An aortic aneurysm is a balloon-like bulge that forms in the aorta, the largest artery in your body. The aorta carries blood from your heart to the rest of your organs, so any weakness in its wall is serious. Over time, this weakened area can enlarge, stretch, and even rupture. A ruptured aneurysm causes massive internal bleeding and can be fatal within minutes. Many aneurysms grow silently without causing symptoms, which makes early detection and monitoring very important. With proper treatment and timely intervention, most people can live safely and avoid life-threatening complications.
Overview
An aortic aneurysm occurs when part of the aorta becomes weak and begins to bulge outward like a balloon. This can happen in the chest (thoracic aortic aneurysm) or in the abdomen (abdominal aortic aneurysm), with abdominal aneurysms being more common.
Aneurysms form slowly over many years. Many people do not know they have one until it is found by imaging done for another reason. The danger increases as the aneurysm grows. A small aneurysm may be harmless for years, while a large or rapidly growing one carries a high risk of rupture.
The most serious complication is aortic rupture, which causes sudden, massive internal bleeding. Another major complication is aortic dissection, where a tear develops in the inner wall of the aorta, allowing blood to flow between layers of the vessel wall. Both conditions require immediate emergency care.
Causes
Aortic aneurysms usually result from long-term weakening of the artery wall.
One of the leading causes is atherosclerosis, a condition in which plaque builds up inside the arteries. This buildup weakens the aortic wall over time.
- High blood pressure increases stress on the artery wall and accelerates weakening.
- Smoking is one of the strongest risk factors. It directly damages the artery wall and greatly increases the chance of developing an aneurysm—especially abdominal aortic aneurysms.
- Genetic conditions like Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome weaken the connective tissue of the aorta and raise the risk of aneurysms at younger ages.
- Family history plays a role—having a close relative with an aortic aneurysm increases your risk.
- Infections, although rare, can weaken the aorta and cause a “mycotic aneurysm.”
- Trauma, such as from a car accident, can injure the aorta and lead to aneurysm formation later.
- Inflammatory diseases like vasculitis can also damage artery walls.
- In many people, especially older adults, aneurysms develop from a combination of aging, lifestyle factors, and gradual weakening of the vessel wall.
Symptoms
Most aortic aneurysms do not cause symptoms until they become large or are close to rupturing.
Symptoms of an abdominal aortic aneurysm may include:
- A pulsating sensation in the abdomen
- Deep, constant abdominal or back pain
- A feeling of fullness or pressure in the belly
Symptoms of a thoracic aortic aneurysm may include:
- Chest or upper back pain
- Hoarseness
- Difficulty swallowing
- Shortness of breath
If an aneurysm ruptures, symptoms appear suddenly and can include:
- Severe, tearing pain in the chest, back, or abdomen
- Sudden drop in blood pressure
- Fainting or loss of consciousness
- Rapid heartbeat
- Cold, clammy skin
A rupture is a life-threatening emergency requiring immediate medical attention.
Diagnosis
Aortic aneurysms are often discovered during imaging tests done for other reasons.
The main tools used for diagnosis include:
- Ultrasound, especially for abdominal aneurysms, is a simple and accurate test used for screening.
- CT scan provides detailed images and is essential for measuring aneurysm size and planning treatment.
- MRI offers detailed imaging without radiation and is often used for follow-up.
- Chest X-ray may show a widened aorta in some cases, but it cannot diagnose aneurysms alone.
Once an aneurysm is found, regular imaging is used to monitor its size and growth rate.
Treatment
Treatment depends on the size of the aneurysm, its growth rate, location, and the person’s overall health.
Small aneurysms that are not growing rapidly are usually managed with regular monitoring, blood pressure control, and lifestyle changes such as quitting smoking.
Medications help reduce strain on the aorta:
- Blood pressure medications
- Cholesterol-lowering drugs
- Medications to reduce heart rate (in thoracic aneurysms)
Surgical treatment becomes necessary when an aneurysm is:
- Large (generally ≥5.0–5.5 cm depending on location)
- Growing quickly
- Causing symptoms
- Found in someone with certain genetic conditions
Two main surgical approaches exist:
- Open surgery involves removing the weakened section of the aorta and replacing it with a synthetic graft.
- Endovascular repair (EVAR/TEVAR) uses a catheter to place a stent graft inside the aneurysm, reinforcing the weakened area. This method is less invasive and has a quicker recovery time.
The choice between procedures depends on aneurysm anatomy and the patient’s health.
What Happens If Left Untreated
An untreated aortic aneurysm grows larger over time. As it expands, the wall becomes thinner and more likely to rupture. A rupture causes massive internal bleeding, shock, and often death within minutes.
Even before rupture, aneurysms can cause aortic dissection, where blood enters the wall through a tear and separates its layers. Dissection is a life-threatening emergency and can lead to organ damage, stroke, or heart failure.
Untreated aneurysms can also create blood clots that may travel to other organs, causing serious complications like stroke or limb ischemia.
Without monitoring and treatment, the risk of catastrophic outcomes is high.
What to Watch For
People with known or suspected aneurysms should watch for:
- Persistent chest, back, or abdominal pain
- A pulsating sensation in the abdomen
- Sudden onset of severe, tearing pain
- Dizziness or fainting
- Rapid heartbeat
- Shortness of breath
If any of these symptoms appear—especially sudden, severe pain—seek emergency care immediately.
Regular follow-up imaging is crucial for monitoring aneurysm growth and determining when treatment is needed.
Living with Aortic Aneurysm
Most people with aortic aneurysms can live full, active lives with careful monitoring and healthy lifestyle choices.
Important steps include:
- Controlling blood pressure and cholesterol
- Quitting smoking
- Maintaining a healthy weight
- Exercising regularly but avoiding heavy lifting or intense straining
- Attending all scheduled imaging appointments
- Taking medications as prescribed
People with genetic conditions may require more frequent monitoring and earlier surgical intervention.
Emotional support also matters. Living with a known aneurysm can create anxiety, so regular communication with your healthcare team helps provide reassurance and clarity.
Key Points
- Aortic aneurysm is a bulging, weakened area of the aorta that can grow silently for years.
- Most aneurysms cause no symptoms until they become large or close to rupture.
- Ultrasound, CT, and MRI are essential for diagnosis and monitoring.
- Treatment includes monitoring, medication, lifestyle changes, and surgery when needed.
- Rupture and dissection are life-threatening emergencies requiring immediate care.
- With timely treatment and regular follow-up, most people with aortic aneurysms live safely and well.
Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC5290913/
