Aortic aneurysm

An aortic aneurysm is a bulge in the wall of the body’s largest artery (the aorta). Read about the causes, symptoms and the treatment of an aortic aneurysm.

The aorta is the main pipe which takes oxygen-rich blood from your heart to the rest of your body. It is the largest artery in your body.

What is an aortic aneurysm?

Sometimes a section of the aorta wall is damaged or weakened. This can cause it to bulge or swell, a bit like a balloon. This is an aortic aneurysm.

Usually this bulge occurs in the lower part of your aorta, which runs through your abdomen (tummy). This is an abdominal aortic aneurysm (AAA).

In a quarter of cases, the bulge occurs in the upper part of your part of your aorta, which runs through your chest. This is a thoracic aortic aneurysm.

Occasionally people have both kinds of aortic aneurysm at the same time.

Aortic aneurysms are relatively common, especially as people get older. They are present in up to 10% of older men and 1–2% of older women. In New Zealand they cause approximately 350 deaths a year. 

Aortic aneurysm complications

When an aortic aneurysm is small it doesn’t usually cause problems, but when it grows too large it can be very dangerous. It can cause:

• a tear in the lining of the aorta (aortic dissection) or
• the aorta to burst (aortic rupture).

Both of these conditions are life-threatening and have to be treated with emergency surgery. The good news is that an aortic aneurysm can be monitored by your cardiologist and repaired before it causes complications.

Causes and risk factors

Doctors don’t know why aneurysms occur in some people and not others. However there are a number of things that increase your risk of having one.

• Smoking
• High blood pressure
• High cholesterol
• Coronary artery disease
• Age – aortic aneurysms are most common people over 60
• Gender – they’re more common in men
• Ethnicity – Māori and Pacific people have an increased risk of aortic aneurysm, and are likely to get them at a younger age
• Family history – if someone in your family has had an aortic aneurysm, you’re more at risk of having one yourself
• Injury from a trauma, like being in a car accident
• Certain inherited or congenital heart conditions, such as Marfan syndrome, Ehlers-Danlos syndrome and Loeys-Dietz syndrome

How can I manage my risk of aortic aneurysm?

You can’t change things like your age or gender, but there are some things you can do to reduce your risk of an aortic aneurysm, such as:

• quitting smoking
• maintaining a healthy weight
• managing high blood pressure.

What are the symptoms?

You might not know if you have an aortic aneurysm. Often there are no symptoms, especially if the aneurysm is small.

Some people feel symptoms as the aneurysm gets bigger. The symptoms differ slightly depending on whether it is a thoracic aortic aneurysm or an abdominal aortic aneurysm.

Symptoms of a thoracic aortic aneurysm include:

• tenderness or pain in the chest 
• back pain
• hoarseness
• cough
• shortness of breath.

Symptoms of an abdominal aortic aneurysm include:

• deep pain in your abdomen or the side of your abdomen
• back or groin pain
• pulsing feeling near your belly button.

If you experience these symptoms, you should contact your GP.

Ruptured aortic aneurysm or aortic dissection:

If an aneurysm ruptures or causes an aortic dissection, you may experience a sudden onset of severe symptoms including:

• sudden severe chest or upper back pain, sometimes described as a tearing or ripping feeling
• severe abdominal pain
• loss of consciousness
• breathlessness
• fainting or dizziness
• trouble talking or a croaky voice
• loss of vision
• weakness or paralysis on one side of your body (similar to stroke)
• weak pulse in one arm compared to the other.

In this instance you should call 111 immediately. Do not drive yourself to hospital. 

How is an aortic aneurysm diagnosed?

People who don't have symptoms usually don’t know they have an aortic aneurysm. Often it's discovered during tests or treatments for other medical conditions.
If your doctor thinks you have an aortic aneurysm, you will need to undergo a few tests to confirm it. These might include:

• an ultrasound
• a CT scan
• an MRI
• a chest X ray 
• an echocardiogram.

Aortic aneurysm treatment

Treatment for an aortic aneurysm depends on a number of factors, including:

• the size of the aneurysm
• how quickly it is getting bigger
• where it is situated in the aorta
• your age and general health.

Once you've been diagnosed, a specialist will monitor your condition.

If the aneurysm is small and not causing any symptoms, your doctor will probably just monitor it with regular scans.

You may also be prescribed heart medication to lower your blood pressure and cholesterol levels to minimise any complications from your aneurysm.

When the risk of the aneurysm bursting becomes greater than the risk of surgery, your doctor will usually recommend that you have it repaired.

Surgery to treat an aortic aneurysm

Open surgical repair

This surgery is done in hospital under a general anaesthetic, so you will be asleep during the procedure and you won't feel pain.

A cut is made in the abdomen or chest and the aneurysm is repaired using a synthetic patch or graft.

You will probably be in intensive care for a couple of days, followed by another week or so in hospital.

Endovascular aneurysm repair (EVAR)

An endovascular aneurysm repair (EVAR) is also called an endovascular stent graft.

For this procedure you don’t need large cuts to your abdomen or chest. Instead a small cut is made in your groin and a stent graft, like a small pipe, is inserted via a tube (catheter) in an artery. The catheter is removed from the aorta, and the stent graft is inflated. The graft fits inside the aneurysm, allowing blood flow freely through the aorta.

For this procedure, you’ll be given a local anaesthetic and a sedative. This means you’ll be awake but sleepy throughout and you shouldn’t feel any pain.

The procedure usually takes two or three hours and is carried out by a doctor in a hospital. You will usually stay in hospital for a day or two afterwards. Full recovery should take around a month.

This surgery isn’t suitable for all aneurysms. Your medical team will talk with you about which procedure is best for you.

Recovery from treatment

It is normal to feel tired and sore after surgery and it's important you give yourself time to recover fully, both physically and emotionally.

If you've had open heart surgery, you will probably be able to resume most of your normal activities after four to six weeks. However, it will probably be two or three months before you’re fully recovered. The recovery period will be shorter if you've had an endovascular repair.

Talk to your medical team about specific advice for your recovery, and things like when you can drive, and when you’re ok to have sex.

What’s it like to have an aortic aneurysm?

Finding out you’ve got an aortic aneurysm can be frightening. If doctors are monitoring your aneurysm, you may feel worried about the risk it poses to your health. If you've had surgery to repair an aortic aneurysm, you may be wondering when you’ll be back to normal.

Don't be surprised if you experience a wide range of emotions after your diagnosis or surgery. Some people feel sad, angry or very emotional after a heart procedure. This is quite normal, but if it lasts for longer than six weeks, it's a good idea to mention it to your doctor.

If doctors are monitoring your aneurysm, there are some lifestyle changes you can make to slow the speed at which it gets bigger. These changes will also keep you healthy for surgery and recovery. These include:

• quitting smoking
• taking your medication as prescribed
• being physically active
• reducing your alcohol intake to 1-2 drinks a day maximum
• reducing your sodium intake
• adopting a heart-healthy diet.

You may find it useful to hear from other people living with an aortic aneurysm or who’ve had an aortic dissection. You can read personal stories from people living with heart conditions on our Journeys page.

Hear from others with an aortic aneurysm

Read about aortic dissections