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.
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.
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.
An aortic aneurysm can also lead to other problems. Blood flow
often slows in the bulging section of an aortic aneurysm, causing clots to
form. If a blood clot breaks off from an aortic aneurysm in the chest area, it
can travel to the brain and cause a
stroke. Blood clots that break off from an aortic
aneurysm in the belly area can block blood flow to the belly or legs.
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
Experts recommend screening tests for abdominal aneurysms for men who
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.3
If your doctor thinks you have an
aneurysm, you may have tests such as an
CT scan, or an
MRI to find out where it is and how big it is.
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, such as
beta-blockers. 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
ultrasound tests to see if the aneurysm is getting
Even if your aneurysm does not grow 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.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about aortic aneurysms:
Living with an aortic aneurysm:
thoracic aortic aneurysms have a number of causes,
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.
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
common symptoms of
abdominal aortic aneurysm include general abdominal
(belly) pain or discomfort, which may come and go or be constant. Other
Symptoms of a thoracic aortic aneurysm are most
evident when the aneurysm occurs where the aorta curves down (aortic arch). They may include:
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.
The leading risk factors
aortic aneurysm are:
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 50.4
Call 911 or other emergency services immediately if you have signs of a ruptured
aortic aneurysm such as:
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:
Call for a doctor appointment if you have:
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:
If you have a fast-growing aortic aneurysm, you may be
referred to a vascular surgeon, who can evaluate your need for surgery.
Aortic aneurysms are often discovered during an
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:
Your doctor may ask:
As part of a physical exam, your doctor might:
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.
Tests to help find out the location, size, and rate of
growth of an aneurysm include:
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
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.5
Your doctor may recommend an
abdominal ultrasound screening test if you are a man
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.
Ehlers-Danlos syndrome, or another condition that puts
them at risk may benefit from screening.
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.3
After you are diagnosed with an
aortic aneurysm, your doctor will evaluate:
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
If surgery is not done to repair your aneurysm, you will
have regular tests to see if it is getting bigger.
aneurysms (less than 5.5 cm in diameter) that are not at high risk for
rupturing are typically treated with medicine used to treat high blood
pressure, such as a
beta-blocker. Beta-blockers may decrease the rate at
which aneurysms grow. In general, the risks of surgery to repair smaller
aneurysms outweigh the possible benefits, because smaller aneurysms rarely
You may need to
take medicine to treat
high cholesterol and
high blood pressure. These measures have not
been proved to slow aneurysm growth, but they can improve your life in other ways.
These measures reduce your risk of dying from heart attack and stroke.
Despite some claims, taking antioxidant vitamins has not been proved to
reduce the risk of aneurysm or the risk of rupture.
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.
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.
Blood clots in the aorta is another complication. When an aneurysm develops, it can damage the wall of the aorta. The damage leads to clot formation. A blood clot can narrow the aorta and slow down blood flow to the rest of the body. Pieces of the blood clot can break off and get stuck in the bloodstream. This blocks
blood flow and causes damage to tissue beyond the blood clot.
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,
ureter, or the veins to the kidney. Any of these
body parts can become blocked by the inflammation.
If you have an
aortic aneurysm, you need close medical monitoring and
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
high blood pressure.
Medicines used to treat high blood
pressure, such as
beta-blockers, may be used to slow the growth rate of
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
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
When making a decision about repairing an aortic
aneurysm, you and your doctor will think about the benefits in relation to the risks. People who are at significant risk from
surgery might be able to have a less invasive repair procedure.
It is not an option to wait until an aneurysm has ruptured
before surgery is done. Most people who have a ruptured aortic aneurysm die.
Surgery for a ruptured aneurysm is dangerous because of the large amount of
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
Repair options are:
Talk to your doctor about the benefits and risks of each
repair option to see which is better for you.
will recommend that you have surgery for a
thoracic aortic aneurysm based on many things. These include:3
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.4
Many of the risks of surgical or endovascular repair are similar for abdominal and thoracic aortic aneurysms.6
The Society of Interventional Radiology is a national organization of physicians, scientists, and health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapies.
Intervention radiology includes using X-rays, MRI, and other imaging to move a thin tube in the body, usually in an artery, to treat a disease. An example is angioplasty for heart disease. The Web site includes a section on patient information. This section gives information on therapies for various diseases and conditions. The Web site can also help you find a doctor.
The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the website describes diseases, surgeries, patient options, and what to expect after surgery. And using the website, you can search for surgeons in your area.
This Agency for Healthcare Research and Quality (AHRQ) website has evidence-based tips on staying healthy, choosing quality care, getting safe care, understanding diseases, comparing medical treatments, and more. AHRQ is part of the U.S. Department of Health and Human Services. It supports research that will help people make more informed decisions and improve the quality of health care services.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
VascularWeb is a Web site provided by the Society for Vascular
Surgery. This Web site provides information about vascular conditions for
patients and families. VascularWeb can help you learn about how to prevent and
treat vascular diseases, learn about vascular screening, and find a vascular
CitationsU.S. Preventive Services Task Force (2005). Screening for Abdominal Aortic Aneurysm. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsaneu.htm.Hirsch AT, et al. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, SoHiratzka LF, et al. (2010). 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation, 121(13): e266–e369.Braverman AC, et al. (2012). Diseases of the aorta. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1309–1337. Philadelphia: Saunders.Rooke TW, et al. (2011). 2011 ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (Updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 58(19): 2020–2045.Lau WC, Eagle KA (2009). Diseases of the aorta. In EG Nabel, ed., ACP Medicine, section 1, chap. 12. Hamilton, ON: BC Decker.Other Works ConsultedDe Bruin JL, et al. (2010). Long-term outcomes of open or endovascular repair or abdominal aortic aneurysm. New England Journal of Medicine, 362(20): 1881–1889.Elefteriades JA, et al. (2011). Diseases of the aorta. In V Fuster et al., eds., Hurst's The Heart, 13th ed., pp. 2261–2289. New York: McGraw-Hill.Eliason JL, Upchurch GR Jr (2008). Endovascular abdominal aortic aneurysm repair. Circulation, 117(13): 1738–1744.Gornik HL, Creager MA (2007). Diseases of the aorta. In EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd ed., pp. 1473–1495. Philadelphia: Lippincott Williams and Wilkins.Hirsch AT, et al. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, SoLau WC, Eagle KA (2009). Diseases of the aorta. In EG Nabel, ed., ACP Medicine, section 1, chap. 12. Hamilton, ON: BC Decker.Lederle FA, et al. (2009). Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial. JAMA, 302(14): 1535–1542.Rooke TW, et al. (2011). 2011 ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (Updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 58(19): 2020–2045.Schermerhorn ML, et al. (2008). Endovascular vs. open repair of adominal aortic aneurysms in the Medicare population. New England Journal of Medicine, 358(5): 464–474.Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.United Kingdom EVAR Trial Investigators (2010). Endovascular versus open repair of abdominal aortic aneurysm. New England Journal of Medicine, 362(20): 1863–1871.
February 22, 2012
E. Gregory Thompson, MD - Internal Medicine & David A. Szalay, MD - Vascular Surgery
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