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Aortic Aneurysm

What is it?

Your aorta is the largest artery in your body. It carries blood and oxygen from your heart to other parts of your body. It’s shaped like a curved candy cane. Your ascending aorta leads up from your heart. Your descending aorta travels back down into your abdomen (belly).

An aneurysm can develop in any artery. An aortic aneurysm develops when there’s a weakness in the wall of your aorta. The pressure of blood pumping through the artery causes a balloon-like bulge in the weak area of your aorta. This bulge is called an aortic aneurysm.

Aortic aneurysms are balloon-like bulges that occur in the aorta, the main artery carrying oxygen-rich blood to your body.

The aorta has thick walls that stand up to normal blood pressure. However, certain medical problems, genetic conditions, and trauma can damage or weaken these walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm.

This health topic focuses on two types of aneurysms that affect the aorta: abdominal aortic aneurysm (AAA) and thoracic aortic aneurysms (TAA). Both types are separate conditions with different risk factors and causes.

Abdominal aortic aneurysm: The most common place for an aneurysm. The abdominal part of the aorta runs through the stomach area. It carries oxygen-rich blood from the heart to the tissues and organs of the abdomen and lower limbs.

Thoracic aortic aneurysm: A thoracic aortic aneurysm (heart aneurysm) occurs in the section that’s shaped like an upside-down U at the top of your aorta. In people with Marfan syndrome (a connective tissue disorder), a TAA may occur in the ascending aorta.

Aortic aneurysms can develop and grow before causing any symptoms. If the aortic aneurysm grows large, it can burst (rupture) or tear the wall of the artery (dissection), both of which can be life-threatening. Early diagnosis and treatment may slow the growth and prevent serious or life-threatening complications.

To screen for an aortic aneurysm, your provider may recommend an imaging study to look at and measure the aorta. Heart-healthy lifestyle changes can help prevent aortic aneurysms from developing or from growing larger.

How common are they?

Abdominal aortic aneurysms are 4 to 6 times more common in men. They affect only about 1% of men aged 55 to 64. They become more common with every decade of age. The likelihood increases by up to 4% every 10 years of life.

Abdominal aortic aneurysms occur more frequently than thoracic aortic aneurysms. This may be because the wall of your thoracic aorta is thicker and stronger than the wall of your abdominal aorta.

Symptoms

What are the symptoms of an aortic aneurysm?

An aortic aneurysm may not cause any symptoms. The types of symptoms you have will depend on the location of the aneurysm and whether it has become large enough to affect other parts of your body.

If you do have symptoms of an aortic aneurysm, they may include:

Difficult or painful swallowing if the aneurysm pushes on your esophagus, the tube that connects your mouth and your stomach

Difficulty breathing if it pushes on your trachea, or windpipe

Feeling full after not eating very much

Hoarseness

Pain in the neck, jaw, back, chest, stomach area or shoulder, depending on where the aneurysm is located

A pulsating or throbbing feeling in your stomach area

Shortness of breath if the aneurysm presses on your lung

Swelling of the face, neck, or arms if the aneurysm pushes on the superior vena cava, the main vein returning blood from your upper body to your heart

If you know you have an aortic aneurysm, it is important to know the symptoms of a rupture, or tear in the aorta, since quick treatment may save your life.

Symptoms of a rupture may include:

Light-headedness

Rapid heart rate

Sudden, severe pain in your stomach area, chest, or back

Diagnosis

To diagnose an aortic aneurysm, your healthcare provider will do a physical exam and an imaging test. An abdominal aortic aneurysm is diagnosed when your abdominal aorta is three centimeters or greater in diameter. The normal diameter of the thoracic aorta depends on your age, your sex, and which part of the thoracic aorta is measured.

Physical exam

During a physical exam, your provider may do a few basic steps to look for an aortic aneurysm.

Feel your stomach area.

Listen to your heart for a heart murmur, softer heart sounds, or other changes in your blood flow that could be a sign of an aneurysm.

Check your pulse in your arms and legs to see whether it feels weaker than normal.

Look for symptoms of medical conditions that are risk factors for an aortic aneurysm, such as Marfan or Ehlers-Danlos syndromes. This may include looking at your skin, muscles and bones, eyes, head and face, and heart.

Screening and diagnostic tests

Screening for aortic aneurysm is usually done using ultrasound. This test shows if the diameter of your aorta is bigger than it should be. If it is larger than normal, your provider may recommend another screening later to check for growth.

To make the diagnosis your provider may order some tests.

Ultrasound provides information about the size of the abdominal aortic aneurysm and monitors the aorta over time. If you have abdominal or back pain, an ultrasound can check for an abdominal aortic aneurysm or other possible causes of your pain. Once an aortic aneurysm is seen or suspected on ultrasound, you may have a CT scan or an MRI to provide more details about the shape or location of the aneurysm.

Echocardiography provides information about the size of the aortic aneurysm and about the thoracic aorta, which is close to heart. Other parts of the thoracic aorta are better seen with other imaging studies such as CT or magnetic resonance imaging (MRI).

MRI provides information about the size, shape, and location of the aneurysm.

Who should be screened for a thoracic aortic aneurysm?

Certain groups of people may be screened for a thoracic aortic aneurysm.

They include:

People who have Marfan, Loeys–Dietz, Ehlers–Danlos, or Turner syndrome

Parents, children, and siblings (first-degree relatives) of people who have a thoracic aortic aneurysm or a bicuspid aortic valve (BAV)-associated thoracic aortic aneurysm

Who should be screened for an abdominal aortic aneurysm?

There are certain groups of people who may be screened for abdominal aortic aneurysm:

Men 65 to 75 years old who have ever smoked or who have a first-degree relative with the condition

Men 65 to 75 years old who never smoked but have other risk factors, such as a family history, other vascular aneurysms, or coronary heart disease

Men and women more than 75 years old who are in good health, who have ever smoked, or who have a first-degree relative with the condition

People who have peripheral artery disease, regardless of age, sex, smoking history, or family history

Causes and Risk Factors

What raises my risk for aortic aneurysms?

You may have an increased risk of developing an aortic aneurysm because of your age, family history, gene, lifestyle habits, medical conditions, or sex.

Age

Your risk for aortic aneurysms goes up as you age. Abdominal aortic aneurysms are most common in adults after age 65.

Family history and genetics

One in 10 people with abdominal aortic aneurysms have a family history of them. The chance of developing an abdominal aortic aneurysm is 1 in 5 for people who have a parent, brother, sister, or child with the condition, what is known as a first degree relative.

Several family or genetic conditions increase your risk for a thoracic aortic aneurysm.

These include:

Ehlers–Danlos syndrome

Loeys–Dietz syndrome

Marfan syndrome

Turner syndrome

Familial thoracic aortic aneurysms

Bicuspid aortic valve (BAV), which is an abnormal aortic valve

Lifestyle habits

Some lifestyle habits increase your risk of having an aortic aneurysm. These include:

Cigarette smoking is one of the main factors that increases your risk for an aortic aneurysm, especially an abdominal aortic aneurysm. If you are a current smoker, an abdominal aortic aneurysm may grow more quickly and be more likely to burst.

Stimulants such as cocaine, increase your blood pressure and your risk for an aortic aneurysm.

Medical conditions

Medical conditions that are risk factors for aortic aneurysms include:

Aneurysms of blood vessels in other parts of your body

Chronic obstructive pulmonary disease (COPD)

Cardiovascular conditions, such as atherosclerosis, coronary heart disease, and peripheral artery disease

Unhealthy blood cholesterol level

High blood pressure, which is the leading risk factor for thoracic aortic aneurysms but also a risk factor for abdominal aortic aneurysm

Bacterial infections, which are a risk factor for thoracic aortic aneurysms.

Kidney conditions, such as renal failure, chronic kidney disease, and polycystic kidney disease

Obesity

Pheochromocytoma, a rare tumor of the adrenal gland that can lead to high blood pressure

Trauma, such as from car accidents or falls, which is a risk factor for thoracic aortic aneurysms

Vasculitis

Sex

Men are more likely than women to develop aortic aneurysms. However, an existing aneurysm is more likely to rupture at a smaller size in women than in men.

Race and ethnicity

Aortic abdominal aneurisms are less common in Hispanics, African Americans and Asian Americans.

Preventing aortic aneurysms

If you have risk factors for developing an aneurysm, your provider may recommend heart-healthy lifestyle changes to help prevent the condition, including:

Avoid stimulants, such as cocaine

Heart-healthy eating

Manage stress, which can help lower high blood pressure

Quit smoking, especially cigarette smoking, a leading risk factor for developing an aortic aneurysm

What are the complications of an aortic aneurysm?

If an aortic aneurysm ruptures, it causes internal bleeding. Depending on the location of the aneurysm, a rupture can be very dangerous — even life-threatening. With immediate treatment, many people can recover from a ruptured aneurysm.

A growing aortic aneurysm can also lead to a tear (aortic dissection) in your artery wall. A dissection allows blood to leak in between the walls of your artery. This causes a narrowing of your artery. The narrowed artery reduces or blocks blood flow from your heart to other areas. The pressure of blood building up in your artery walls can also cause the aneurysm to rupture.

Treatment

If you have an unruptured aortic aneurysm, your provider will monitor your condition closely. If you have risk factors for developing an aortic aneurysm, your provider may also recommend regular screenings.

Treatment aims to prevent the aneurysm from growing large enough to tear the artery or burst. For smaller, unruptured aneurysms, your provider may prescribe medications to improve blood flow, lower blood pressure or manage cholesterol. All can help slow aneurysm growth and reduce pressure on the artery wall.

Treatment for your aortic aneurysm will depend on its size, location, and the factors that put you at risk. Small aortic aneurysms may be managed with healthy lifestyle changes. The goal is to slow the growth of the aneurysm and lower the chance of rupture or dissection. Your healthcare provider may treat other medical conditions that raise your risk for rupture or dissection, such as high blood pressure, coronary heart disease, chronic kidney disease, and high blood cholesterol. Surgery may be recommended to repair large aneurysms.

Healthy lifestyle changes

Your provider may recommend heart-healthy lifestyle changes.

Quit smoking. This is the most important part of your treatment to slow the growth of the aneurysm. The risk of rupture drops after smoking stops, especially in women. For free help and support to quit smoking, you can call the National Cancer Institute's Smoking Quitline at 1-877-44U-QUIT.

Heart-healthy eating helps lower high blood pressure or high blood cholesterol.

Manage stress to help control high blood pressure, especially for thoracic aortic aneurysms. Your provider may also suggest that you avoid heavy weightlifting and powerful stimulants, such as cocaine.

Get physical activity. Studies show that moderate physical activity does not raise the risk of rupture or growth of the aneurysm and can have health benefits. Talk to your provider to learn which level of physical activity is right for you.

Medicines

Your provider may recommend some medicines.

Aspirin, may be recommended, especially if you have other cardiovascular risks. This medicine may increase the risk of bleeding.

Blood pressure medicines lower blood pressure. These medicines include beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs).

Statins control cholesterol levels.

Procedures or surgery

Depending on the cause or size of an aortic aneurysm or how quickly it is growing, your provider may recommend surgery to repair it. Rupture or dissection of an aneurysm may require emergency surgery.

Open surgical repair is the most common type of surgery. You will be asleep during the procedure. Your doctor first makes a large cut in your stomach area or chest, depending on the location of the aneurysm. Then, the aneurysm is removed and a graft is sewn in its place. This graft is typically a tube made of leak-proof polyester. Recovery time for open surgical repair is about a month.

Endovascular aneurysm repair (EVAR) is done by cardiac catheterization and is less invasive than open surgical repair. This is because the cut is smaller, and you usually need less recovery time. EVAR is used to repair abdominal aortic aneurysms more often than thoracic aortic aneurysms. During the procedure, your surgical team makes a small cut, usually in the groin, then guides a stent graft — a tube covered with fabric — through your blood vessels up to the aorta. The stent graft then expands and attaches to the aortic walls. A seal forms between the stent graft and the vessel wall to prevent blood from entering the aortic aneurysm.

Possible surgical risks

Complications of both types of aortic aneurysm repair can occur, and they may be life-threatening.

These include:

Bleeding and blood loss

Blood clots in blood vessels leading to the bowel, kidneys, legs, or in the graft

Damage to blood vessels or walls of the aorta when placing the stent graft or if the stent graft moves after it is placed

Decreased blood flow to the bowels, legs, kidneys or other organs during surgery, which may lead to injury to these organs

Endoleak, or a blood leak around the stent graft into the aneurysm, must be treated to prevent aneurysm rupture if it happens

Gastrointestinal bleeding rarely occurs, but can happen if an abnormal connection forms between the aorta and your intestines after the repair

Heart problems such as heart attack or arrhythmia

Infection of the incision or the graft

Kidney damage

Spinal cord injury, which may cause paralysis

Stroke

What can I expect after aortic aneurysm surgery?

Recovery after aneurysm surgery takes a month or longer. Your provider will continue to monitor you for changes to the aneurysm, growth or complications. Most people have positive outcomes after surgery.

All surgery has risks. Possible complications after surgery include:

Leaking blood around the graft (called endoleak).

Movement of the graft away from where it was placed.

Formation of blood clots.

Infection.

Living With

Monitor your condition

As aneurysms increase in size, they expand more quickly and are more likely to rupture. Your healthcare provider may recommend regular imaging tests, such as CT scans, MRIs, or ultrasounds, to see how quickly your aortic aneurysm is growing, to decide if you need surgery, or to check for leaks and monitor repairs after surgery. How often these tests are done depends on your risk factors, the causes, and the size of your aortic aneurysm. People who had surgical treatment to repair an aortic aneurysm may need regular monitoring.

Know the warning signs of problems Learn the signs and symptoms of an aortic aneurysm and those of possible rupture or dissection. Contact your provider immediately or call 9-1-1 if you experience any symptoms that may be related to serious problems with your aortic aneurysm.

Aortic dissection, a tear in the inner layer of the aortic wall, causes blood to collect between the inner and middle layers of the aortic wall, which may lead to rupture of the aorta or not enough blood flow to your organs.

Aortic insufficiency and aortic regurgitation are both conditions that may occur when the aortic valve does not close properly because a nearby section of the aorta is enlarged. This allows some backward flow of blood back into the heart. As a result, your heart works harder and that may lead to heart failure.

Aortic rupture causes serious bleeding inside the body and can lead to shock

Cardiac tamponade occurs when there is pressure on the heart from fluid or blood build up in between the heart muscle and outer heart covering.

Kidney failure can happen when there is a lack of blood flow to the kidneys

Reduced blood flow to the bowels may cause inflammation and injury in the large intestine

Infection may occur after surgery to repair an aortic aneurysm. Pain, drainage, or fever may be some signs to look for that you may have a graft infection.

Prevent problems over your lifetime

Having high blood pressure, high cholesterol or using tobacco products increases your risk of developing an aortic aneurysm. You can reduce your risk by maintaining a healthy lifestyle. This includes:

Continue any medicines as prescribed, including those to control other conditions such as high blood cholesterol and high blood pressure.

Take antibiotics, if they are prescribed, to prevent infection of the stent graft before dental and other medical procedures.

Avoid lifting heavyweights or objects, stress, and other situations that might raise your blood pressure.

Quit smoking and adopt a heart-healthy lifestyle. For free help and support to quit smoking, you can call the National Cancer Institute's Smoking Quitline at 1-877-44U-QUIT.

Screen for aneurysms in other locations, such as your pelvis or legs.

Prognosis

What is the prognosis for people with an aortic aneurysm?

With careful monitoring and treatment, your provider can help you manage an aortic aneurysm. Ideally, your healthcare team can identify and care for an aortic aneurysm before it ruptures.

If an aortic aneurysm ruptures, seek medical care immediately. Without prompt treatment, a ruptured aortic aneurysm can be fatal. Both open and endovascular surgery can successfully treat a ruptured aortic aneurysm.

When should I call the doctor?

You should call your healthcare provider if you experience:

Loss of consciousness (syncope, fainting or passing out).

Low blood pressure.

Rapid heart rate.

Sudden, severe pain in your chest, abdomen or back.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

Am I at risk of developing an aortic aneurysm?

How will I know if I have an aortic aneurysm?

What steps can I take to prevent an aortic aneurysm from dissecting or rupturing?

What lifestyle changes will help reduce my risk of an aortic aneurysm?

One Final Note..

Taking steps to improve your heart health can help prevent aortic aneurysms from developing or getting worse. Talk to your doctor about lifestyle changes you can make. If you’re at risk for an aortic aneurysm, be sure to get regular screenings. Finding and treating an aneurysm early greatly reduces the risk of rupture or other complications.

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