Definition

An aortic aneurysm is a bulge in the wall of the aorta. The aorta is the body's largest artery. It carries blood from the heart to the rest of the body. The aorta goes through the chest and the abdomen.

An aneurysm tends to get bigger over time. It can burst and lead to heavy, uncontrollable bleeding.

Aortic aneurysms include:

• Thoracic—happens in the chest
• Abdominal—happens below the chest

Abdominal Aortic Aneurysm

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Causes

An aortic aneurysm is caused by weakness in the walls of the aorta. This may be due to aging, genes, and certain conditions. When the aorta walls weaken, a bulge forms.

Risk Factors

Aortic aneurysms are more common in older adults. Other things that raise the risk are:

• Smoking
• Family members with aneurysms
• High blood pressure
• Prior aneurysm
• Arteriosclerosis and atherosclerosis
• Certain genetic conditions such as Marfan syndrome or Ehlers-Danlos syndrome
• Conditions that can inflame the aorta, such as:
  • Great vessel arteritis (Takayasu disease)
  • Polyarteritis nodosa
• Infections from certain bacteria

Symptoms

Many aneurysms do not have symptoms. Symptoms may happen as it gets bigger.

Symptoms depend on the size and site of the aneurysm. They may include:

• Pain in the belly or lower back that may be:
  • Deep, gnawing, or constant
  • Sudden, severe, or stabbing
  • Spreading to the groin, buttocks, or leg
• Pulsing sensation in the belly
• Coughing, problems breathing, or chest pain
• Fainting
• Hoarseness
• Problems swallowing
• Coughing up blood
• Weight loss

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done. Most aortic aneurysms are found during a physical exam.

Images of the heart and blood vessels may be done with:

• Abdominal ultrasound
• CTA scan
• MRA scan
• Abdominal CT scan
• Aortography
• Transesophageal echocardiography
• Cardiac catheterization

Treatment

The goal of treatment is to repair the aortic aneurysm. This is done to prevent more problems. If the aneurysm bursts, it is life-threatening. It needs treatment right away.

The type of treatment depends on the site of the problem and how severe it is.

Options are:

• Surgery called (aneurysmectomy)—Part of the aorta (with the aneurysm) is removed. It is replaced with a mesh graft. In some thoracic aneurysms—the aortic valve or other nearby vessels are replaced or repaired.
• Stents—a tube is inserted into the aorta. It channels the blood away from the aneurysm. This is to prevent it from bursting.

Prevention

There are no current guidelines to prevent an aneurysm. Screening may be advised for those with certain risks.