Aortic Aneurysm

An aortic aneurysm is a dangerous bulge in the wall of the aorta, the body’s largest blood vessel, which can rupture and cause life-threatening bleeding if left untreated.

Table of contents

• What Is an Aortic Aneurysm?
• Types of Aortic Aneurysms
• Signs and Symptoms
• Causes and Risk Factors
• Complications
• Diagnosis and Screening
• Treatment Options
• Living With an Aortic Aneurysm
• Prevention

What Is an Aortic Aneurysm?

An aortic aneurysm is a bulge or balloon-like swelling that develops in the wall of the aorta, the main artery that carries oxygen-rich blood from your heart to the rest of your body^[1][2]. The aorta is shaped like a curved candy cane, with the ascending aorta leading up from the heart and the descending aorta traveling back down into the abdomen^[4].

An aortic aneurysm develops when there is a weakness in the aortic wall. The pressure of blood pumping through the artery causes the weak area to bulge outward^[1][4]. An aneurysm is typically defined as an enlargement of the aorta to greater than 1.5 times its normal size^[5].

While the bulging itself is not immediately dangerous, aortic aneurysms can grow over time and may eventually burst (rupture) or develop a tear in the artery wall (dissection), both of which can cause severe internal bleeding and are life-threatening emergencies^[2][3].

Types of Aortic Aneurysms

Aortic aneurysms are classified based on their location along the aorta. The two main types are:

Abdominal aortic aneurysm (AAA) occurs in the portion of the aorta that runs through the abdomen, or belly area. This is the most common type of aortic aneurysm^[1][2]. The abdominal aorta is responsible for delivering blood to the legs, digestive tract, and kidneys^[6]. Every year, 200,000 people in the United States are diagnosed with an abdominal aortic aneurysm^[6].

Thoracic aortic aneurysm (TAA) occurs in the part of the aorta that passes through the chest cavity, above the diaphragm^[1][2]. Thoracic aortic aneurysms are less common than abdominal ones. This may be because the wall of the thoracic aorta is thicker and stronger than the wall of the abdominal aorta^[4].

Some people may have aneurysms in both locations^[1]. Additionally, thoracoabdominal aortic aneurysms involve portions of the aorta in both the chest and abdomen^[5].

Signs and Symptoms

Most aortic aneurysms do not cause any symptoms, which is why they are often called the “silent killer”^[9]. Many people do not know they have an aneurysm until it ruptures or is discovered during a test performed for another reason^[4][7].

As an aortic aneurysm grows larger, some people may notice symptoms including:

• Pain in the abdomen, back, chest, neck, or jaw, depending on where the aneurysm is located^[4][10]
• A pulsing or throbbing feeling in the belly^[7]
• Difficulty breathing or shortness of breath^[3][4]
• Trouble swallowing^[3][4]
• Feeling full after eating only a small meal^[4]
• Swelling in the arms, neck, or face^[4]
• Coughing or hoarseness^[10]

Symptoms of a ruptured aneurysm come on suddenly and are a medical emergency. If you experience any of these symptoms, call 911 immediately^[4]:

• Sudden, severe pain in the chest, abdomen, or back, often described as ripping or tearing^[3][4]
• Dizziness or lightheadedness^[4]
• Rapid heart rate^[4]
• Pale or gray skin^[7]
• Loss of consciousness^[7]

Causes and Risk Factors

The causes of aortic aneurysms are often not fully understood, but they result from damage or weakness in the aortic wall^[2][4]. Several factors can contribute to the development of an aneurysm:

Atherosclerosis, or hardening of the arteries, occurs when fatty deposits build up on artery walls. This is a common cause of abdominal aortic aneurysms^[3][4].

High blood pressure puts extra force on the artery walls, which can weaken them over time^[3][4].

Inflammation of the arteries can damage the aortic wall^[4].

Inherited conditions that affect connective tissue, such as Marfan syndrome and Ehlers-Danlos syndrome, increase the risk of thoracic aortic aneurysms^[3][4].

Injury or trauma to the aorta, such as from a car accident, can lead to aneurysm formation^[4][10].

Infections, though rare, can also cause aortic aneurysms^[4][7].

Several risk factors increase your likelihood of developing an aortic aneurysm:

• Smoking is the most important behavioral risk factor. A history of smoking accounts for about 75% of all abdominal aortic aneurysms^[3]
• Being male or assigned male at birth^[10]
• Age over 65 years^[3][4]
• Family history of aortic aneurysms^[3][4]
• High blood pressure^[3][4]
• High cholesterol levels^[3][10]
• Having a bicuspid aortic valve, a heart valve defect present from birth^[9][10]

Abdominal aortic aneurysms are more common in men, occurring four to six times more often than in women^[4]. They affect about 1% of men aged 55 to 64, and the likelihood increases by up to 4% every 10 years^[4]. If a first-degree relative, such as a parent or sibling, has had an abdominal aortic aneurysm, you are 12 times more likely to develop one^[6].

Complications

Aortic aneurysms can lead to serious, life-threatening complications:

Aortic rupture occurs when an aneurysm bursts completely, causing severe bleeding inside the body^[3]. This leads to a sudden drop in blood pressure and can cause shock and death. According to one review, up to 81% of people who experience a ruptured abdominal aortic aneurysm will die, with 32% dying before reaching a hospital^[5]. With immediate treatment, many people can recover from a ruptured aneurysm, but it remains extremely dangerous^[4].

Aortic dissection is a tear in the inner layer of the aortic wall. Blood leaks between the layers of the artery wall, which can narrow the aorta and reduce blood flow to organs^[1][3]. This is also a medical emergency.

Other complications include reduced blood flow to organs such as the kidneys or intestines, formation of blood clots that can block circulation to other parts of the body, and problems with the aortic valve if the aneurysm is located near the heart^[4][6].

Diagnosis and Screening

Because most aortic aneurysms do not cause symptoms, they are often discovered by chance during imaging tests performed for other reasons^[9][12]. Your doctor may also find an aneurysm during a physical examination by feeling a pulsing mass in your abdomen or hearing an unusual sound when listening with a stethoscope^[10].

Tests used to diagnose an aortic aneurysm include:

Abdominal ultrasound is the most common test to diagnose abdominal aortic aneurysms. It is a painless, safe test that uses sound waves to create pictures of the inside of your abdomen^[6][12].

CT scan (computed tomography) uses X-rays to create detailed cross-sectional images of the aorta. It can show the size, shape, and location of an aneurysm^[1][12].

MRI (magnetic resonance imaging) uses a magnetic field and radio waves to create detailed pictures of the aorta without using radiation^[1][12].

Echocardiogram uses sound waves to show how blood moves through the heart and blood vessels, including the aorta. A standard echocardiogram looks at the aorta from outside the body. If more detail is needed, a transesophageal echocardiogram may be done, which looks at the aorta from inside the body through the esophagus^[16].

Screening recommendations vary, but in general, the U.S. Preventive Services Task Force recommends that men aged 65 to 75 who have ever smoked cigarettes should have a one-time screening using abdominal ultrasound, even if they have no symptoms^[3][12]. For men aged 65 to 75 who have never smoked, the need for screening depends on other risk factors, such as a family history of aneurysms^[12]. There is not enough evidence to recommend routine screening for women who have never smoked, but screening may be considered for women with a history of smoking or a family history of aneurysms^[12].

Treatment Options

Treatment for an aortic aneurysm depends on its size, location, and how quickly it is growing, as well as your overall health and risk factors^[11][12].

Monitoring and Lifestyle Changes

For small aortic aneurysms that are not causing symptoms, your healthcare provider may recommend careful monitoring through regular imaging tests to check if the aneurysm is growing^[2][7]. The goal is to slow the growth of the aneurysm and prevent rupture.

Heart-healthy lifestyle changes are an important part of managing an aortic aneurysm^[11]:

• Quit smoking. This is the most important step you can take to slow aneurysm growth, especially for women^[11]
• Eat a heart-healthy diet low in sodium, saturated fat, and cholesterol, and rich in fruits and vegetables^[7]
• Get regular physical activity. Moderate exercise does not increase the risk of rupture and can have health benefits^[11]
• Avoid heavy weightlifting and powerful stimulants like cocaine^[11]
• Manage stress^[11]

Medications

Your doctor may prescribe medicines to help manage conditions that can worsen an aneurysm^[7][11]:

• Blood pressure medications help keep your blood pressure under control and reduce strain on the aortic wall
• Cholesterol-lowering medications can slow the progression of atherosclerosis
• Aspirin may be recommended in some cases

Currently, there is no medication that has been proven to shrink or decrease the size of an aneurysm^[22].

Surgery

Surgery may be recommended if your aneurysm is large (typically 5.5 centimeters or bigger), is growing quickly, or is causing symptoms^[7][12]. The two main types of surgery are:

Open surgical repair involves making an incision in the chest or abdomen to reach the aneurysm. The surgeon removes the bulging section of the aorta and replaces it with a synthetic tube called a graft^[6][10]. The hospital stay after this major surgery can exceed two weeks, and full recovery takes a couple of months^[14].

Endovascular repair is a less invasive procedure. The surgeon inserts a device called a stent graft through small incisions in the groin and guides it through the blood vessels to the site of the aneurysm. The stent graft is placed inside the aorta to reinforce the weakened wall and reduce pressure on it^[6][10]. Recovery time is shorter, and the hospital stay can be as brief as one to two days^[14].

The type of surgery recommended depends on the location of your aneurysm, its size and shape, your age, and your overall health^[10].

Living With an Aortic Aneurysm

Once an aortic aneurysm develops, it is at risk of growing larger^[19]. It is very important to keep regular follow-up appointments with your healthcare provider. You will need regular imaging tests to monitor the size of the aneurysm and check for any changes^[21]. How often these tests are done depends on your risk factors and the size of your aneurysm^[21].

Controlling your blood pressure is the most important way you can slow the progress of an aneurysm. If you have been prescribed blood pressure medication, it is very important to take it exactly as instructed^[19].

Many patients with an aortic aneurysm can continue living normally with close monitoring and careful management^[9][22]. If you have had surgery to repair your aneurysm, you may need continued monitoring to check for leaks and ensure the repair is holding^[21].

Learn the warning signs of serious problems with your aneurysm, such as rupture or dissection. Contact your provider immediately or call 911 if you experience sudden severe pain or other emergency symptoms^[21].

Prevention

While you cannot always prevent an aortic aneurysm, you can take steps to reduce your risk and slow the growth of an existing aneurysm^[2][7]:

• Do not smoke, or quit if you do. Smoking is the most important modifiable risk factor^[11]
• Keep your blood pressure under control through medication, diet, and lifestyle changes^[7]
• Maintain healthy cholesterol levels^[7]
• Eat a heart-healthy diet^[7]
• Exercise regularly^[7]
• Maintain a healthy weight^[7]
• Limit alcohol consumption to one to two drinks per day^[19]

If you have a family history of aortic aneurysms or certain genetic conditions that increase risk, talk to your doctor about screening and monitoring^[9].