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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.
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.footnote 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. 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 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.
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.footnote 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 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
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.
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
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
diameter. In general, the risks of surgery to repair smaller
aneurysms outweigh the possible benefits, because smaller aneurysms rarely
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.
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,
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.
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
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
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
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:footnote 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.footnote 4
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. 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.
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.
ByHealthwise Staff Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine Kathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer Jeffrey J. Gilbertson, MD - Vascular Surgery
Current as ofApril 7, 2017
Current as of:
April 7, 2017
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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