Aortic Aneurysm: Symptoms, Causes, and Treatment

An aortic aneurysm is the enlargement of the aorta, your body’s largest artery, to 1.5 times its normal diameter or more. The aorta, normally about 2-3 cm in diameter, begins to balloon due to this condition. Aneurysms progress insidiously because they usually don’t cause symptoms and are discovered incidentally during imaging tests performed for routine check-ups. However, when an aneurysm exceeds 5.0-5.5 cm in diameter in the abdominal region or 5.5 cm in the chest region, it carries the risk of rupture. This rupture is a very urgent condition that can lead to internal bleeding and sudden death. Therefore, it is vitally important to know what an aortic aneurysm is, its causes, symptoms, and most importantly, how it is diagnosed and treated.

What is an aortic aneurysm?

An aortic aneurysm is a bulge caused by weakening in the wall of the aorta, your body’s main artery. The aorta is the main vessel that exits from your heart and carries oxygen-rich blood to your body. The enlargement or ballooning of this vital vessel increases tension in its wall, raising the risk of rupture. An aortic aneurysm can occur anywhere along the aorta but is most commonly seen in the abdomen or chest cavity.

What are the types of aortic aneurysm?

Aortic aneurysms are classified according to which region of the aorta they occur in. Each type has different symptoms, risks, and treatment approaches. The two most common types are:

Abdominal aortic aneurysm

This is the most common type of aneurysm. It develops in the abdominal portion of the aorta. It is generally more common in elderly men, smokers, and patients with high blood pressure. It may not cause symptoms but can rarely cause abdominal pain or back pain.

Thoracic aortic aneurysm

This occurs in the chest cavity portion of the aorta. It is a rare type and can usually manifest with symptoms such as chest pain, back pain, difficulty swallowing, or shortness of breath.

What are the symptoms of aortic aneurysm?

Aortic aneurysms usually progress insidiously and don’t cause symptoms. Many aneurysms are discovered incidentally during imaging tests (such as ultrasound or tomography) performed for other complaints. However, as the aneurysm grows or approaches rupture, some symptoms may appear.

• When an abdominal aneurysm grows, it can cause deep, persistent pain in the abdomen or back.
• In chest aneurysms, sudden sharp pain in the chest, shoulder, or back can be felt.
• Some people with abdominal aneurysms may feel a pulsating mass in their abdomen that beats in sync with their pulse.
• Chest aneurysms can cause cough, shortness of breath, and difficulty swallowing by pressing on the lungs or esophagus.

When an aneurysm ruptures, sudden and severe pain, dizziness, fainting, and shock symptoms appear. This condition is a life-threatening emergency requiring immediate medical intervention.

What causes aortic aneurysm?

The most common cause of aortic aneurysm is the decrease in elasticity and strength in arterial walls. This weakening is usually associated with the aging process. However, some diseases and lifestyle factors can also trigger aneurysm formation.

• Atherosclerosis (arterial hardening) is the most common cause. Plaques accumulating in vessel walls lead to weakening and enlargement of the vessel wall.
• Uncontrolled high blood pressure can cause weakening over time by applying constant pressure to the aortic wall.
• People with a family history of aortic aneurysm have higher risk. Genetic diseases such as Marfan syndrome and Ehlers-Danlos syndrome can also predispose to aortic aneurysm.
• Smoking can accelerate aneurysm development by damaging elastic fibers in the aortic wall.
• Some infections that cause inflammation in the aortic wall can lead to aneurysm formation.

Who develops aortic aneurysm?

Aortic aneurysms are more common in people with certain risk factors. These factors include age, gender, genetic predisposition, and lifestyle habits.

• The risk of aortic aneurysm significantly increases in people aged 65 and over.
• It is more common in men than women.
• The risk of developing aneurysms is much higher in smokers and former smokers.
• Uncontrolled high blood pressure is one of the most important risk factors.
• People with first-degree relatives (mother, father, sibling) who have aortic aneurysm have higher risk.
• High cholesterol levels increase aneurysm risk by accelerating atherosclerosis (arterial hardening) development.

How is aortic aneurysm diagnosed?

Aortic aneurysms are usually discovered during physical examinations or imaging tests performed for other reasons. Methods used for diagnosis help determine the location, size, and structure of the aneurysm.

• Ultrasonography is the most common and easiest method for diagnosing abdominal aneurysms. It allows quick and painless measurement of the aortic diameter.
• Computed tomography (CT) is one of the most detailed methods for diagnosing both abdominal and chest aneurysms. It shows the exact size, shape of the aneurysm and the aorta’s relationship with other organs.
• Magnetic resonance imaging (MRI) provides similar details to CT but may be preferred because it doesn’t contain radiation.
• Angiography is a procedure performed using contrast material for detailed examination of the aorta.

How is aortic aneurysm treated?

Treatment of aortic aneurysm is determined according to the size, location, growth rate of the aneurysm, and the patient’s general health condition. Treatment options are divided into three: monitoring, endovascular treatment, and open surgery.

Medical monitoring

Aneurysms that have not yet reached dangerous size are monitored regularly with ultrasound or CT scans. During this process, blood pressure is kept under control, smoking is stopped, and cholesterol levels are lowered.

Endovascular aneurysm repair (EVAR/TEVAR)

This is a minimally invasive method. A thin catheter is inserted through the groin artery, and a special tube called a stent graft is placed in the aneurysmal area. This stent fills the inside of the aneurysm, reducing pressure on the aortic wall and preventing rupture.

Open surgical repair

This is a traditional surgery. An incision is made through the abdomen or chest, the aneurysmal aortic section is removed, and a synthetic graft is sewn in its place. This method may be preferred especially in young patients and people with unsuitable aneurysm anatomy.

At what size does aortic aneurysm become dangerous?

The dangerous size of an aortic aneurysm varies according to where the aneurysm is located. Generally, as the aneurysm diameter increases, the rupture risk also increases exponentially.

• The normal diameter of the abdominal aorta is approximately 2-2.5 cm. When the diameter exceeds 5.0-5.5 cm, the rupture risk increases significantly and surgical intervention is usually recommended.
• The normal diameter of the thoracic aorta is 2.5-3 cm. When the diameter exceeds 5.5 cm, it is usually considered dangerous and treatment decisions are made. However, this limit may be lower in patients with genetic diseases or young patients.

Even if the aneurysm size is small, it is considered dangerous if it is growing rapidly or showing signs of rupture.

What are the risks of aortic aneurysm?

The greatest risk of aortic aneurysm is aortic rupture and aortic dissection. Both conditions are complications that require emergency intervention and can usually be fatal.

• Aneurysm rupture: As the aneurysm grows, tension in the aortic wall increases and the vessel wall may rupture. This condition can result in major bleeding into the abdominal or chest cavity and sudden death.
• Aortic dissection: A tear occurs in the inner layers of the aorta and blood seeps between the vessel layers, causing wall separation. This condition requires emergency surgical intervention and is life-threatening.
• Clotting: Clots formed inside the aneurysm can break off and travel to other parts of the body, causing blockages (emboli).

Can aortic aneurysm be prevented?

Although it is not possible to completely prevent aneurysms caused by genetic predisposition, the risk of aneurysm development and growth can be significantly reduced by lifestyle changes and keeping risk factors under control.

• Smoking is the most important risk factor for aortic aneurysm. Quitting smoking slows aneurysm growth rate and protects your overall vascular health.
• High blood pressure damages the aortic wall. Regularly check your blood pressure and keep it at normal levels by using medications recommended by your doctor.
• Keep your cholesterol levels under control by eating a low-fat and low-salt diet.
• Regular physical activity supports your vascular health and ensures weight control.
• Screening with abdominal aortic ultrasound is especially recommended for men over 65 with a family history of aortic aneurysm.

Frequently asked questions

Does aortic aneurysm require surgery?

Not every aortic aneurysm requires surgery. It depends on the size of the aneurysm, its growth rate, and the patient’s general health condition. Small aneurysms (usually smaller than 4 cm) are monitored with regular follow-up, while surgical intervention may be required for aneurysms that cause symptoms, grow rapidly, or exceed a certain threshold (such as 5.5 cm). The doctor decides by evaluating the risk-benefit balance.

If aortic aneurysm is painless, is it not dangerous?

The fact that an aortic aneurysm is painless does not mean it is harmless. Most aneurysms can grow for a long time without causing symptoms and can silently carry rupture risk. Therefore, regular screening and monitoring are vitally important, especially for people in the risk group.

Can it occur at a young age?

Aortic aneurysm can also occur at a young age, but it is rare. Usually, genetic connective tissue diseases such as Marfan syndrome, Ehlers-Danlos syndrome, or congenital vascular anomalies can cause aortic aneurysm in young people.

Does aortic aneurysm completely heal?

Aortic aneurysm does not spontaneously “heal” because it is a weakness in the vessel wall. However, small aneurysms can be kept under control with monitoring, their growth can be slowed or stopped. The aneurysm can be repaired with surgical or endovascular treatment, but this does not mean the vessel returns to its original state, but rather that the risk is eliminated.

Does pregnancy affect aortic aneurysm?

During pregnancy, blood volume and pressure increase, which can trigger aortic aneurysm risk or growth of existing aneurysms, especially in women with connective tissue diseases such as Marfan syndrome. Therefore, it is recommended that at-risk individuals undergo cardiology examination before pregnancy.

How long does surgery take?

Surgery duration varies depending on the location of the aneurysm and the method applied (open surgery or endovascular). Open surgery can take 4-8 hours, while endovascular repair (stent) can take 2-4 hours.

Reference: Aortic aneurysm