What Are the Warning Signs and Symptoms of an Aortic Aneurysm?

The aorta carries oxygen-rich blood from the heart to the rest of the body. When part of the artery wall weakens, it can stretch and bulge outward, forming an aneurysm.

Aortic aneurysms can occur anywhere along the aorta, but they are most commonly found in the abdomen (abdominal aortic aneurysm or AAA) or the chest (thoracic aortic aneurysm).

According to the Society for Vascular Surgery, abdominal aortic aneurysms are the most common type, with about 200,000 people diagnosed with this type each year.

Many aortic aneurysms cause no symptoms and are discovered during imaging performed for another reason or through screening in people at increased risk.

As an aneurysm enlarges, symptoms may develop.

A growing abdominal aortic aneurysm may cause:

• Deep, constant pain in the abdomen
• Persistent back pain
• A pulsating sensation near the belly button

A thoracic aortic aneurysm may cause:

• Chest pain
• Upper back pain
• Shortness of breath
• Hoarseness
• A persistent cough
• Difficulty swallowing

The larger an aneurysm becomes and the faster it grows, the greater the risk of rupture.

A ruptured aortic aneurysm is a medical emergency. Call 911 immediately if you or someone else develops:

• A sudden, severe chest, back or abdominal pain
• Dizziness or lightheadedness
• Fainting or loss of consciousness
• Rapid heartbeat
• Low blood pressure
• Cold, clammy skin

An aortic aneurysm can increase the risk of an aortic dissection, although the two are different conditions.

An aortic dissection occurs when the inner layer of the aorta tears, allowing blood to flow between the layers of the artery wall. This can reduce blood flow to organs and is a life-threatening medical emergency.

Symptoms of aortic dissection may resemble those of a heart attack.

Seek emergency help if you experience:

• Sudden, severe chest or back pain
• Severe abdominal pain
• Loss of consciousness
• Shortness of breath
• Stroke-like symptoms, including sudden vision changes, trouble speaking or weakness or numbness on one side of your body
• A weaker pulse in one arm or leg
• Leg pain or difficulty walking

Several conditions and lifestyle factors can weaken the aorta and increase the risk of developing an aneurysm.

Common risk factors include:

 Smoking: Smoking is the strongest modifiable risk factor for abdominal aortic aneurysm. Current and former smokers are at significantly higher risk than people who have never smoked.

Atherosclerosis: A buildup of cholesterol-rich plaque in the arteries can weaken the wall of the aorta.

High cholesterol: High cholesterol contributes to atherosclerosis, increasing the risk of aneurysm formation.

High blood pressure: Over time, high blood pressure can weaken the wall of the aorta, leading to an aneurysm.

Blood vessel inflammation or certain infections: Less commonly, these conditions can damage the aortic wall.

Trauma: Serious injuries, including motor vehicle accidents, can sometimes cause an aneurysm.

Inherited connective tissue disorders: Conditions such as Marfan syndrome and vascular Ehlers-Danlos syndrome can weaken the aorta.

Family history: Having a parent, sibling or child with an abdominal aortic aneurysm significantly increases your risk.

“If aortic aneurysms run in your family, speak with your doctor about getting a screening test, which can help detect an aneurysm early before it can become a serious problem,” Dr. Weiss says.

Additional factors that increase risk include:

• Age 65 or older
• Male sex
• Having an aneurysm in another large artery

Although abdominal aortic aneurysms are less common in women, they can still occur and may carry a higher risk of rupture.

Screening can detect an aortic aneurysm before symptoms develop.

A one-time abdominal ultrasound is recommended for men ages 65 to 75 who have ever smoked.

Some people with a strong family history or other risk factors may also benefit from screening. Talk with your doctor about whether screening is right for you.

Your doctor will review your medical history, perform a physical exam and may order imaging tests to evaluate the aorta.

Tests may include:

• Abdominal ultrasound
• Echocardiogram
• CT scan
• MRI

These imaging tests help determine the size of the aneurysm and whether it is changing over time.

“If you are at risk for an aortic aneurysm, we may prescribe medicine to lower your blood pressure and reduce the stress on your blood vessels,” Dr. Weiss says. “We also may order an ultrasound test to scan for aneurysms, especially if you are over 65 and a former or current smoker.”

Treatment depends on the aneurysm’s size, location and rate of growth.

“Small aneurysms may be monitored through regular physical exams and imaging tests,” Dr. Weiss says. “Large or ruptured aneurysms may need surgery.”

For smaller aneurysms, treatment often focuses on reducing the risk of growth or rupture by:

• Controlling blood pressure
• Lowering cholesterol when appropriate
• Quitting smoking
• Monitoring the aneurysm with regular imaging

If surgery is needed, there are two main approaches.

Open surgical repair removes the damaged section of the aorta and replaces it with a synthetic graft.

Endovascular aneurysm repair is a minimally invasive procedure that uses a catheter to place a stent graft inside the aorta to reinforce the weakened section. Whether this approach is an option depends on the aneurysm's size, location and your overall health.

At Scripps, vascular surgeons collaborate with other specialists to provide comprehensive care for people with aortic aneurysms.

“Aortic aneurysm patients benefit from multidisciplinary care like that found at Scripps,” Dr. Weiss says. “Vascular surgeons, cardiac surgeons, cardiologists and radiologists all collaborate to ensure that the best care pathway is chosen.”