What is aortic aneurysm?

Dr. Jeffrey De Jesus, an interventional cardiologist at St. Luke’s Medical Center in Bonifacio Global City, described it as “a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso. It is usually due to a defect in the walls of the large arteries.”

“The force of blood pumping can split the layers of the artery wall, allowing blood to leak in between them,” said De Jesus, referring to how the bulge may rupture. 

Among its risk factors are old age, male gender, cigarette smoking, Caucasian race, atherosclerosis, hypertension, and family history of aneurysm. 

“Many patients who suffer from this disease may have no symptoms, although some may present with pain in the chest or abdomen depending on the location of aneurysm,” De Jesus said. “In some cases, even if the aneurysm has leaked or ruptured, symptoms may present as mild abdominal pain. This causes more problems as patients may delay seeking medical attention owing to the atypical presentation of the disease.”

Its treatment varies depending on the severity of the aneurysm. “The greatest factor that determines the risk of rupture is the size. The size of an aneurysm that requires immediate repair is when its largest diameter is 5.5 cm. If less than 5.5 cm, most will recommend close monitoring with imaging modalities and conservative treatment with medicines to control blood pressure, heart rate, and cholesterol. Smokers are advised to quit smoking,” he continued. 

For aneurysms greater than 5.5 cm, their primary recommendation is endovascular repair or EVAR.

“EVAR is a minimally invasive procedure in which an interventional cardiologist or cardiothoracic surgeon places a covered stent or a metal mesh tube covered with fabric into the area with the aneurysm so that blood can flow through the vessel and seal the dissection or leakage,” he said.

“For ruptured and leaking aneurysm, emergency endovascular aortic repair is the first recommendation,” De Jesus added. “The next option if EVAR is not available is open surgery, which has greater risks and complications.”

He added that it’s “quite rare” for young populations to experience aneurysm.

“Young patients who develop aneurysm may be related to bad lifestyle such as smoking and alcohol use, which may precipitate damage to the arteries,” he explained. “Some may have associated rare diseases such as Marfan’s syndrome and Takayasu’s arteritis, which make the arterial walls weak and cause aneurysms at a young age.” 

In a separate interview with PhilSTAR L!FE, a cardiologist at the Philippine Heart Center in Quezon City, who declined to be named for fear of reprisal, said that the illness is only common among the elderly.

“Usually, patients who are more than 55 years old or 60 years old experience aortic aneurysm. It’s a long process, with symptoms that include chest pain and shortness of breath,” he said. 

Highlighting atherosclerosis (or the hardening of arteries) as one of the most common causes of aortic aneurysm, he said, “Kaya nakikita yung aortic aneurysm sa elderly kasi nung mga bata sila, they may not have been conscious of their diet kaya nag-add up. Gradual siya.”

He additionally discussed that its risk factors may be avoided through diet and exercise as they help them keep their blood pressure and blood sugar in check.

What’s more common in young people and females, he said, is cerebral aneurysm or “the ballooning of the artery in the brain.” They can experience it even without symptoms and risk factors can be presented with headache, vomiting, and other symptoms of increased intracranial pressure.

“Aortic aneurysm may be caused by habits over the years, but cerebral aneurysm can happen in a day or any time. It can be a walking time bomb,” he explained, advising relatives of those who have experienced symptoms to have themselves screened as it may also be hereditary.