Diseases of the Aorta and Aneurysms

The aorta and its branch arteries are elastic living tubes made of structural proteins that are bound together.   Genetic errors have been identified in most patients with aneurysms which result in weakening of the structure of the wall and allow the wall to balloon.  As the arterial wall becomes stretched, laws of physics which govern wall tension predict inevitable rupture with life threatening consequences.   The open surgical option is to replace the aneurismal region with an artificial tube graft.  The open surgical approach affords associated risks, postoperative pain and a protracted recovery time. 

Over the past several decades, innovative technology has led to the iterative development of implantable stent grafts which are inserted through a branch artery and deployed under X-ray guidance to line and buttress the inner wall of an aneurysm.   While aneurysms of the abdominal aorta were the initial target, iterative stent graft development for aneurysms and dissections of the entire aorta are now available.   This minimally invasive approach has significantly reduced postoperative discomfort, recovery time and complications.

While genetic patches are not available for the chromosomal defects associated with aneurysm development, identification of inheritance patterns allows relatives to be notified of the risks of aneurysm formation and to initiate screening surveillance radiography. 

Discussions of aneurysms would be incomplete without mentioning the impact of the fluoroquinolone class of antibiotics on aneurysm formation.  It is well documented that this class of antibiotics is associated with aneurysm formation irrespective of the genetics, doubling the growth rate and rupture rate of existing aneurysms.  Their use is associated with the initiation of aneurysm formation and may take as little as a single course of the medication.   Each drug now carries a black box pharmaceutical warning.