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Overview
What Is an Aortic Aneurysm?
An aortic aneurysm is a weakened, bulging area in the aorta, the body’s largest artery. It can develop in the chest, where it is called a thoracic aneurysm, or in the abdomen, where it is called an abdominal aneurysm. Many aneurysms cause no symptoms until they become large, tear apart in a dissection, or rupture. The risk is higher with factors such as older age, smoking, high blood pressure, family history, and certain inherited conditions.
Emergency Warning Signs
Emergency Warning Signs of Rupture or Dissection
CALL EMERGENCY SERVICES
Get immediate help for sudden severe symptoms
Call emergency services immediately for sudden, severe chest, upper-back, or abdominal pain; fainting or collapse; severe weakness; shortness of breath; a rapid heartbeat; or signs of shock. Do not drive yourself to the hospital.
- Abrupt, severe tearing or ripping pain in the chest, upper back, or abdomen may signal dissection or rupture.
- Pain that spreads to the back, abdomen, neck, or legs requires immediate emergency assessment.
- Loss of consciousness or collapse can occur when bleeding or a major blood-flow problem develops.
- Clammy, pale skin may be a sign of shock from internal bleeding.
- Confusion, extreme weakness, or inability to stay awake can indicate dangerously reduced blood flow.
- Sudden neurologic symptoms, such as weakness on one side, trouble speaking, or vision changes, require emergency care.
Symptoms
Aortic Aneurysm Symptoms
Most aortic aneurysms do not cause symptoms, so feeling well does not rule one out. When symptoms occur, they often result from the aneurysm’s location or pressure on nearby structures. Sudden severe pain is an emergency because it may indicate aortic dissection or rupture.
THORACIC ANEURYSM
Chest or upper-back discomfort, cough, hoarseness, shortness of breath, or difficulty swallowing may occur with a thoracic or ascending aortic aneurysm.
ABDOMINAL ANEURYSM
Persistent abdominal or back pain, or a pulsating sensation in the abdomen, may occur with an abdominal aortic aneurysm.
Causes
What Causes an Aortic Aneurysm?
Changes in the structure and strength of the aortic wall can allow it to widen over time. More than one cause or contributor may be present, including aging-related wear, inflammation, inherited weakness, or injury to the aorta.
- Atherosclerotic and degenerative changes can damage the aortic wall and contribute to aneurysm formation.
- Chronic inflammation may weaken the tissues that support the aorta.
- Inherited connective-tissue disorders can make the aortic wall more fragile.
- Congenital aortic valve abnormalities, including some bicuspid valves, can increase stress on the aorta.
- Infection can damage the aortic wall and cause an infectious aneurysm.
- Prior trauma or aortic surgery can injure the artery and contribute to later widening.
Risk Factors
Aortic Aneurysm Risk Factors
| Risk factor type | Examples |
|---|---|
| Nonmodifiable or inherited | Older age, male sex, family history, inherited connective-tissue conditions, congenital valve disease, and prior aortic disease |
| Potentially modifiable | Smoking, high blood pressure, high cholesterol, atherosclerosis, and other cardiovascular risks |
Complications
Aortic Aneurysm Complications
- Aortic dissection occurs when a tear allows blood to separate layers of the aortic wall.
- Rupture can cause life-threatening internal bleeding and severe shock.
- Blood clots or emboli can form near an aneurysm and travel to other blood vessels.
- Reduced blood flow can injure organs or limbs supplied by branches of the aorta.
- A growing aneurysm can compress nearby structures and cause pain, breathing problems, or swallowing difficulty.
Risk is influenced by the aneurysm’s size, location, shape, growth rate, symptoms, and the person’s underlying conditions. Rupture or dissection is an emergency requiring immediate medical care.
Diagnosis
How Is an Aortic Aneurysm Diagnosed?
Clinicians may discover an aortic aneurysm while evaluating symptoms, during a routine examination or screening test, or on imaging performed for another reason. They consider the medical and family history, examine the person, and use imaging to confirm and characterize the aneurysm.
- Abdominal ultrasound can detect and measure many abdominal aortic aneurysms.
- Echocardiography can assess the heart, aortic root, and parts of the ascending aorta.
- CT angiography provides detailed images of the aorta and its branches using X-rays and contrast material.
- MRI or magnetic resonance angiography can show the aorta without X-rays and may be useful in selected situations.
- Repeat imaging can show whether the aneurysm is stable or growing over time.
Treatment & Management
Aortic Aneurysm Treatment and Management
| Clinical situation | Typical management approach |
|---|---|
| Small or stable aneurysm | Scheduled imaging, blood pressure and cholesterol management, smoking cessation, and specialist follow-up |
| Enlarging or high-risk aneurysm | Planned repair may be recommended based on size, growth, location, symptoms, anatomy, and overall health |
| Rupture or dissection | Immediate emergency evaluation and urgent repair or other specialist treatment |
Endovascular and Open Repair
Endovascular repair places a stent graft inside the aorta through blood vessels, helping reinforce the weakened area and redirect blood flow. Open repair removes or bypasses the damaged section through surgery and places a durable graft. The choice depends on the aneurysm’s anatomy, location, urgency, and the person’s overall health; ongoing imaging is often needed after either approach.
Prevention & Screening
Aortic Aneurysm Prevention and Screening
- Do not smoke, and seek support to quit if you currently smoke.
- Control blood pressure and cholesterol with lifestyle measures and prescribed treatment.
- Stay physically active as advised by your clinician.
- Follow a heart-healthy eating pattern that supports cardiovascular health.
- Manage diabetes and other vascular risks with regular medical care.
Screening is not a universal test for everyone. A one-time abdominal ultrasound is commonly considered for men ages 65 to 75 who have ever smoked, while decisions for other people depend on family history and individual risk.
Outlook and Prognosis
Aortic Aneurysm Outlook and Prognosis
Many small, stable aortic aneurysms can be monitored for years. Faster growth, symptoms, larger size, dissection, or rupture can change the urgency and prognosis and may lead to a recommendation for repair.
Follow-up should be individualized and may include imaging, medication, and lifestyle changes to reduce cardiovascular risk. Seek urgent care for sudden severe chest, back, or abdominal pain, fainting, severe weakness, or other warning symptoms.
Branches
2 topics
Aortic Aneurysm
Cardiovascular Surgery
Aortic Aneurysm
Vascular Surgery
