Aortic Aneurysm

Overview

An aortic aneurysm is a bulge or ballooning in the wall of the aorta, the large main artery that carries blood from the heart to the rest of the body. It can happen in the chest (thoracic aortic aneurysm) or more commonly in the belly (abdominal aortic aneurysm). Most aortic aneurysms grow slowly and often cause no symptoms until they become large or rupture.

Aortic aneurysms are not extremely common, but they are more frequent in older adults. The exact number varies by country, but it is a well-recognised health concern, especially for men over 65.

Aortic aneurysms affect mainly older adults, especially men aged 65 and over. People with high blood pressure, high cholesterol, a history of smoking, or a family history of aneurysm are at higher risk. Certain genetic conditions can also make them more likely in younger people.

Symptoms

Common symptoms

• Often there are no symptoms, especially in the early stages.
• A pulsing sensation in the belly, particularly near the navel.
• Deep, constant pain in the abdomen, chest, or back.
• Hoarseness or difficulty swallowing (more common with thoracic aneurysms).
• A feeling of fullness or pressure in the belly.

Symptoms in children

• Aortic aneurysms in children are very rare and are usually linked to genetic conditions such as Marfan syndrome or Ehlers-Danlos syndrome.
• Symptoms may include chest or back pain, a hoarse voice, or difficulty breathing, but often there are no symptoms until the aneurysm is large.

Symptoms in older adults

• Older adults may notice vague symptoms like tiredness, mild back pain, or a dull ache in the belly.
• Because symptoms can be subtle, an aneurysm may be found during a routine check-up or imaging test for something else.
• If the aneurysm is large, it can cause noticeable pain or a throbbing sensation in the abdomen.

Causes

Main causes

• A weakening of the aortic wall, which can be present from birth or develop over time.
• Atherosclerosis, a build-up of fatty deposits that damages the artery wall.
• Inflammation of the aorta, sometimes caused by certain infections or autoimmune conditions.
• Genetic disorders that affect connective tissue, such as Marfan syndrome.

Risk factors

• Smoking or tobacco use.
• High blood pressure.
• High cholesterol.
• Age over 65.
• Being male.
• Having a family history of aortic aneurysm.
• Certain genetic conditions, like Marfan syndrome or Ehlers-Danlos syndrome.
• Having had an injury to the chest or back.

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe pain in your chest, abdomen, or back, call your local emergency number immediately.
• If you have new or worsening symptoms like a pulsing belly, pain, fainting, or trouble breathing, seek urgent care.

Book a routine appointment if:

• If you are over 65 and have smoked or have a family history of aortic aneurysm, ask your doctor about screening.
• If you notice a persistent, dull ache in your belly, chest, or back, make an appointment to get it checked.
• If you have high blood pressure, high cholesterol, or other risk factors, talk to your doctor about your overall vascular health.

Diagnosis

Doctors often find aortic aneurysms during a physical exam or when an imaging test is done for another reason. If an aneurysm is suspected, your doctor will arrange imaging tests to see the aorta clearly.

Tests that may be done

• Ultrasound of the abdomen – the most common test for abdominal aortic aneurysm.
• CT scan – provides detailed pictures of the aorta and can show its size and shape.
• MRI scan – another imaging option that gives clear pictures without X-rays.
• Chest X-ray – may sometimes reveal a thoracic aortic aneurysm.

What to expect at your appointment

If you need an imaging test, you will usually lie still on a table while a scanner takes pictures. It is painless and normally takes less than an hour. Your doctor will explain the results to you and what they mean for your health. No special preparation is usually needed, but follow any instructions your healthcare team gives you.

Treatment

Treatment for an aortic aneurysm depends on its size, how fast it is growing, and your overall health. Small aneurysms are often monitored with regular scans. Larger or fast-growing aneurysms may need surgery to prevent rupture. Your doctor will discuss the best option for you.

Self-care at home

• Stop smoking – this is one of the most important things you can do to slow aneurysm growth.
• Keep your blood pressure in a healthy range by following your doctor's advice.
• Stay physically active with moderate activity, like walking, as recommended by your healthcare team.
• Avoid heavy lifting and straining, as this can increase pressure in your abdomen and chest.
• Take all medicines your doctor prescribes, and attend all follow-up appointments.

Medical treatments

Your doctor may prescribe medicines to lower blood pressure or cholesterol. Managing these risk factors helps reduce stress on the aortic wall and can slow the growth of an aneurysm. The specific medicines will depend on your individual needs, and your doctor or pharmacist will explain how to take them correctly.

When is surgery considered?

Surgery may be recommended if the aneurysm is large (usually about 5.5 centimetres in the abdomen or a similar threshold for the chest), if it is growing quickly, or if it causes symptoms. The two main types of surgery are open repair, which involves replacing the weakened section with a graft, and endovascular repair, a less invasive procedure using a stent. Your doctor will discuss which is safer for you.

Living with this condition

Living with an aortic aneurysm means keeping it under close watch. You will likely need regular ultrasound or scan appointments to check the size. Knowing the warning signs of rupture is important, and you should always call for emergency help if you have sudden severe pain or collapse.

Lifestyle tips

• Eat a balanced diet rich in fruit, vegetables, whole grains, and lean proteins.
• Limit salt to help control blood pressure.
• Avoid smoking and second-hand smoke.
• Manage stress through relaxation techniques, hobbies, or talking to someone you trust.
• Stay active with gentle exercises like walking or swimming, but avoid heavy lifting or intense straining.

Diet and exercise

A heart-healthy diet is good for your aorta. Aim for plenty of vegetables, fruits, whole grains, and fish, while cutting back on processed foods, salt, and unhealthy fats. Regular moderate exercise, such as 30 minutes of walking on most days, can help keep your blood pressure down. Always check with your doctor before starting a new exercise programme.

Mental health and emotional wellbeing

Learning you have an aortic aneurysm can be stressful and may cause anxiety. It is normal to worry about the future. Talking with your doctor, family, or a counsellor can help. Some people find comfort in joining a support group, either online or in person, where you can share experiences with others who understand.

Prevention

You cannot always prevent an aortic aneurysm, but you can significantly lower your risk. The most important steps are not smoking, keeping your blood pressure within a healthy range, and eating a heart-healthy diet. If you have high cholesterol or diabetes, work with your doctor to manage these conditions.

Vaccines

There is no vaccine specifically for aortic aneurysm, but staying up to date with recommended vaccines, such as the flu shot and others advised by your doctor, supports your overall health and may reduce the risk of infections that could strain your heart and blood vessels.

Screening programmes

Screening for abdominal aortic aneurysm is offered in some countries to men aged 65 and over, especially those with a history of smoking. If you have a family history or other risk factors, talk to your doctor about whether screening is right for you.

Complications

If left untreated

• The aneurysm can continue to grow and eventually rupture, causing life-threatening internal bleeding.
• A rupture leads to a sudden drop in blood pressure and shock, which is fatal without emergency treatment.
• Blood clots may form inside the aneurysm and break off, blocking blood flow to legs or other organs.
• Large aneurysms can press on nearby structures, causing pain, trouble swallowing, or breathing difficulties.

Long-term outlook

The outlook for people with aortic aneurysm is often good when it is found early and monitored carefully. Many small aneurysms never need treatment, and when surgery is required, modern techniques are safe and effective. Following your healthcare team's advice and attending regular check-ups greatly improves your chances of a healthy outcome.

Find support

International organisations

• World Health Organization ↗

Local organisations

• NHS ↗ · United Kingdom

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