying oxygenated blood to the chest and abdomen.

Functions of the Aorta

The aorta performs critical functions that are vital for our survival. These functions include:

  • Distribution of Oxygenated Blood: The aorta ensures the efficient transportation of oxygenated blood from the heart to the rest of the body, providing the necessary nutrients and oxygen for various bodily functions.
  • Maintaining Blood Pressure:By acting as a conduit for blood flow, the aorta helps maintain the required blood pressure to sustain circulation throughout the body.
  • Elasticity and Compliance:The aorta possesses elastic properties, enabling it to expand during ventricular contraction and recoil during diastole. This elasticity ensures a continuous flow of blood, reducing stress on the heart and minimizing turbulence.

Now that we have a basic understanding of the aorta, let's explore the meaning of aortic aneurysm.

Aortic Aneurysm Means: Understanding the Condition

An aortic aneurysm refers to an abnormal bulging or ballooning of the aorta's wall. It occurs when the arterial wall weakens, causing it to stretch and form a bulge. If left untreated, an aortic aneurysm can potentially rupture, leading to life-threatening complications. To gain a comprehensive understanding, let's address some key questions about aortic aneurysms.

what is an aneurysm in the aorta

What Causes an Aortic Aneurysm?

Aortic aneurysms can have several causes, including:

  • Atherosclerosis: This condition occurs when fatty deposits build up within the arterial walls, causing them to become stiff and weak.
  • Genetic Factors: Some individuals may inherit a predisposition to developing aortic aneurysms.
  • Inflammation: Infections or inflammatory diseases can weaken the arterial walls, increasing the risk of aneurysm formation.

How Does an Aortic Aneurysm Develop?

The development of an aortic aneurysm involves a gradual weakening of the arterial wall. Over time, this weakened area bulges outward due to the pressure of the blood flowing through the aorta. The aneurysm may remain small and stable, or it can expand and become more susceptible to rupture.

What Are the Risk Factors for Aortic Aneurysms?

Several factors can increase an individual's risk of developing an aortic aneurysm, such as:

  • Age: The risk tends to increase with age, particularly in individuals over 60.
  • Gender: Men are more likely to develop aortic aneurysms than women.
  • Tobacco Use: Smoking can weaken arterial walls, making them more susceptible to aneurysm formation.
  • High Blood Pressure: Hypertension puts additional strain on the arterial walls, increasing the risk of an aortic aneurysm.

How Is an Aortic Aneurysm Diagnosed?

Detecting an aortic aneurysm typically involves a combination of medical history assessment, physical examination, and diagnostic tests. These tests may include:

  • Ultrasound: A non-invasive imaging technique that uses sound waves to visualize the aorta and identify any abnormal bulging.
  • Computed Tomography (CT) Scan: This imaging method provides detailed cross-sectional images of the aorta, allowing healthcare professionals to evaluate the size and location of the aneurysm accurately.
  • Magnetic Resonance Imaging (MRI): In some cases, an MRI may be used to obtain detailed images of the aorta and assess the aneurysm's characteristics.

Now that we have covered the basics of aortic aneurysms, let's explore how they are classified according to the International Classification of Diseases (ICD 10).

Aorta Aneurysm ICD 10: Classifying Aortic Aneurysms

The International Classification of Diseases (ICD) is a standardized system used by healthcare professionals to classify diseases and medical conditions. In the case of aortic aneurysms, the ICD 10 provides a specific coding system for accurate diagnosis and billing purposes. Let's take a closer look at the ICD 10 codes for aortic aneurysms.

    ICD 10 Codes for Aortic Aneurysms:
  • I71.9: Abdominal aortic aneurysm, without rupture.
  • I71.9: Abdominal aortic aneurysm, without rupture.
  • I71.4: Thoracoabdominal aortic aneurysm, without rupture.
  • I71.3: Thoracic aortic aneurysm, without rupture.
  • I72.9: Aneurysm of unspecified site, without rupture.

These codes help healthcare professionals accurately document and communicate the diagnosis, ensuring appropriate treatment and billing procedures.

What Is an Aneurysm in the Aorta? Understanding the Condition

An aneurysm in the aorta refers to the abnormal enlargement of the aorta's wall, typically forming a bulge or sac-like structure. It can occur in different sections of the aorta, including the ascending, arch, descending, thoracic, or abdominal regions. An aneurysm poses a significant health risk, as it can potentially rupture, leading to severe internal bleeding and life-threatening consequences.

Symptoms of an Aneurysm in the Aorta

In many cases, aneurysms in the aorta do not cause noticeable symptoms until they reach a critical size or rupture. However, some individuals may experience the following symptoms:

  • Pulsating Sensation: A throbbing or pulsating feeling in the abdomen, chest, or back.
  • Back or Abdominal Pain: Discomfort or pain in the back or abdomen.
  • Shortness of Breath: Difficulty breathing or breathlessness.
  • Hoarseness: A change in voice or hoarseness.
  • Swallowing Difficulties: Trouble swallowing, especially for larger aneurysms that exert pressure on surrounding structures.

Treatment Options for Aortic Aneurysms

The appropriate treatment for an aortic aneurysm depends on several factors, including the aneurysm's size, location, and overall health of the individual. Treatment options may include:

  • Regular Monitoring: For small, stable aneurysms, routine imaging tests are conducted to monitor their growth and detect any changes.
  • Medication: Certain medications, such as beta-blockers, may be prescribed to lower blood pressure and reduce the risk of an aneurysm's growth or rupture.
  • Surgical Intervention: Surgical procedures may be recommended for larger aneurysms or those at risk of rupture. These procedures aim to repair or remove the aneurysm and reinforce the weakened arterial wall.

aortic aneurysm means

Aorta is the largest artery of the body. Its average normal diameter in the chest (thoracic aorta) is up to 28mm, and around 20mm in the abdomen (abdominal aorta). The normal diameter of the abdominal aorta ranges between 14 – 30 mm.

When a weak area of the abdominal aorta bulges or expands to reach over 1.5 times its average normal diameter, it is called an aortic aneurysm. The pressure of the blood with every heart beat can cause a weakened area of the aorta to gradually bulge (much like a balloon).

The term aortic aneurysm is used as almost equivalent to the term aortoiliac aneurysm, because of the fact that the iliac arteries are quite commonly also aneurysmal in the presence of an abdominal aortic aneurysm and their treatment is typically common. Isolated iliac artery aneurysms are rare. A common iliac artery is considered normal if its diameter is less than 17mm (males) or 15mm (females), ectatic if between 17-25mm, and aneurysmal if above 25mm.

The aneurysms of the aorta are classified as:

  • suprarenal aneurysms, if they affect the abdominal aorta proximally to the origins of the renal arteries; these are one of the types of thoracoabdominal aneurysms. An aneurysm that involves the renal arteries may be classified as juxtarenal or pararenal
  • infrarenal aneurysms, if they affect only the segment of the aorta distally to the origins of the renal arteries; these are the most common type (about 95%)

If the aneurysm is not treated, the aortic wall continues to weaken and the aneurysm to enlarge. Eventually, the aneurysm becomes large enough and its wall too weak and bursts (ruptures). A ruptured aneurysm can cause very severe internal bleeding leading to shock and death in most cases.

Most people with an aneurysm do not have symptoms, and it is usually diagnosed by investigations done for irrelevant reasons.

If you have symptoms, these may be:

  • Feeling of pulsations in your abdomen, similar to a heartbeat

  • Pain in the abdomen or in the lower back. If there is severe pain of sudden onset, it is likely that the aneurysm is about to rupture. A less common type of aneurysm, the inflammatory aortic aneurysm, which is characterised by retroperitoneal fibrosis and obstruction of the ureters, is more likely to cause pain
  • In rare cases, your feet and toes may develop areas with bluish discolouration and pain, because of embolization (ie shedding of debris downstream) from the the aneurysm. Another term for peripheral atheroembolism is “blue toe syndrome”

If the aneurysm ruptures, you may feel intense weakness, dizziness or pain and lose consciousness. This is a life threatening situation and you should immediately seek medical care.

Aortic aneurysms are commoner in men. You are at increased risk of developing an aortic aneurysms if you are:

  • A man over 60 years of age. The risk increases with the age. Among men of 65-80, the percentage of those with an AAA is 2-5%. Among women of the same age, the percenage is up to 1%
  • A smoker
  • A man whose father or brother has/had got an aneurysm
  • A man with either coronary or peripheral arterial disease

Although hypertension, or high blood pressure, (especially if not well controlled) would intuitively seem to enhance the development and expansion of AAA, it has not been documented to be a factor in population-based studies.

The simplest way to diagnose an arotic aneurysm is by ultrasound scanning of the abdomen. If your physician suspects you might have an aneurysm, he/she may organize one of the following imaging investigations: duplex ultrasonography of the abdominal aorta & the iliac arteries, computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen.

Not all abdominal aortic aneurysms require repair. The risk for rupture – and consequently the indication for repair – increases together with the size of the AAA.

Whether you need operative repair for your AAA or not shall be decided by your vascular surgeon who is the only physician capable of performing all types of AAA repair.

If your AAA is small (30-50mm), your vascular surgeon will generally recommend watchful waiting with follow-up ultrasound scans (usually every 6-12 months). Abdominal aortic aneurysms in general grow slowly. However, the larger they are, the faster they grow.

As an exception, repair for a small aneurysm may be recommended, (i) if its morphologic features are thought to pose an increased risk for rupture, such as false aneurysms (versus true atherosclerotic aneurysms) or saccular (versus fusiform aneurysms) or (ii) if the aneurysm is inflammatory and causes symptoms or hydronephrosis.

If the AAA is large enough (over 50-55mm), it is generally safer for you to have it repaired. Because the operation carries certain risks, the exact size for which the operation will be elected depends upon any other medical conditions you may have. For example, heart, lung or kidney problems increase the surgical risk. After successful open surgical repair the risk for rupture is zero. Ideally, repair will be recommended when the rupture risk is higher than the surgical risk. Your vascular surgeon will discuss with you in detail the possible risks and complications of the operation.

With regard to isolated common iliac aneurysms, repair is recommended if the aneurysm exceeds 30 to 35 mm in diameter to prevent the risk of rupture. Simultaneous aortic replacement should also be a serious consideration.

If rupture of an abdominal aortic aneurysm occurs, the chance of survival is less than 20%.

The approach may be one of the following:

  • Watchful waiting – As mentioned above, aneurysms less than 50mm in diameter, should be followed up every 6-12 months for signs of change with an imaging investigation such as duplex ultrasonography or computed tomography (CT). If you are a smoker you need to quit and if you have a high blood pressure you need to take your relevant medications regularly. Your physician is likely to recommend that you take an antiplatelet drug (Aspirin or similar) and a statin. It is crucial to comply with the medical instructions.
  • For an aneurysm of over 50-55mm in maximal diameter or in the presence of an aorto-iliac aneurysm of any size with an expansion rate which is faster than average or if symptoms (pain in the abdomen or in lower back) occur, repair will probably be required. There are two types of repair: the (open) surgical repair and the endovascular repair (EVAR). The vascular surgeon will discuss it with you which method is most suitable in your case.

Most people with an AAA will eventually need repair of their aneurysm with a graft.

For open repair, through an incision in your abdomen, the weakened part of your aorta is replaced with a graft, or a plastic tube, which allows your blood to flow through it.

The graft is made of very strong durable plastic material either Dacron (polyester) or polytetrafluorethylene (PTFE) in the size of normal aorta. The graft lasts for a lifetime and is very unlikely to require replacement. The operation is successful in 90-98% of cases.

Following the operation you will stay in the hopital for 5-8 days. It will take you 2-3 months for a complete recovery, but this period depends on your biological age.

Instead of the open repair, your vascular surgeon may consider this newer procedure, the endovascular repair. Endovascular or endoluminal means that the procedure is done through the wall of your arteries inside their lumen using very fine and long tubes, called catheters. This type of operation is less invasive and may be performed under regional anasthesia.

Initially, a small incision is made in each groin area. During the procedure, the vascular team will use x-ray pictures viewed on a screen to guide a tube (made of plastic and metal material), called stented graft or endograft, to the site of the aneurysm. Like the graft in open repair the endograft reinforces the aorta.

Your recovery time after EVAR is shorter than with the open repair and hospital stay may be reduced to 2-3 days. However, this procedure requires follow-up for a long time (probably for your lifetime) with imaging inestigations, currently CT scans, to confirm that it continues to function properly.

Your aneurysm may not be suitable for this procedure, because of its shape, its extent, its relation to the renal arteries etc. While endovascular repair may be a good option for some patients, in other cases open repair may be the best way to cure the problem.

Your vascular surgeon is the only physician qualified to offer all types of treatment for an AAA, and will help you decide the best method of repair in your particular situation.

It is prudent to improve your general health state even if you don’t need an operation at present:

  • Quit smoking completely
  • Exercise aerobically (brisk walking, cycling etc) for 25 to 30 minutes daily
  • Maintain your ideal body weight
  • Eat foods low in animal fat, cholesterol, and calories
  • Avoid lifting weights over 10kg
  • Take your medication to control blood pressure, blood cholesterol and diabetes