Aneurysm

Most aneurysms are in the aorta, the main artery that runs from the heart through the chest and abdomen.

There are two types of aortic aneurysm:

• Thoracic aortic aneurysms – these occur in the part of the aorta running through the chest
• Abdominal aortic aneurysms – these occur in the part of the aorta running through the abdomen

Most aneurysms are found during tests done for other reasons. Some people are at high risk for aneurysms. It is important for them to get screening, because aneurysms can develop and become large before causing any symptoms Screening is recommended for people between the ages of 65 and 75 if they have a family history, or if they are men who have smoked. Doctors use imaging tests to find aneurysms. Medicines and surgery are the two main treatments.

Prevention

The best way to prevent an aortic aneurysm is to avoid the factors that put you at higher risk for one. You can’t control all aortic aneurysm risk factors, but lifestyle changes can help you lower some risks.

For example, if you smoke, try to quit. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

Another important lifestyle change is following a healthy diet. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

Be as physically active as you can. Talk with your doctor about the amounts and types of physical activity that are safe for you.

Work with your doctor to control medical conditions such as high blood pressure and high blood cholesterol. Follow your treatment plans and take all of your medicines as your doctor prescribes.

Risk Factors

Certain factors put you at higher risk for an aortic aneurysm. These factors include:

• Male gender. Men are more likely than women to have aortic aneurysms.
• Age. The risk for abdominal aortic aneurysms increases as you get older. These aneurysms are more likely to occur in people who are aged 65 or older.
• Smoking. Smoking can damage and weaken the walls of the aorta.
• A family history of aortic aneurysms. People who have family histories of aortic aneurysms are at higher risk for the condition, and they may have aneurysms before the age of 65.
• A history of aneurysms in the arteries of the legs.
• Certain diseases and conditions that weaken the walls of the aorta. Examples include high blood pressure and atherosclerosis.

Causes

The force of blood pushing against the walls of an artery combined with damage or injury to the artery’s walls can cause an aneurysm.

Many conditions and factors can damage and weaken the walls of the aorta and cause aortic aneurysms. Examples include aging, smoking, high blood pressure, and  atherosclerosis.

Rarely, infections—such as untreated syphilis (a sexually transmitted infection)—can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that inflame the blood vessels, such as vasculitis.

A family history of aneurysms also may play a role in causing aortic aneurysms.

In addition to the factors above, certain genetic conditions may cause thoracic aortic aneurysms (TAAs).

These genetic conditions can weaken the body’s connective tissues and damage the aorta. People who have these conditions tend to develop aneurysms at a younger age than other people. They’re also at higher risk for rupture and dissection.

Trauma, such as a car accident, also can damage the walls of the aorta and lead to TAAs.

Symptoms

The signs and symptoms of an aortic aneurysm depend on the type and location of the aneurysm and whether the aneurysm has ruptured or is affecting other parts of the body.

Aneurysms can develop and grow for years without causing any signs or symptoms. They often don’t cause signs or symptoms until they rupture, grow large enough to press on nearby body parts, or block blood flow.

Abdominal Aortic Aneurysms

Most abdominal aortic aneurysms (AAAs) develop slowly over years. They often don’t cause signs or symptoms unless they rupture. If you have an AAA, your doctor may feel a throbbing mass while checking your abdomen.

When symptoms are present, they can include:

• A throbbing feeling in the abdomen
• Deep pain in your back or the side of your abdomen
• Steady, gnawing pain in your abdomen that lasts for hours or days

If an AAA ruptures, symptoms may include sudden, severe pain in your lower abdomen and back; nausea (feeling sick to your stomach) and vomiting; constipation and problems with urination; clammy, sweaty skin; light-headedness; and a rapid heart rate when standing up.

Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can’t get enough blood to work well. Shock can be fatal if it’s not treated right away.

Thoracic Aortic Aneurysms

A thoracic aortic aneurysm (TAA) may not cause symptoms until it dissects or grows large. If you have symptoms, they may include:

• Pain in your jaw, neck, back, or chest
• Coughing and/or hoarseness
• Shortness of breath and/or trouble breathing or swallowing

A dissection is a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall.

If a TAA ruptures or dissects, you may feel sudden, severe, sharp or stabbing pain starting in your upper back and moving down into your abdomen. You may have pain in your chest and arms, and you can quickly go into shock.

If you have any symptoms of TAA or aortic dissection, call 9–1–1. If left untreated, these conditions may lead to organ damage or death.

Diagnosis

AAA screening is done using an ultrasound. This safe and painless test uses sound waves to create a picture of the abdominal aorta. The width of the aorta is measured to find out whether it has a bulge.

Treatment for an AAA depends on the size of the aneurysm. If it is small—less than 5.5 centimeters wide (about 2 inches)—the doctor may suggest repeat screenings every so often to monitor for any changes. Surgery is generally recommended only if the AAA is large—5.5 centimeters or more—or is growing very quickly.

Treatment

Treatment for an AAA depends on the size of the aneurysm. If it is small—less than 5.5 centimeters wide (about 2 inches)—the doctor may suggest repeat screenings every so often to monitor for any changes. Surgery is generally recommended only if the AAA is large—5.5 centimeters or more—or is growing very quickly.

Surgery to repair an AAA can be done in two ways. The most common way is open abdominal surgery, in which a surgeon removes the portion of the aorta with the aneurysm. That portion is replaced with a man-made, cloth-like tube, known as a graft. An AAA also can be repaired through endovascular surgery. In this procedure, the doctor does not remove the aneurysm but inserts a metal tube into that portion of the aorta to strengthen it. The tube, which is called a stent graft, is attached to the aorta and forms a stable channel for blood flow.

Recovery

If you have an aortic aneurysm, following your treatment plan and having ongoing medical care are important. Early diagnosis and treatment can help prevent rupture and dissection.

Your doctor may advise you to avoid heavy lifting or physical exertion. If your job requires heavy lifting, you may be advised to change jobs.

Also, try to avoid emotional crises. Strong emotions can cause blood pressure to rise, which increases the risk of rupture or dissection. Call your doctor if an emotional crisis occurs.

Your doctor may prescribe medicines to treat your aneurysm. Medicines can lower your blood pressure, relax your blood vessels, and lower the risk that the aneurysm will rupture (burst). Take all of your medicines exactly as your doctor prescribes.

If you have a small aneurysm that isn’t causing pain, you may not need treatment. However, aneurysms can develop and grow large before causing any symptoms. Thus, people who are at high risk for aneurysms may benefit from early, routine screening.