An aortic aneurysm is a balloon-like bulge in the wall of the aorta, the main artery that carries blood from the heart to the rest of the body. Aneurysms can develop slowly and silently, and if they rupture, they can cause life-threatening internal bleeding. These aneurysms can occur in different parts of the aorta, most commonly in the chest (thoracic) or abdomen (abdominal).

There are two primary types of aortic aneurysms:

• Thoracic Aortic Aneurysm (TAA) – Occurs in the chest. May affect the ascending aorta, aortic arch, or descending thoracic aorta.
• Abdominal Aortic Aneurysm (AAA) – Occurs in the abdomen. This is the more common type and often affects older adults. Sometimes, an individual may have both types, which is referred to as a thoracoabdominal aortic aneurysm.

Several health conditions and lifestyle factors contribute to aortic aneurysm formation:

• Atherosclerosis – Fatty buildup in artery walls weakens vessel integrity.
• High Blood Pressure – Increases stress on arterial walls.
• Genetic Conditions – Such as Marfan syndrome or Ehlers-Danlos syndrome that affect connective tissue strength.
• Tobacco Use – Damages blood vessels and speeds aneurysm growth.
• Age & Gender – Risk increases after age 65 and is more common in men.

Aortic aneurysms are often asymptomatic but when symptoms do appear, they depend on location:

• Thoracic Aneurysm – Chest pain, hoarseness, cough, shortness of breath.
• Abdominal Aneurysm – Abdominal or back pain, pulsating feeling in the abdomen. A ruptured aneurysm causes sudden, severe pain and is a medical emergency.

Diagnosis is often made incidentally during tests for other conditions. When screening is intentional, tests may include:

• Ultrasound: Non-invasive test that uses sound waves to create images of the aorta. It’s the first-line screening tool for abdominal aortic aneurysms, especially in men over 65 who have a history of smoking.
• CT Scan (Computed Tomography): Produces detailed images of the aorta; often used to confirm the size, shape, and exact location of an aneurysm and is essential for surgical planning.
• MRI (Magnetic Resonance Imaging): Offers high-resolution images without radiation. An excellent option for patients who cannot receive contrast dye or when a detailed view of the aorta is needed.
• Angiography (CT, MRI, or catheter): Advanced imaging using contrast to map blood flow and identify the extent of the aneurysm. These are typically used when planning endovascular or surgical repair.

If you are over 65, smoke, or have a family history, screening may be recommended.

Treatment depends on the aneurysm’s size, location, and growth rate.

For small or slow-growing aneurysms, your care team may recommend monitoring (watchful waiting). This includes:

• Regular imaging (ultrasound, CT, or MRI) to track changes in size, controlling blood pressure and cholesterol through medications
• Lifestyle changes such as quitting smoking, maintaining a healthy weight, and eating a heart-healthy diet

For larger, symptomatic, or rapidly growing aneurysms, minimally invasive or surgical repair may be necessary:

• Endovascular Aneurysm Repair (EVAR) for abdominal aneurysms and TEVAR for thoracic aneurysms involve placing a stent graft inside the aorta through small incisions in the groin. These procedures offer faster recovery, less blood loss, and lower surgical risk.
• Open Surgical Repair involves removing the damaged portion of the aorta and replacing it with a synthetic graft. This approach may be recommended for patients with complex anatomy or when endovascular repair is not suitable.

Without treatment, aortic aneurysms can lead to:

• Rupture – Large aneurysms may press on surrounding organs, causing pain or urinary symptoms
• Aortic Dissection – A tear in the aorta’s wall that can be deadly.
• Blood Clots – Can travel and block blood flow to limbs and vital organs.

Prevention strategies include:

• Quitting smoking
• Managing hypertension and cholesterol
• Regular physical activity
• Heart-healthy diet
• Screening if at risk or over age 65