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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.
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.
The U.S. Preventive Services Task Force recommends screening tests for abdominal aneurysms for men who are ages 65 to 75 and have ever smoked.footnote 1
Experts recommend screening tests for a thoracic aneurysm for anyone who has a close relative who has had a thoracic aortic aneurysm.footnote 2
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.
Repair of an aortic aneurysm is typically recommended if there's a risk of it bursting open (rupturing). If you have symptoms, a large aneurysm, or a fast-growing aneurysm, you may 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. They are not usually treated. 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 blood pressure and cholesterol.
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Abdominal and thoracic aortic aneurysms have a number of causes, including:
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.
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:
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 for an aortic aneurysm are:
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 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:
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 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.
For abdominal aortic aneurysm
The U.S. Preventive Services Task Force recommends a screening test for abdominal aneurysms for men who are ages 65 to 75 and have ever smoked.footnote 1
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 yourcase.
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 2
After you are diagnosed with an aortic aneurysm, your doctor will evaluate:
Aortic aneurysms that are large, causing symptoms or enlarging rapidly are considered at risk of rupturing. Repair is usually recommended.
Small aneurysms are not usually treated. In general, the risks of surgery to repair smaller aneurysms outweigh the possible benefits, because smaller aneurysms rarely rupture.
If surgery is not done to repair your aneurysm, you will have regular tests to check its size.
You may take medicine to help lower blood pressure and cholesterol.
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.
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.
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.
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.
If you have an aortic aneurysm, you may be at risk for heart problems. You may take medicine to help lower blood pressure and cholesterol. 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:
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.
Repair is typically recommended for abdominal aortic aneurysms that are causing symptoms, are large, or are growing rapidly.
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.
Your doctor will recommend that you have surgery for a thoracic aortic aneurysm based on many things. These include:footnote 2
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.
Many of the risks of surgical or endovascular repair are similar for abdominal and thoracic aortic aneurysms.
U.S. Preventive Services Task Force (2014). Screening for abdominal aortic aneurysm. http://www.uspreventiveservicestaskforce.org/uspstf14/abdoman/abdomanfinalrs.htm. Accessed August 27, 2014.
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.
Other Works Consulted
De 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, 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.
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.
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.
Current as of: September 26, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson MD - Internal MedicineKathleen Romito MD - Family MedicineAdam Husney MD - Family MedicineJeffrey J. Gilbertson MD - Vascular Surgery
Current as of:
September 26, 2018
Medical Review:E. Gregory Thompson MD - Internal Medicine & Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & Jeffrey J. Gilbertson MD - Vascular Surgery
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