Aortic Aneurysm

Condition Basics

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.

A pseudoaneurysm happens when a bulge occurs but doesn't affect all three layers of tissue in the wall of the aorta. This type of aneurysm might be caused by an injury.

What causes it?

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 atherosclerosis and certain infections, weaken the artery walls. These problems, along with the natural wear and tear of aging, can cause an aneurysm.

What are the symptoms?

Most aortic aneurysms don't cause symptoms. But symptoms may occur if the aneurysm gets bigger. The most common symptoms include belly, chest, or back pain that may spread to the groin, buttocks, or legs. The pain may be deep, aching, or throbbing. If the aneurysm bursts, or ruptures, it causes sudden, severe pain.

How is it diagnosed?

Aneurysms are often diagnosed by chance during tests done for other reasons. In some cases, they are found during a screening test for aneurysms. If your doctor thinks you have an aneurysm, you may have tests such as an ultrasound or CT scan to find out where it is and how big it is.

How is an aortic aneurysm treated?

An aortic aneurysm may be repaired with surgery or a procedure if the aneurysm is at risk of bursting open (rupturing). If you have symptoms, a large aneurysm, or a fast-growing aneurysm, you need surgery to fix it.

Cause

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 things weaken the artery walls and can cause an aneurysm. These things include:

Atherosclerosis.

Exactly how atherosclerosis, or hardening of the arteries, leads to aortic aneurysms isn't clear. It may cause changes in the lining of the artery wall that lead to tissue damage.

Genetics.

Certain inherited conditions can affect the arteries. These conditions include Marfan syndrome and Ehlers-Danlos syndrome.

Aging.

The aorta naturally becomes less elastic and stiffer with age.

Infection.

Some infections can cause aneurysms. Examples include syphilis and endocarditis.

Injury.

A sudden, intense blow to the chest or belly can damage the aorta.

Inflammation.

But what causes the aorta to become inflamed isn't clear.

Symptoms

Most people who have an aortic aneurysm don't have symptoms. But symptoms may occur if the aneurysm gets bigger.

Symptoms may include:

• Pain in the chest, belly, or lower back, which may spread to the groin, buttocks, or legs. The pain may be deep, aching, or throbbing.
• A pulsating feeling in the belly.
• A "cold foot" or a black or blue painful toe. This can happen if a blood clot breaks off and blocks blood flow to the legs or feet.
• A cough or shortness of breath if the aneurysm is in the area of the lungs.
• Hoarseness.
• Trouble swallowing, or pain while swallowing.
• Fever or weight loss.

If an aortic aneurysm bursts, or ruptures, it causes sudden, severe pain, an extreme drop in blood pressure, and signs of shock. Without immediate treatment, it can quickly lead to death.

What Happens

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.

When to Call a Doctor

Call 911 or other emergency services immediately if you have signs of a ruptured aortic aneurysm such as:

• Sudden, severe pain.
• Sudden weakness in the leg or foot on one side of the body.
• An extreme drop in blood pressure.
• Chest, belly, or back pain you have not had before.
• Signs of shock, such as passing out or feeling very dizzy, weak, or less alert.

If you see someone pass out, call 911 or other emergency services and start cardiopulmonary resuscitation (CPR). The emergency operator can coach you on how to do CPR.

Call a doctor now if you have:

• A throbbing lump in your abdomen.
• You have sudden symptoms in your leg or foot such as severe pain, numbness, weakness, tingling, cool skin, or skin color changes. Your skin may be pale, bluish, or purplish.

Call for a doctor appointment if you have:

• Fever or weight loss for no clear reason.

Exams and Tests

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 condition before symptoms appear.

Screening for aortic aneurysms

The U.S. Preventive Services Task Force recommends a screening ultrasound test for abdominal aneurysms for men ages 65 to 75 who 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 your case.

Experts recommend screening tests for a thoracic aneurysm for anyone who has a close relative who's had a thoracic aortic aneurysm.^{footnote 2}

Diagnosing aortic aneurysms

Sometimes an abdominal aneurysm is felt during a routine physical exam. If your doctor thinks you might have an aortic aneurysm, the doctor may:

Do a physical exam.

As part of a physical exam, your doctor might:

• Listen to your heart to check for blood flow problems.
• Check your legs and feet.

Ask about your medical history.

Your doctor may ask questions such as:

• Do you have symptoms? When did they start?
• Do you smoke?
• Do you have other diseases, such as high blood pressure?
• Do you have a family member who has had an aortic aneurysm?

Do imaging tests.

You might have imaging tests to:

• Pinpoint the location of the aneurysm.
• Estimate its size and how fast it is growing.
• Find out if other blood vessels are involved.
• Look for blood clots or inflammation.

Imaging tests

These tests include:

Abdominal ultrasound.

Ultrasounds help your doctor check the size of the aneurysm.

CT scan and MRA.

Computed tomography (CT) and magnetic resonance angiogram (MRA) are used if the doctor needs a more detailed view than an ultrasound provides. This is important when information is needed about the aneurysm's relation to the blood vessels of the kidney or other organs. Your doctor needs this information especially before surgery.

Echocardiogram.

This is an ultrasound used to study the heart and the aorta. You might have one of these:

• Transthoracic echocardiogram (TTE)
• Transesophageal echocardiogram (TEE)

Follow-up testing

One of the most important goals of testing is to estimate the risk that an aneurysm may burst, or rupture. The risk of rupture is compared to the risks of surgery. Tests such as abdominal ultrasound can be used to closely follow any change in the aneurysm and help measure the risk for rupture.

• If the aneurysm is large, you may need an ultrasound every 6 to 12 months.
• If the aneurysm is small, you may need an ultrasound every 2 to 3 years.

There may be other things that determine how often you should get an ultrasound.

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Treatment Overview

Repair of an aortic aneurysm may be done if there's a risk of it bursting open (rupturing). Treatment of an aneurysm is based on how big it is, how fast it's growing, and if you have symptoms.

Large or fast-growing aneurysms.

If you have symptoms, a large aneurysm, or a 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.

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's growing.

Even if your aneurysm doesn't grow fast, 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 medicine to help lower blood pressure and cholesterol.

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Self-Care

If you have an aortic aneurysm, you need close medical monitoring and possibly treatment.

Your doctor may also suggest lifestyle changes that are good for your heart and blood vessels.

• 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.

• Quit smoking.

  Medicines and counseling can help you quit for good.

• Manage blood pressure and cholesterol.

  A heart-healthy lifestyle and medicines can help you do this.

• Stay at a healthy weight.

  Try to lose weight if you need to.

• Be active.

  Ask your doctor what type and amount of exercise is safe for you. If aerobic activity is safe, try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.

• Eat a heart-healthy diet.

  Heart-healthy foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit foods that are not so good for your heart, like sodium, alcohol, and sugar.

• Manage other health problems.

  Other health problems include conditions such as diabetes or heart disease. If you think you may have a problem with alcohol or drug use, talk to your doctor.

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