Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Houston Methodist DeBakey Heart & Vascular Center

Frequently Asked Questions (FAQ)

Questions About Aortic Aneurysms

Questions About Aortic Dissection

Questions About Aortic Stenosis

Questions About Other Aortic Conditions

Questions About Aortic Aneurysms

What is an aneurysm?

An aneurysm is a dilation or "bulging" of a blood vessel that looks like a small balloon. Aneurysms pose a serious health risk due to the potential for rupture, clotting or aortic dissection (a tear in the inner wall of the aorta that causes blood to flow between the layers of its wall). They can occur in the arteries of the brain, in the aorta and in other arteries.

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What is an aortic aneurysm?

An aortic aneurysm is an aneurysm in the aorta, the body's largest artery that leads directly from the heart. The two main types of aortic aneurysm are:

  • Thoracic aortic aneurysms (TAAs), which occur in the chest portion of the aorta, above the diaphragm. Even large TAAs don't always cause symptoms, but they can be identified through chest X-rays or CT scans.
  • Abdominal aortic aneurysms (AAAs), which occur in the abdominal portion of the aorta, usually near the kidneys. Small AAAs rarely rupture, but they can grow very large without causing symptoms. AAAs are usually found while performing CT scans for other medical conditions.

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What causes aortic aneurysms?

Several health factors can contribute to the formation and growth of aortic aneurysms:

  • The natural aging process
  • High blood pressure (hypertension)
  • Atherosclerosis (cholesterol buildup and hardening of the arteries)
  • Previous aortic dissection
  • Inflammation of the arteries (giant cell arteritis)
  • Takayasu arteritis (an autoimmune disorder that inflames the aorta)
  • Syphilis
  • Smoking

Certain congenital conditions (abnormal conditions present at birth) are also associated with aortic aneurysms, including bicuspid aortic valve, Marfan syndrome, Ehlers Danlos syndrome, and Turner syndrome.

Those who have a family history with aortic aneurysms may share a genetic abnormality and therefore are more likely to have an aortic aneurysm themselves.

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Who is at greatest risk for aortic aneurysms?

Aortic aneurysms occur most often in white males age 60 or over. Other risk factors include cigarette smoking, high blood pressure, atherosclerosis and a family history of aneurysms.

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Why are aortic aneurysms so dangerous?

Aortic aneurysms are dangerous because they are usually "silent" until a medical emergency such as a rupture, clotting or aortic dissection (a tear in the inner wall of the aorta causes blood to flow between the layers of its wall) occurs.

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How can I find out if I have an aortic aneurysm?

Many aortic aneurysms are discovered incidentally as a result of medical imaging for other conditions, such as ultrasound exams, CAT scans, MRIs, or even plain X-rays. If you are over 55 and other members of your family have had aneurysms, be sure to discuss it with your doctor so that you can be screened for aneurysms if needed.

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If I have an aortic aneurysm, what is the risk of death from a rupture?

If a rupture occurs, the chances of surviving are slim. The best predictor of the risk of rupture is the size of the aneurysm.

The diameter of a normal aorta is about 2 centimeters (a little less than an inch). Once an aneurysm has reached 5–6 centimeters in diameter (about the size of a small orange), the risk of rupture is substantial, probably about 50 percent over the next few years following diagnosis.

Most cardiovascular surgeons would agree that large aneurysms should be repaired, unless a patient's other medical factors make the operation too risky. There is less agreement around smaller aneurysms, since the risk of rupture is much lower. Some surgeons are now recommending repair of smaller aneurysms, but others advise watchful waiting.

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How will my doctors determine if or when I need surgery?

Surgery is recommended when aneurysms grow large enough that they have a significant risk of rupturing or tearing. The specific size at which surgery is recommended depends on the location of the aneurysm, how quickly the aneurysm is growing and the age of the patient.

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What is "monitoring" for an aortic aneurysm?

For patients with small aortic aneurysms, most cardiovascular surgeons monitor their condition with an ultrasound examination every 6 months. The average growth rate of an aneurysm is less than 0.5 cm per year, and some grow much more slowly. Others may demonstrate "growth spurts," which is a serious warning sign.

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What should I do while an aneurysm is being monitored?

If your doctor is monitoring a small aneurysm, he or she may advise certain lifestyle changes, such as quitting smoking, controlling your blood pressure and engaging in mild exercise to improve your overall fitness. In some instances, specific medications have been shown to significantly slow the progression of aneurysm growth.

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What are the risks of surgical repair?

Patients without any history or signs of heart disease generally do very well in aneurysm repair surgery. Those with known coronary artery disease should have a thorough cardiological evaluation in advance to ensure that they are fit for surgery.

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What do you use to replace the part of the aorta with the aneurysm, and how long does the replacement part last?

The damaged section of the aorta is replaced with an artificial tube, much like you'd replace a broken piece of pipe with a new one. In this case, the replacement tube is made out of a tightly woven fabric called Dacron® or Gore-Tex®. The material is highly durable and the graft will last for the rest of your lifetime.

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Can I have some sort of stent instead of regular surgery to fix my aortic aneurysm?

In certain circumstances and for certain aneurysms, a new technique known as stent graft repair offers a minimally invasive approach for aneurysm repair. This procedure can only be performed at select medical centers such as Houston Methodist, where physicians have been specifically trained in this technique.

In addition, stent grafts can only be performed if the patient's aortic anatomy is appropriate; if not, a standard surgical procedure will have to be performed. The major advantage of this method is that it avoids the large chest incision that open surgery requires.

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How long does it take to recover, and what is the likelihood of returning to a normal life?

The average hospital stay following surgery is 5–10 days, and most patients take about 6 weeks to recover before returning to work. The majority of patients return to a normal life expectancy, comparable to other individuals of the same age and in similar health.

One unfortunate complication for male patients is the possibility of sexual dysfunction. For more information, please consult your doctor.

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Can the aneurysm come back if I have surgery to fix it? Will I still need to take medication after surgery?

When a portion of the aorta is replaced surgically, the aneurysm is removed and cannot recur in that location. If there is only one segment of the aorta that is abnormal, once that segment has been replaced, the risk of aortic aneurysms forming elsewhere is slight. However, when aneurysms occur due to a systemic problem, such as atherosclerosis or Marfan syndrome, the risk of future aneurysms in other segments of the aorta is significant.

Therefore, almost all patients who have had aortic aneurysm repair should undergo regular imaging (ultrasound scans, CT scans or MRI scans) to check for new aneurysms. Your doctor will probably also prescribe blood pressure medication to lower the risk of future aneurysms.

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Questions About Aortic Dissection

What is an aortic dissection? How is it different from an aneurysm?

An aortic dissection is a life-threatening condition that involves a tearing away of the innermost lining of the aorta. This occurs when a weakened aortic wall develops a tear in its inner lining, which allows blood from within the aorta to penetrate into the middle layer.

Although most patients with an aortic dissection have an underlying aortic aneurysm, some do not. Similarly, not all patients with an aortic aneurysm go on to develop an aortic dissection.

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What are the symptoms of an aortic dissection?

Almost all patients with an acute aortic dissection experience pain in the chest, neck, back, abdomen or legs, depending on the location of the dissection. The pain often comes on suddenly and is at its most severe at the start. Patients often describe it as "sharp," "stabbing" or "tearing."

Symptoms of an aortic dissection are usually different from those associated with a heart attack, but there can be overlap. If you have an aortic aneurysm, make sure you understand the symptoms associated with aortic dissection.

Houston Methodist DeBakey Heart & Vascular Center has created an Acute Aortic Treatment Center (AATC) for the sole purpose of providing rapid care to patients with acute aortic syndromes, including aortic dissection; for more information, visit the AATC Web page.

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What is the risk from an aortic dissection?

The early mortality (death rate) from aortic dissection is about one percent per hour, so the sooner it is diagnosed and treated, the better the outcome. Dissections that involve the ascending thoracic aorta (the part of the aorta leading from the heart) are at high risk of aortic rupture, which can be fatal. This condition requires immediate surgery to replace the ascending portion of the aorta. Conversely, aortic dissections that do not involve the ascending thoracic aorta are at much lower risk of aortic rupture, and are usually managed with medications rather than surgery.

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Questions About Aortic Stenosis

What is aortic stenosis?

Aortic stenosis is a serious heart condition involving a narrowing of the aortic valve, the "gateway" through which oxygenated blood passes from the heart to the rest of the body. As a result of this narrowing, the heart must work harder to pump blood out and gradually grows weaker over time, which could lead to heart failure and death.

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What causes aortic stenosis?

Aortic stenosis can be caused by a buildup of calcium on the aortic valve over time, by a bicuspid aortic valve or in rare cases by rheumatic fever.

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How is aortic stenosis treated?

Houston Methodist DeBakey Heart & Vascular Center Valve Clinic offers a full range of treatments for aortic stenosis, including leading-edge therapies such as trans-catheter aortic valve implantation (TAVI). For more information, including a list of current clinical trials, visit the Valve Clinic website.

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Questions About Other Aortic Conditions

What is Marfan syndrome?

Marfan syndrome is a genetic disorder that contributes to the formation of thoracic aortic aneurysms. It is due to an abnormality in the gene responsible for the formation of fibrillin-1, a major structural component of the fibers called elastin that give the normal aorta its remarkable strength. A defect in this elastin makes the aorta weak, and a weak aorta is prone to stretch over time and become an aneurysm. Patients with Marfan syndrome are at markedly increased risk for both aortic aneurysm formation and the occurrence of aortic dissection.

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What is a bicuspid aortic valve?

The aortic valve, located at the base of the aorta, opens when the heart beats to allow blood to be pumped out; then, when the heart relaxes, the valve closes and prevent blood from leaking backward. The normal aortic valve is "tricuspid," which means it has three separate leaflets, or cusps, that meet in the middle to form an effective seal when the valve closes.

In some cases, however, a baby is born with only two aortic valve cusps instead of the normal three; in other words, a "bicuspid" (two-cusp) valve has developed. Bicuspid valves may function relatively well, but in most cases they are either narrowed (a condition known as aortic stenosis) or they leak (a condition known as aortic insufficiency or regurgitation). People with bicuspid aortic valves have been shown to have premature aortic valve degeneration and also have an abnormal tissue structure of the aorta, which makes them predisposed to a faster aortic aneurysm growth rate.

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Do the surgeons of the Houston Methodist DeBakey Heart & Vascular Center perform minimally invasive procedures to treat aortic conditions?

At the Houston Methodist DeBakey Heart & Vascular Center, our surgeons are leaders in catheter-based stent treatment of aortic disease and even catheter-based aortic valve replacement. Talk to your doctor to find out if a minimally invasive procedure is appropriate for your condition.

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For more information about the Methodist Aortic Network or to schedule an appointment, please call 713-441-5200 or complete our online contact us form.