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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.
Types of Aortic Aneurysms
The type of aortic aneurysm you have depends on where it is
located. They can occur anywhere along the aorta, from your
heart all the way down to your abdomen, just below the kidneys.
-
Abdominal aneurysms occur in the abdomen, below the
arteries to both kidneys
-
Ascending aortic aneurysms occur on the aorta as it
leaves the heart
-
Arch aneurysms occur on the part of the aorta that
curves around the chest near where the arteries extend to
the head and arms
-
Thoracic aneurysms occur in the chest
-
Thoraco-abdominal aneurysms occur on the thoracic
(chest) aorta extending into the abdomen
This
page focuses on three types of aneurysms that affect the
aorta: abdominal aortic aneurysm (AAA), thoracic aortic aneurysms (TAA)\,
and when the aneurysm occurs in both areas, it is called
thoracoabdominal (TAAA). All types are separate conditions with different risk
factors and causes.
Abdominal Aortic Aneurysm:
An abdominal aortic aneurysm happens below the chest.
Abdominal aortic aneurysms happen more often than thoracic
aortic aneurysms.
Abdominal aortic aneurysms are more common in men and
among people age 65 and older. Abdominal aortic aneurysms
are more common among White people than among Black people.
Abdominal aortic aneurysms are usually caused by
atherosclerosis (hardened arteries), but infection or injury
can also cause them.
Abdominal aortic aneurysms often don't have any symptoms.
If an individual does have symptoms, they can include the
following:
- Throbbing or deep pain in the back
or side.
- Pain in the buttocks, groin, or
legs.
Thoracic Aortic Aneurysm:
A thoracic aortic aneurysm happens in the chest. Men and
women are equally likely to get thoracic aortic aneurysms,
which become more common with increasing age.
Thoracic aortic aneurysms are usually caused by
high blood pressure or
sudden injury. Sometimes people with inherited connective
tissue disorders, such as Marfan syndrome and Ehlers-Danlos
syndrome, get thoracic aortic aneurysms.
Signs and symptoms of thoracic aortic aneurysm can
include the following:
- Sharp, sudden pain in the chest or
upper back.
- Shortness of breath.
- Trouble breathing or swallowing.
Thoracoabdominal Aortic Aneurysm:
A thoracoabdominal aortic aneurysm is a bulging in the aorta
that extends from the chest to the abdomen. Thoracoabdominal
aneurysms are often one of the most complex aortic aneurysms to
treat due to the complexity of their location.
Thoracoabdominal aneurysms are classified according to the
Crawford Classification:
- Extent I: involves the majority of the descending thoracic aorta as well as the
upper abdominal aorta.
- Extent II: involves the majority of the descending thoracic aorta and the
majority of the abdominal aorta
- Extent III: involves the lower descending thoracic aorta and the majority of the
abdominal aorta.
- Extent IV: involves most or all of the abdominal aorta
- Extent V: involves the lower descending thoracic aorta and the upper abdominal
aorta.
The decision to treat TAAAs is based on several factors, the
most important of which is size. The general recommendation is
to repair TAAAs when they reach 5.5 cm – 6.0 cm in diameter as the
risk of rupture becomes significant.
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?
The aorta is the body’s largest artery. It runs from the
heart to the pelvis and supplies most of your organs with
oxygen-rich blood.
When a portion of the aorta bulges or balloons outward, it’s
called an aortic aneurysm. If an aortic aneurysm ruptures,
it can be a life threatening medical emergency.
One way doctors assess the risk of an aortic aneurysm is by
measuring it with imaging, such as a CT scan.
An aneurysm under 4 cm may be monitored yearly. It may not
require any intervention.
An aneurysm greater than 4 cm is more concerning. It may
require more frequent imaging or surgery if it appears
likely to rupture.
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.
Most aortic aneurysms are smaller than 4 cm and should be
monitored annually for growth and a change in rupture risk.
Larger aortic aneurysms, though less common, must be
monitored more frequently. Surgery may be needed to treat
the bulging artery and prevent serious health risks.
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).
-
Abdominal CT scan. This test uses X-rays to create
detailed images of the structures inside the belly area. It
can create clear images of the aorta. This test also shows
the size and shape of an aneurysm.
-
MRI This imaging
test uses a magnetic field and radio waves to make detailed
pictures of the structures inside the belly area. It 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,
Serious inflammation within the
aorta and other arteries can
occasionally cause AAAs, but
this happens very rarely.
Aneurysms can form in any blood
vessel in your body. However,
AAAs are considered particularly
serious because of the size of
the aorta.
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 types of abdominal aortic aneurysms?
AAAs are usually classified by their size and the speed at
which they’re growing. These two factors can help predict
the health effects of the aneurysm.
Small: (less than 5.5 centimeters) or slow-growing
AAAs generally have a much lower risk of rupture than larger
aneurysms or those that grow faster. Doctors often consider
it safer to monitor these with regular abdominal ultrasounds
than to treat them.
Large: (greater than 5.5 centimeters) or fast-growing
AAAs are much more likely to rupture than small or
slow-growing aneurysms. A rupture can lead to internal
bleeding and other serious complications. The larger the
aneurysm is, the more likely that it will need to be treated
with surgery. These types of aneurysms also need to be
treated if they’re causing symptoms or leaking blood.
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.
Can you shrink an
aortic aneurysm?
An aortic aneurysm will not disappear on
its own or shrink once it has been
formed.
Some aneurysms may reach a certain size
and remain that way, but they won’t grow
smaller.
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?
Facts about aortic aneurysm in the US
- Aortic aneurysms or aortic dissections were the
cause of 9,904 deaths in 2019.
- In 2019, about 59% of deaths due to aortic
aneurysm or aortic dissection happen among men.
- A history of smoking accounts for about 75% of
all abdominal aortic aneurysms.
- The US Preventive Services Task Force recommends
that men aged 65 to 75 years old who have ever smoked should get an
ultrasound screening for abdominal aortic aneurysms, even if they
have no symptoms.
How dangerous are aortic aneurysms?
According to the Centers for Disease and Prevention, 9,863
Americans died of aortic aneurysms in 2014 (the last year for
which data is available). Every year, 200,000 Americans are
diagnosed with an AAA. A ruptured AAA is the 10th leading cause
of death in men 55 or older. Left untreated, dissections and
ruptures can be fatal. With proper treatment and monitoring,
however, most patients with these conditions will survive with
improved quality of life.
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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