Aortic Aneurysm

Topic Overview

What is an aortic aneurysm?

An aortic aneurysm (say "a-OR-tik AN-yuh-rih-zum") is a bulge in a section of the aorta, the body's main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is overstretched and weak, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death.

Aneurysms can form in any section of the aorta, but they are most common in the belly area (abdominal aortic aneurysm). They can also happen in the upper body (thoracic aortic aneurysm). Thoracic aortic aneurysms are also known as ascending or descending aortic aneurysms.

What causes an aortic aneurysm?

The wall of the aorta is normally very elastic. It can stretch and then shrink back as needed to adapt to blood flow. But some medical problems, such as high blood pressure and atherosclerosis (hardening of the arteries), weaken the artery walls. These problems, along with the wear and tear that naturally occurs with aging, can result in a weak aortic wall that bulges outward.

What are the symptoms?

Most aortic aneurysms don't cause symptoms. Sometimes a doctor finds them during exams or tests done for other reasons. People who do have symptoms complain of belly, chest, or back pain and discomfort. The symptoms may come and go or stay constant.

In the worst case, an aneurysm can burst, or rupture. This causes severe pain and bleeding. It often leads to death within minutes to hours.

How is an aortic aneurysm diagnosed?

Aneurysms are often diagnosed by chance during exams or tests done for other reasons. In some cases, they are found during a screening test for aneurysms. Screening tests help your doctor look for a certain disease or condition before any symptoms appear.

Experts recommend screening tests for abdominal aneurysms for men who are:

• Ages 65 to 75 and have ever smoked.^{footnote 1}
• At least 60 years old and have a first-degree relative (for example, father or brother) who has had an aneurysm.^{footnote 2}

These men are more likely to have an aneurysm than are women or nonsmoking men.

Experts recommend screening tests for a thoracic aneurysm for anyone who has a close relative who has had a thoracic aortic aneurysm.^{footnote 3}

If your doctor thinks you have an aneurysm, you may have tests such as an ultrasound, a CT scan, or an MRI to find out where it is and how big it is.

How is it treated?

Treatment of an aortic aneurysm is based on how big it is and how fast it is growing. If you have a large or fast-growing aneurysm, you need surgery to fix it. A doctor will repair the damaged part of the blood vessel during open surgery or a minimally invasive procedure.

Small aneurysms rarely rupture and are usually treated with high blood pressure medicine. This medicine helps to lower blood pressure and stress on the aortic wall. If you don't have a repair surgery or procedure, you will have routine ultrasound tests to check the size of the aneurysm and see how fast it is growing.

Even if your aneurysm does not grow fast or rupture, you may be at risk for heart problems. Your doctor may suggest that you exercise more, eat a heart-healthy diet, and stop smoking. He or she may also prescribe medicines to help lower high cholesterol.

Frequently Asked Questions

Cause

Abdominal and thoracic aortic aneurysms have a number of causes, including:

• Hardening of the arteries (atherosclerosis). Exactly how atherosclerosis leads to abdominal aortic aneurysms is unclear. It is thought that atherosclerosis causes changes in the lining of the artery wall that may affect oxygen and nutrient flow to the aortic wall tissues. The resulting tissue damage and breakdown may lead to the development of an aneurysm.
• Genetics. In some people who have Marfan's syndrome, Ehlers-Danlos syndrome, or other inherited conditions, the walls of the major arteries, including the aorta, are weakened. Aortic aneurysms can run in families.
• Aging. The aorta naturally becomes less elastic and stiffer with age, increasing the risk for an abdominal aortic aneurysm.
• Infections. Infections such as syphilis and endocarditis, an infection of the lining of the heart, can cause aneurysms.
• Injury. A sudden, intense blow to the chest or abdomen, such as hitting the steering wheel in a car accident, can damage the aorta.
• Inflammation. Inflammation of the aorta can weaken the aortic wall. What causes the aorta to become inflamed is not clear.

Thoracic aortic aneurysms are much less common than abdominal aortic aneurysms. They are often caused by an abnormal breakdown of the elastic fibers in the aortic wall.

A pseudoaneurysm happens when a bulge occurs in the wall of the aorta. But the bulge doesn't affect all three layers of tissue in the wall of the aorta. This type of aneurysm might be caused by an injury.

Symptoms

Most people with aortic aneurysms, especially ones in the chest area (thoracic aortic aneurysms), do not have symptoms. But symptoms may begin to occur if the aneurysm gets bigger and puts pressure on surrounding organs.

If an aortic aneurysm bursts, or ruptures, there is sudden, severe pain, an extreme drop in blood pressure, and signs of shock. Without immediate medical treatment, death occurs.

Abdominal aortic aneurysm

The most common symptoms of abdominal aortic aneurysm include general abdominal (belly) pain or discomfort, which may come and go or be constant. Other symptoms include:

• Pain in the chest, abdomen, lower back, or flank (over the kidneys), possibly spreading to the groin, buttocks, or legs. The pain may be deep, aching, gnawing, and/or throbbing, and may last for hours or days. It is generally not affected by movement, although certain positions may be more comfortable than others.
• A pulsating sensation in the abdomen.
• A "cold foot" or a black or blue painful toe, which can happen if an abdominal aortic aneurysm produces a blood clot that breaks off and blocks blood flow to the legs or feet.
• Fever or weight loss, if it is an inflammatory aortic aneurysm.

Thoracic aortic aneurysm

Symptoms of a thoracic aortic aneurysm are most evident when the aneurysm occurs where the aorta curves down (aortic arch). They may include:

• Chest pain, generally described as deep and aching or throbbing. This is the most frequent symptom.
• Back pain.
• A cough or shortness of breath if the aneurysm is in the area of the lungs.
• Hoarseness.
• Difficulty or pain while swallowing.

The symptoms of aortic aneurysm are similar to the symptoms of other problems that cause chest or belly pain such as coronary artery disease, gastroesophageal reflux (GERD), and peptic ulcer disease.

What Increases Your Risk

The leading risk factors for an aortic aneurysm are:

• Being over 65 years old.
• Being male.
• Smoking.
• High blood pressure.
• Family history of aortic aneurysms in first-degree relatives (parent, brother, or sister).

Abdominal aortic aneurysms are about 5 times more common in men than in women. An aneurysm happens in about 3 to 9 men out of 100 who are older than 50.^{footnote 4}

When to Call a Doctor

Call 911 or other emergency services immediately if you have signs of a ruptured aortic aneurysm such as:

• Sudden, severe pain.
• An extreme drop in blood pressure.
• Signs of shock, such as passing out or feeling very dizzy, weak, or less alert.

If you witness a person become unconscious, call 911 or other emergency services and start cardiopulmonary resuscitation (CPR). The emergency operator can coach you on how to do CPR. For more information about CPR, see the Rescue Breathing and Cardiopulmonary Resuscitation section of the topic Dealing With Emergencies.

Call a doctor immediately if you have:

• A pulsating mass in your abdomen.
• Sudden weakness in the lower extremities on one side of the body.
• Chest pain you have not experienced before.
• A "cold foot" or a black or blue painful toe for no apparent reason.

Call for a doctor appointment if you have:

• Fever or weight loss for no apparent reason.

Who to see

Health professionals who can evaluate symptoms that may be related to an aortic aneurysm and order the tests needed for further evaluation of symptoms include:

• Family medicine physicians.
• Internists.
• Nurse practitioners.
• Physician assistants.
• Cardiologists or vascular surgeons.

If you have a fast-growing aortic aneurysm, you may be referred to a vascular surgeon, who can evaluate your need for surgery.

Exams and Tests

Aortic aneurysms are often discovered during an X-ray, ultrasound, or echocardiogram done for other reasons. Sometimes an abdominal aneurysm is felt during a routine physical exam. If your doctor thinks you might have an aortic aneurysm, you will likely have a medical history and physical exam. You might have further tests to locate the aneurysm.

When an aneurysm is suspected or diagnosed, it is important to:

• Pinpoint the location of the aneurysm.
• Estimate its size.
• Find out how fast it is growing.
• Find out whether other blood vessels are involved.
• See if there are blood clots or inflammation.

Medical history and physical exam

Your doctor may ask:

• Do you have symptoms and when did they start?
• Do you smoke?
• Do you have other diseases, such as high blood pressure?
• Do you have a family member who has had an aortic aneurysm?
• Have you had a chest injury recently?

As part of a physical exam, your doctor might:

• Listen to your heart to check for blood flow problems.
• Check your legs and feet.

If your doctor finds a mass in your abdomen, he or she will suggest further testing. If you are overweight and your doctor feels strongly that you may have an abdominal aortic aneurysm, he or she may also suggest further testing. This is because an abdominal aortic aneurysm is typically more difficult to find in those who are overweight.

Imaging tests

Tests to help find out the location, size, and rate of growth of an aneurysm include:

• Abdominal ultrasound. Ultrasounds help your doctor check the size of the aneurysm.
• Computed tomography (CT) and magnetic resonance angiogram (MRA), which are used if a view more detailed than an ultrasound is needed. This is important when information is needed about the aneurysm's relation to the blood vessels of the kidney or other organs. Your doctor needs this information especially before surgery. CT is used to watch the growth of a thoracic aortic aneurysm.
• Echocardiogram, an ultrasound exam used to study the heart. A transthoracic echocardiogram (TTE) or a transesophageal echocardiogram (TEE) may be done to diagnose thoracic aortic aneurysm.
• Angiogram. An angiogram can help your doctor know what the size of the aneurysm is and if there are aortic dissections, blood clots, or other blood vessel involvement.

Ongoing testing

One of the most important goals of testing is to estimate the risk that an aneurysm may burst, or rupture, and to compare the risk of rupture to the risks of surgery. If an aortic aneurysm is detected, tests such as abdominal ultrasound can be used to closely follow any change in the size or other aspect of the aneurysm and help measure the risk for rupture.

If your aneurysm is large, you may need an ultrasound every 6 to 12 months. If your aneurysm is small, you may need one every 2 to 3 years.

If you had an endovascular repair of an aneurysm, and you have a stent graft, you will need tests every year, such as a CT scan, to check for problems with the graft.^{footnote 5}

Screening tests

For abdominal aortic aneurysm

Your doctor may recommend an abdominal ultrasound screening test if you are a man who is:

• Age 65 to 75 and has ever smoked.^{footnote 1}
• At least 60 years old and who has a first-degree relative (for example, father or brother) who has had an aneurysm.^{footnote 2}

Some doctors think that other groups should be screened too. Talk to your doctor about whether the benefits of screening would outweigh the risks in your case.

Abdominal Aortic Aneurysm: Should I Get a Screening Test?

For thoracic aortic aneurysm

Your doctor may recommend screening tests for a thoracic aortic aneurysm if you have a close relative (parent, brother, or sister) who has had a thoracic aortic aneurysm.^{footnote 3}

Treatment Overview

After you are diagnosed with an aortic aneurysm, your doctor will evaluate:

• Whether you need the aneurysm repaired.
• Whether you will be able to withstand a surgery or procedure.
• Whether you should wait to repair the aneurysm and get regular tests to check its size and growth.

When repair is recommended

Aortic aneurysms that are causing symptoms or enlarging rapidly are considered at risk of rupturing. Repair is usually recommended if either of these factors is present.

In men, repair is also typically recommended for abdominal aortic aneurysms that are 5.5 cm or larger in diameter, causing symptoms, or are rapidly growing. In women, repair may be recommended for smaller aneurysms.

Repair of thoracic aortic aneurysms is usually recommended when they reach 5.5 to 6.0 cm in diameter. In general, the risks of surgery to repair smaller aneurysms outweigh the possible benefits, because smaller aneurysms rarely rupture.

Monitoring and medical treatment for aortic aneurysm

If surgery is not done to repair your aneurysm, you will have regular tests to check its size.

You may need to take medicine to treat high cholesterol and high blood pressure.

For more information, see:

• High Cholesterol.
• High Blood Pressure.

Despite some claims, taking antioxidant vitamins has not been proved to reduce the risk of aneurysm or the risk of rupture.

Lifestyle changes for aortic aneurysm

If you smoke, try to quit. Medicines and counseling can help you quit for good.

Your doctor will probably recommend that you make other lifestyle changes, such as following a heart-healthy diet, limiting alcohol, and exercising. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.

Ongoing Concerns

If you have an aortic aneurysm, you will see your doctor regularly to check on the size of the aneurysm. The size of the aneurysm and how fast it is growing both help determine how and when to treat it.

Rupture is a dangerous complication. As an aneurysm expands, the tension on the blood vessel wall increases. This causes the aneurysm to expand further, which puts even more tension on the wall. The larger the aneurysm gets, the greater the chances that it will grow larger and eventually burst. Your doctor will want to repair an aneurysm before it has a risk of rupture.

Inflammatory aneurysms are not common, but they can cause complications like fever and weight loss. A massive inflammatory reaction can affect body parts close to the aorta, including part of the small intestine, the ureter, or the veins to the kidney. Any of these body parts can become blocked by the inflammation.

Living With an Aortic Aneurysm

If you have an aortic aneurysm, you need close medical monitoring and possibly treatment.

Go to your regular checkups. You will have regular tests to check the size and growth of the aneurysm. Talk with your doctor about how often you should get tested.

Home treatment is appropriate to help prevent or control conditions that may be causing you to have an aortic aneurysm, such as atherosclerosis or high blood pressure.

• Quit smoking. Medicines and counseling can help you quit for good.
• Control high blood pressure. To control high blood pressure, eat a low-sodium diet, and get regular exercise. For more information, see the topic High Blood Pressure.
• Control high cholesterol. To control high cholesterol, eat a low-fat diet and get regular exercise. For more information, see the topic High Cholesterol.
• Manage your weight. Losing weight will not likely change the course of an aortic aneurysm, but it may lower the risk of complications if you eventually need surgery. For more information, see the topic Weight Management.
• Be active. Ask your doctor what type and amount of exercise is safe for you. If aerobic activity is safe, try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.
• Eat a heart-healthy diet. A heart-healthy diet includes fruits, vegetables, high-fiber foods, and foods low in saturated fat and trans fat. For more information, see the topic Heart-Healthy Eating.

Medications

You may take a medicine to lower your blood pressure. This lowers stress on your aorta.

If you have high cholesterol, your doctor might recommend that you take medicines, such as statins, to lower it. Having high cholesterol increases your risk of atherosclerosis, which can cause aortic aneurysms and other conditions, such as coronary artery disease and stroke.

Surgery

Thoracic or abdominal aortic aneurysms that are large, causing symptoms, or rapidly getting bigger are considered at risk of rupturing. A repair surgery or procedure is usually recommended if any one of these factors is present. A doctor uses a man-made graft to repair an aortic aneurysm.

Your doctor will consider:

• Whether you need the aneurysm repaired right away.
• Whether you will be able to withstand a surgery or procedure.
• The shape and location of your aneurysm to see which repair option is possible.

It is not an option to wait until an aneurysm has ruptured before having it repaired. Most people who have a ruptured aortic aneurysm die. A ruptured aneurysm is dangerous because of the large amount of blood loss.

Abdominal aortic aneurysm

In men, repair is typically recommended for abdominal aortic aneurysms that are causing symptoms, are growing rapidly, or that are 5.5 cm or larger in diameter. In women, repair may be recommended for smaller aneurysms.

The decision to have your aneurysm repaired or not depends on other things too. These may include older age or medical problems that make the repair more dangerous.

Repair options are:

• Open repair surgery.
• Endovascular repair.

Talk to your doctor about the benefits and risks of each repair option to see which is better for you.

Thoracic aortic aneurysm

Your doctor will recommend that you have surgery for a thoracic aortic aneurysm based on many things. These include:^{footnote 3}

• The location of the aneurysm, such as the ascending or descending part of the aorta.
• The size of the aneurysm. Repair might be recommended if an aneurysm is 5.5 to 6.0 cm in diameter.
• Whether the aneurysm is part of a genetic problem, such as Marfan's syndrome.
• Whether you need another heart surgery such as a heart valve replacement surgery.

Open surgery and the less invasive procedure, called endovascular repair, are the two options for repairing a thoracic aortic aneurysm. The choice of repair can depend on the size and location of the aneurysm.^{footnote 4}

Many of the risks of surgical or endovascular repair are similar for abdominal and thoracic aortic aneurysms.