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Types of Aortic Aneurysms
Aortic aneurysms are classified by shape, location along the aorta and the process that leads to their formation. The wall of the aorta is made up of three layers: a thin inner layer of smooth cells called the endothelium, a muscular middle layer which has elastic fibers, and a tough outer layer. When the walls of the aneurysm have all three layers, they are called true aneurysms. If the wall of the aneurysm has only the outer layer remaining, it is called a pseudoaneurysm. Pseudoaneurysms may occur as a result of trauma when the inner layers are torn apart.
Fusiform aneurysms Most fusiform aneurysms are true aneurysms. The weakness is often along an extended section of the aorta and involves the entire circumference of the aorta. The weakened portion appears as a generally symmetrical bulge. Saccular aneurysms Saccular aneurysms appear like a small blister or bleb on the side of the aorta and are asymmetrical. Typically they are pseudoaneurysms caused either by trauma such as a car accident or as the result of a penetrating aortic ulcer.
Degenerative aneurysms Degenerative aneurysms are the most common. They occur as the result of breakdown of the connective tissue and muscular layer. The cause could be cigarette smoking, high blood pressure and/or genetic conditions.
Dissecting aneurysms Dissecting aneurysms occur when a tear begins within the wall of the aorta causing the three layers to separate similar to what happens to plywood that is left out in the weather. The dissection (separation of the layers) causes the wall of the aorta to weaken, and the aorta enlarges. Dissections may occur any place along the aorta and treatment depends upon the location. Frequently, dissections involving the ascending aorta are treated with emergency surgery while those involving the descending thoracic aorta are treated with medication. Although dissections are uncommon, they are the most common of the acute aortic syndromes. They are lethal if not treated. They should be treated only by surgeons who have special expertise.
Thoracic aortic aneurysms The aorta is shaped like an old-fashioned walking cane with the short stem of the curved handle coming out of the heart and curling through the aortic arch, which gives off branches to the head and arms. Then the aorta descends through the chest cavity into the abdomen and separates to provide blood to the abdominal organs and both legs. Thoracic aneurysms can occur anywhere along the aorta above the diaphragm, including the ascending aorta, the aortic arch, and the descending thoracic aorta. Up to 25 percent of aortic aneurysms are thoracic. They can result from various connective tissue disorders (such as Marfan's syndrome), atherosclerosis, previous dissection of the aorta, prolonged high blood pressure (hypertension), and trauma (usually falls or motor vehicle accidents).
Abdominal aortic aneurysms Abdominal aortic aneurysms are located along the portion of the aorta that passes through the abdomen. Continuing from the thoracic aorta, the abdominal aorta carries blood down through the abdomen until it eventually splits off into two smaller arteries that provide blood to the pelvis and legs. Abdominal aortic aneurysms are far more common than thoracic aortic aneurysms, comprising up to 75 percent of aortic aneurysms. They can affect anyone, but are most often seen in men ages 40 to 70. Most abdominal aortic aneurysms are caused by atherosclerosis.
The risks and benefits of surgery for abdominal aortic aneurysms differ from those for thoracic aortic aneurysms. Abdominal aortic aneurysms are unlikely to rupture if they develop slowly, are less than four or five centimeters (about two inches) in diameter, and cause no symptoms. In these cases, the risk of rupture within a five-year period is low and observation with periodic rechecks of the aneurysm is often advised. The risks involved with surgery outweigh the risk of the aneurysm rupturing. At surgery, the weakened aorta is replaced with a polyester tube and sutured in place. The polyester graft is permanent and will last for many years. This method is tried and true, and has been used for many years at Mayo Clinic. Repair of these aneurysms can usually be accomplished with traditional abdominal surgery or with the newer endovascular surgical techniques.