About the aorta
The forgotten organ.
What is the aorta?
The aorta is the largest artery in the body, through which all of the 'red' (oxygenated) blood is distributed around the body by the pumping of the heart.
What can go wrong with it?
One way or another, the things that can go wrong with the aorta lead to it bursting.
This can either occur suddenly when the aorta splits (aortic dissection) or as a result of progressive enlargement (aneurysm formation) leading to a blowout (rupture).
Diseases of the aorta comprise those conditions which lead either to aneurysm formation (progressive enlargement of the aorta) or aortic dissection (a tear in the aorta). Both dissection and aneurysms can eventually lead to rupture with fatal consequences.
What is aortic disease?
Aortic disease includes anything that leads either to progressive enlargement of the aorta (aneurysm formation) or a tear in the aorta (aortic dissection). Aortic emergencies are responsible for more deaths than prostate cancer. Aortic diseases comprise:
Aneurysms (swellings of the aorta which may eventually rupture)
Aortic aneurysms are insidious; they cause little in the way of symptoms until it is too late
Aortic diseases may be present from birth or the result of lifestyles
Developmental (present from birth) abnormalities of the aorta and its major branches
In the last 20 years, modern genetic techniques have identified a number of hereditary syndromes (Marfan's, Ehlers-Danlos, Loeys-Dietz) that predispose to the development of aortic aneurysms in young people
Statistics
Aortic disease is one of the top ten causes of death of men in the developed world.
Aneurysm of the aorta (weakening of the structure and subsequent stretching of the wall with risk of bursting and death) is the commonest aortic problem.
There are approximately 15,000 aortic surgical procedures performed annually in the UK, of which around 75% are in men.
It occurs mostly in older men - although a significant proportion of aneurysms occur in young adults (20-40 years) who have genetic disorders.
How to investigate the aorta
The preferred way of investigating the aorta depends on the urgency. In an emergency the goal is to make a diagnosis as quickly as possible. These scans are either CT (X-rays analysed by a computer which can produce complex 3-D reconstructions of the aorta), ultrasound which can monitor the size of most parts of the aorta without the need for X-rays and MRI (magnetic resonance imaging which combines many of the advantages of CT without exposure to X-rays). Currently, we rely on CT in emergency situations. In less urgent cases, we are more interested in monitoring the changes in the aorta over a period of time.
The aorta is investigated and monitored by scans of different sorts, performed at intervals by experts in aortic radiology who can interpret any change over time and advise on the need for treatment.
Who is at risk of aortic disease?
Aortic disease can occur in anyone but those most at risk are those who have a history of longstanding high blood pressure or other risk factors for the development of atherosclerosis (the build-up of cholesterol-rich plaques in arteries). These risk factors are increasingly well-known to all but include smoking, diabetes and a family history of atherosclerotic disease. These so-called atherosclerotic aneurysms become more common with advancing age and are much more common in men than women.
There is a second large group of people who have an hereditary syndrome causing a generalised weakness of their arteries leading to the formation of aneurysms at a much younger age. Examples of this sort of syndrome include Marfan's syndrome, Ehlers-Danlos syndrome and Loeys-Dietz syndrome. Indeed, as techniques for detecting the faulty genes responsible for these syndromes become more widely available more and more syndromes are being recognised and characterised.
Future treatments
The treatment of aortic diseases is changing rapidly - strategies for detection of patients at risk, monitoring the evolution of their aortic disease and knowing when to intervene are evolving rapidly. Surgery which carries significant risks of death and spinal injury can now be performed more safely using keyhole technology under x-ray screening. The equipment required to do this is costly and, more significantly, the expertise is hard to come by. The Aortic Centre Trust would like to see every region of the country served by a specialist unit with both the resources and expertise to provide these complex treatments.
FAQs
I have an aneurysm - what should I do now?
The important thing is DO NOT WORRY. If you know that you have an aneurysm, you have already taken the most important step in dealing with it. The next thing you need to decide is whether and when it needs treating. Your GP should be able to advise you and refer you to your nearest specialist aortic centre.
Treatment options
Not necessarily. On the other hand, if you do need an operation, it is much, much better to have a planned (elective) procedure than an emergency one. The important thing is to see your GP, to be referred to an aortic specialist and to make sure that you are seen regularly so that the rate of enlargement of your aneurysm can be assessed. If you do end up needing surgery, this is increasingly possible using minimally invasive ('keyhole') techniques using stents that avoid the need for big operation.
My father has an aneurysm - do I need a screening?
Some aortic diseases are hereditary. If a member of your family has been diagnosed with an aortic aneurysm, you may be at increased risk. First and foremost, don't panic. If you feel well, the chances are that you are well. You should consult your GP. As a minimum, you should have your blood pressure & cholesterol checked regularly. There are many reasons to do this but, whilst some aortic diseases are hereditary, many are due to so-called lifestyle diseases. Your GP should be able to advise on whether or not younger members of the family should be screened.
Can I get referral to an aortic centre?
We believe that aortic diseases should be managed by specialist aortic centres with cardiac surgeons, vascular surgeons, cardiologists and radiologists working across specialities to find the best treatment for you. Your GP should be able to point you in the right direction.
Can ACT help us establish an aortic centre in our hospital?
At present, there are relatively few specialist aortic centres in the UK. We would like to see more. We can help suggest ways in which you may be able to raise funds to help establish an aortic centre in your area.
How we can help you
We've gathered trusted information from the NHS, the British Heart Foundation and the Vascular Society, plus clinical guidelines for health professionals, in the Useful links section of our About us page. These can help you understand your condition and the treatment options your specialist may discuss with you.
How do I become a fundraiser?
The most important thing that we can do is to promote awareness of aortic diseases so that more people seek medical attention before it is too late. This is where you can help. You can help yourself by educating yourself about the problem, by raising your own level of awareness. You can raise awareness within your family and friends. Of course, good intentions are great but research and new state-of-the-art technology are very expensive. One of the best ways to educate yourself and your immediate circle is by organising a small fundraising event: a cake bake, sponsored walk, a dinner... there are literally thousands of ways that you can help. Get in touch, tell us what you want to do and we will do our best to help you make it happen.