Aortaaneurysmata

Aortaaneurysmata refers to aneurysmal dilations of the aorta, a collective term for abnormal enlargements in any part of the aorta (ascending, arch, thoracic, or abdominal). True aneurysms involve all three vessel wall layers; pseudoaneurysms result from a breach with a contained hematoma. They may be fusiform (uniform dilation) or saccular (localized outpouching).

Causes and risk factors: most common are atherosclerosis and hypertension; genetic disorders such as Marfan syndrome, Loeys-Dietz syndrome, and Ehlers-Danlos; congenital bicuspid aortic valve; smoking; advanced age; family history.

Clinical features: many are asymptomatic. When symptomatic, chest, back, or abdominal pain may occur; signs of rupture (hypotension, collapse) or dissection (tearing pain, diminished pulses) may appear.

Diagnosis: imaging is essential. Abdominal aneurysms are often detected by ultrasound and confirmed by CT or MR angiography. Thoracic aneurysms are evaluated with CT/MR angiography and echocardiography for valve involvement.

Management: surveillance for small, stable aneurysms; repair thresholds depend on location and size. Abdominal aneurysms are repaired when diameter exceeds about 5.5 cm in men or rapid growth; thoracic aneurysms based on size/growth. Options include open repair and endovascular repair (EVAR/TEVAR).

Prognosis: rupture carries high mortality; elective repair has improved survival.