​A Ticking Time Bomb

Singapore’s first large scale aortic screening programme to detect fatal conditions

PULSE Issue 41 | July 2023

Beginning from the lower-left chamber of the heart, the aorta looks like a candy cane, arching upwards a short distance before running downwards through the chest cavity into the abdomen. It is the largest blood vessel carrying oxygen-rich blood from the heart to vital organs throughout the body. As the body’s main blood supply, a diseased or damaged aorta could lead to a medical emergency of massive internal bleeding if not attended to immediately. Common conditions which affect the aorta include an aneurysm or a dissection. 

Aortic Aneurysms

Aortic Aneurysms are mainly caused by a weak area in the aorta that results in a bulge or a swelling. The bulge can get bigger over time with the danger of bursting (rupture). Treatment options depends on the size of the bulge and how fast it is growing. 

Aortic Dissection

An Aortic Dissection refers to a tear along the elastic wall of the aorta, which can lead to massive and rapid blood loss if the tear completely dissects (cuts through) the aorta.

Unfortunately, both conditions do not have any obvious symptoms until it is at the risk of rupture and death. This explains why these deadly conditions are often diagnosed when patients are being screened for other conditions, and the swelling of the aorta is being discovered incidentally.

Mr Donald Teo experienced persistent and excruciating pain in his lower back that did not seem to go away even after taking painkillers, thus affecting his sleep and daily activities. When he finally sought help from a General Practitioner (GP), he was immediately admitted to the National University Hospital (NUH) Emergency Department where it was discovered that his aorta had a leak that caused the severe pain.

Following the advice of his doctor, he immediately proceeded with a minimally invasive endovascular repair, where a stent was placed in his leaking aorta to reduce the bulge and and minimise the chance of rupture. Endovascular repair requires regular follow-up visits with an aorta specialist as problems after the procedure may not show any symptoms. Hence, follow-up checks are important to ensure that no relapse occurs.

In Mr Teo’s case, his bulge reduced to half in size over two years after having the stent first inserted in his abdominal aorta. The goal of treatment is to avoid a rupture, as research has shown that less than half survive for patients who are suffering from a ruptured aorta. The only way to prevent a rupture is to detect the Aneurysm or Dissection early through screening, done through an ultrasound or preferably, Computed Tomography (CT) scans where a dye is inserted intravenously to capture an image inside the body. 

If detected early, the treatment for Aortic Aneurysms or Dissections could be managed with medication or monitored with a "wait-and-see" approach, depending on where the Aneurysm or Dissection occurs, its size and the likelihood of rupture. In some people, Aneurysms can remain small and not pose the risk of rupture.

It is not clear why and how fast Aneurysms or Dissections grow. However, risk factors such as being male, having hypertension, and being a smoker can increase the risk of rupture. Genetics seem to play a role as well. 

NUHCS Aortic Screening Programme

To better understand why and how these conditions occur, NUHCS is currently conducting a study where an aorta screening will be be offered to participants.

As early detection will help save lives, NUHCS also hopes to better identify individuals at high-risk of a rupture in their aorta through this study. 

Data collected from this study will further evaluate the necessity of a collaboration with the Ministry of Health, for possible implementation of a National Health Screening Programme for Aortic Diseases, for eligible individuals in the population.

Learn more about NUHCS Aortic Centre.