Aortic Aneurysm Overview

What is an aortic aneurysm?

An aortic aneurysm is a bulge in the aorta that develops in areas where the aorta wall is weak. The pressure of the blood pumping through the aorta causes the weakened section to bulge out like a balloon.

An aneurysm can develop in any section of the aorta. The location of the aneurysm determines its type:

• Abdominal aortic aneurysms (AAAs) are in the section of the aorta that passes through the abdomen (belly area). These are the most common type of aortic aneurysm.
• Thoracic aortic aneurysms (TAAs) are in the section of the aorta that is in the chest. A TAA can develop in the aortic root (part of the aorta attached to the heart), the ascending aorta, aortic arch (the section of the aorta in the chest that bends) or descending aorta.

What are the risks related to an aortic aneurysm?

Aneurysms can grow in size over time. As an aneurysm expands, it can start to cause symptoms. When an aneurysm gets too large, it can rupture and cause life-threatening bleeding or instant death - without warning.

A blood clot is another risk if you have an aneurysm. A clot can form in the aneurysm, and small pieces can break off and travel through your body. If a piece of a clot gets stuck in a brain or heart blood vessel, it can cause a stroke or heart attack. The pieces can also block blood flow to organs like the kidneys and liver, and keep them from working properly. If a piece of a clot blocks the blood flow in your legs, feet or arms, it can cause numbness, weakness, tingling, coldness, light-headedness or pain.

What are the symptoms of an aortic aneurysm?

Most patients with aortic aneurysms do not have any symptoms at all.

Many aortic aneurysms grow slowly for years before they are big enough to cause symptoms. Even large aneurysms may not cause any symptoms.

The most common symptom is pain in the chest or abdomen, depending on the location of the aneurysm. The pain be constant or may come and go.

Some people with an AAA say they have a pulsing sensation in their abdomen. A TAA may cause back pain, shortness of breath or trouble swallowing.

Symptoms of a TAA are most common when the aneurysm is in the aortic arch.

If an aneurysm bursts, it usually causes sudden, severe pain and other symptoms, such as loss of consciousness or shock. Symptoms depend on the location of the aneurysm and how much bleeding there is. A ruptured aneurysm requires emergency treatment.

How are aortic aneurysms diagnosed?

Most aneurysms that do not cause symptoms are found on an X-ray during a routine health exam for some other, unrelated health problem.

Sometimes, an aneurysm is discovered when it is large enough to cause symptoms that lead a person to the doctor. If your doctor thinks you may have an abdominal aortic aneurysm, you may have an ultrasound or CT scan.

If you have any symptoms of an aneurysm, call your doctor right away so your symptoms can be evaluated.

If you think your symptoms are a medical emergency, do not wait for an appointment. Call 999 right away and get to the nearest hospital.

Glossary of Aneurysm Terms

• Abdominal aorta: Section of the aorta that runs through the abdomen.
• Abdominal aortic aneurysm (AAA): Aneurysm that develops in the abdominal aorta.
• Aorta: The main blood vessel that carries oxygen-rich blood from the heart to all parts of the body.
• Aortic aneurysm: A bulge in the aorta that develops in a weakened area of the aorta wall. The pressure of the blood pumping through the aorta causes the weakened section to bulge out like a balloon.
• Aortic dissection: Tearing in the layers of the aorta that can cause life-threatening internal bleeding. An aortic dissection requires emergency treatment.
• Aortic root: The section of the aorta that is attached to the heart. The aortic root includes the annulus (tough, fibrous ring) and leaflets of the aortic valve; and the openings where the coronary arteries attach (coronary ostia).
• Aortic rupture: A section of the aorta that bursts and causes life-threatening internal bleeding. An aortic dissection requires emergent treatment.
• Endovascular repair of aortic aneurysm: Less invasive surgical repair of an aortic aneurysm performed through small groin incisions. A catheter (thin, hollow tube) is used to guide a stent graft through the blood vessels and to the aneurysm. The stent graft acts like a sleeve to move blood flow away from the aneurysm.
• Saccular aneurysm: An aneurysm that is a small, lopsided blister that develops on one side of the aorta.
• Thoracic aorta: Section of the aorta that runs through the chest area and includes the ascending and descending thoracic aorta.
• Thoracic aortic aneurysm (TAA): Aneurysm that develops in the thoracic aorta. It can involve the aortic root, ascending aorta, aortic arch or descending aorta.
• Thoracoabdominal aorta: The descending and abdominal sections of the aorta.
• Thoracoabdominal aneurysm: An aneurysm that develops in the lower part of the thoracic aorta and the upper part of the abdominal aorta.
• Thrombus: Blood clot that forms in the aneurysm. If it dislodges, it can lead to a stroke.

A TAA is usually diagnosed with a computerized tomography (CT) scan or magnetic resonance imaging (MRI).

If you have an aortic aneurysm, a vascular specialist will use several imaging tests to learn more about the size, shape and exact location of the aneurysm. These tests may include:

• High-resolution CT scan
• Angiogram (an X-ray of your blood vessels)
• Transesophageal echocardiography (TEE) to record ultrasound images of the aorta from inside your esophagus
• Intravascular ultrasound to study the inside of your blood vessels

Screening for abdominal aortic aneurysm

If you have a high risk of an AAA, your doctor may use an ultrasound to check for the condition.

Your doctor will help you determine your risk and whether a screening is right for you.

Insurance coverage for AAA screening depends on your insurance provider. If you have questions about coverage, contact your insurance provider.

Medicare covers a one-time AAA screening with a doctor's referral.

What are the risk factors for aortic aneurysm?

Some of the same risk factors for heart attack also increase the risk of aortic aneurysm, including:

• Atherosclerosis (plaque in the artery walls)
• High blood pressure
• Diabetes
• High cholesterol
• Smoking
• Heredity
• Bicuspid aortic valve

Injury or infection that weakens the walls of the aorta can also cause an aneurysm.

Inherited defects

Some defects that are genetic/inherited can cause the blood vessel walls to become weak. If you have a family history of this type of problem, your risk of an aortic aneurysm is higher. Marfan syndrome affects your body's connective tissue and can lead to an aortic aneurysm. The condition is relatively rare, but if you have family members with the Marfan syndrome, talk to your doctor. Cleveland Clinic vascular and cardiovascular surgeons have developed very effective techniques to treat people with Marfan syndrome.

What is the watch and wait approach to treatment?

The goal of treatment for patients with aortic aneurysms is to reduce the risk of rupture. The risk increases as the aneurysm gets bigger. If you have a small aneurysm, your doctor may tell you that the best treatment is to watch and wait. This means your doctor will check the size of your aneurysm on a regular basis (usually every 6 to 12 months) using a CT scan or ultrasound.

Your doctor will consider the size of the aneurysm, how fast it is growing, your symptoms, your age and other health conditions to determine when the best time is to have treatment.

What treatments are available for patients with an aortic aneurysm?

If you need treatment for your aortic aneurysm, you will need surgery. Surgery may be done using a traditional/open surgery approach, or your surgeon may use an endovascular technique.

Your doctor will recommend the best treatment for you depending on the location, shape and size of your aneurysm, as well as other factors such as your age, overall health and results of imaging tests.

If you have more than one aneurysm or if a long section of the aorta is involved, the best approach may be a combination of open and endovascular surgery (hybrid approach).

Open surgical repair

During open surgical repair, an incision is made in the chest or abdomen, depending on the location of the aneurysm. A synthetic (man-made) tube (graft) is used to replace the bulging, diseased section of the aorta. After the graft is stitched into place, it works like a normal, healthy aorta.

The procedure generally takes 3 to 5 hours, and the hospital stay averages 5 to 10 days. Some patients stay at a rehabilitation facility for a short time to complete their recovery. Most people return to their normal activities in 6 to 12 weeks. Open surgical repair is a proven treatment with very good long-term results.

Endovascular repair

Endovascular repair was developed by Cleveland Clinic surgeons. It is the preferred treatment for patients with an AAA. It is also used for patients with a TAA.

During the procedure, the surgeon makes small incisions in the groin area to access the arteries that connect to the aorta. A thin wire is inserted through the arteries and guided into the damaged area of the aorta.

The surgeon inserts the stent graft inside a long, thin tube (catheter) over the guide wire. The stent graft is a fabric tube supported by metal wire stents. It is placed in the weakened area of the aorta.

After the stent graft is in place, the catheter is removed. The stent graft expands like a spring on either side of the aneurysm and creates a new passageway for blood flow without pushing on the aneurysm. Over time, the aneurysm will shrink because of the lack of pressure on it.

Endovascular repair offers these advantages:

• The procedure is shorter than open surgery; it typically takes 1 to 3 hours.
• Patients can go home a few days after the procedure.
• There are smaller scars and less trauma than with open surgery.
• Most people return to their normal activities 2 to 6 weeks after the procedure.

If you have an endovascular stent graft, you must see your doctor for regular visits and CT scans to make sure the stent graft is in place.

Follow-Up Care

After surgery, you will see your doctor for regular visits for exams and testing. These are to see how well your treatment is working. Ask your doctor how often you need to be seen.

A heart-healthy lifestyle is an important part of your follow-up. Your healthcare team can help you achieve your goals, but it is up to you to take your medications as prescribed, keep your follow- up appointments and be an active member of the treatment team.

You can help improve your health by:

• Not smoking
• Treating high cholesterol
• Managing high blood pressure and diabetes
• Exercising regularly
• Eating a heart-healthy diet
• Maintaining a healthy weight
• Controlling stress and anger
• Taking prescribed medications as directed
• Following up with your doctor for regular visits