Illness & Conditions - Special Health Issues
Discusses causes and symptoms of aneurysms that form in an artery called the aorta. Links to pictures of abdominal aneurysm and thoracic aneurysm. Covers treatment with medicines or surgery. Also looks at lifestyle changes that may help.
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.
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.
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:
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
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, 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 have routine ultrasound tests to see if the aneurysm is getting bigger.
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.
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Frequently Asked Questions
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 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:
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:
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:
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
When to Call a Doctor
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:
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:
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:
Medical history and physical exam
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 rupture.
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
For abdominal aortic aneurysm
Your doctor may recommend an abdominal ultrasound screening test if you are a man who is:
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.
People who have Marfan's syndrome, Ehlers-Danlos syndrome, or another condition that puts them at risk may benefit from screening.
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. 3
After you are diagnosed with an aortic aneurysm, your doctor will evaluate:
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.
Monitoring and medical treatment for aortic aneurysm
If surgery is not done to repair your aneurysm, you will have regular tests to see if it is getting bigger.
Smaller 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 rupture.
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.
For more information, see:
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.
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, 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.
Medicines used to treat high blood pressure, such as beta-blockers, may be used to slow the growth rate of an aortic aneurysm.
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 .
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:
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 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:
Talk to your doctor about the benefits and risks of each repair option to see which is better for you.
Thoracic aortic aneurysm
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
Other Places To Get Help
Last Revised: February 22, 2012
U.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, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation, 113(11): e463–e654.
Hiratzka 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.
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