Aortic Aneurysm

An aortic aneurysm is a balloon-like bulge in the wall of the aorta. The aorta is the body’s largest artery and carries oxygen-rich blood from the heart to the rest of the body.

Aortic aneurysms often develop slowly and may not cause symptoms. As an aneurysm grows, the weakened artery wall may tear or rupture, causing life-threatening internal bleeding. An aneurysm may form in the chest, abdomen or across both regions of the aorta.

The two main types are classified by where they develop.

• Thoracic aortic aneurysm: This type develops in the chest and may affect the ascending aorta, aortic arch or descending thoracic aorta.
• Abdominal aortic aneurysm: This type develops in the abdomen and is more common than a thoracic aneurysm. Learn more about an abdominal aortic aneurysm.

An aneurysm that involves both the chest and abdominal portions of the aorta is called a thoracoabdominal aortic aneurysm.

Many aortic aneurysms do not cause symptoms and are found during imaging for another health concern. Symptoms that do occur depend on the aneurysm’s location.

A thoracic aortic aneurysm may cause chest or upper back pain, coughing, hoarseness or shortness of breath. An abdominal aortic aneurysm may cause persistent abdominal or back pain or a pulsing sensation in the abdomen.

A ruptured aneurysm may cause sudden, severe pain, dizziness, weakness, a rapid heartbeat or loss of consciousness. A rupture is a medical emergency. Call 911 immediately if you or someone nearby develops symptoms of a possible rupture.

Aortic aneurysms develop when part of the aortic wall becomes weak. Several health, genetic and lifestyle factors can contribute to this weakening.

Risk factors may include:

• Atherosclerosis, which causes fatty deposits to build up in artery walls
• High blood pressure, which places additional stress on the aorta
• Tobacco use
• Older age
• A family history of aortic aneurysm or aortic disease
• Connective tissue conditions such as Marfan syndrome or Ehlers-Danlos syndrome
• Certain congenital or structural conditions affecting the aorta

Your physician will consider these factors along with the aneurysm’s location, size and growth rate when evaluating your risk.

Because aortic aneurysms may not cause symptoms, they are often discovered during testing for another condition. Your physician will review your health history, family history and risk factors and may perform a physical examination.

Imaging tests may include:

• Ultrasound: Uses sound waves to create images of the abdominal aorta and is commonly used to screen for an abdominal aortic aneurysm.
• CT scan: Produces detailed images that help physicians determine the aneurysm’s size, shape and location and plan treatment.
• MRI: Creates detailed images without radiation and may be appropriate when additional views of the aorta are needed.
• Angiography: Uses contrast material to show blood flow and define the aneurysm’s extent. Options may include computed tomography angiography, magnetic resonance angiography or catheter-based angiography.

Screening may be recommended for certain people based on their age, smoking history, family history and other risk factors.

Treatment depends on the aneurysm’s location, size, growth rate, symptoms and risk of rupture. Your overall health and the anatomy of your aorta also help determine the most appropriate approach.

Small or slow-growing aneurysms may not require immediate repair. Your care plan may include regular ultrasound, CT or MRI scans to track changes in size.

Your physician may also recommend controlling blood pressure and cholesterol, stopping tobacco use, maintaining a healthy weight and following a heart-healthy eating plan.

Endovascular repair is a minimally invasive procedure that places a stent graft inside the weakened area of the aorta. The graft reinforces the artery wall and allows blood to flow through the graft instead of pressing against the aneurysm.

Endovascular aneurysm repair may be used for an abdominal aneurysm. Thoracic endovascular aortic repair may be used for certain aneurysms in the chest.

During open repair, a surgeon removes or bypasses the weakened portion of the aorta and replaces it with a synthetic graft. Open surgery may be recommended for aneurysms with complex anatomy or when an endovascular procedure is not appropriate.

Your multidisciplinary care team will explain the benefits, risks and expected recovery associated with each suitable option.

An aortic aneurysm may continue to enlarge and place pressure on nearby tissues or organs. Serious complications may include:

• Rupture: The aneurysm breaks open, causing severe internal bleeding.
• Aortic dissection: A tear develops within the aortic wall, allowing blood to flow between its layers.
• Blood clots: Clots may form within the aneurysm and travel to other blood vessels, reducing blood flow to the limbs or organs.

Prompt evaluation, ongoing surveillance and treatment when appropriate can help physicians manage these risks.

Not every aortic aneurysm can be prevented, particularly when inherited conditions or family history contribute to the risk. However, protecting your blood vessels may reduce the likelihood of developing an aneurysm or slow the growth of an existing one.

Helpful steps include stopping tobacco use, managing high blood pressure and cholesterol, staying physically active and following a heart-healthy eating plan. People with known risk factors should discuss appropriate screening and surveillance with their physician.

Talk with your physician if you have a family history of aortic aneurysm, a history of tobacco use or other risk factors. Your physician can determine whether screening or evaluation by an aortic specialist is appropriate.

If you have already been diagnosed, keep all recommended imaging appointments and follow your care plan. The specialists at the Center for Aortic Disease and Center for Vascular Disease provide coordinated monitoring and surgical and catheter-based treatment options.

Seek emergency help immediately for sudden, severe chest, back or abdominal pain or other signs of a possible rupture or aortic dissection.