In brief: An aortic aneurysm is a ballooning of the aorta, the body’s main artery. It is often silent but carries a risk of rupture. Small aneurysms are monitored; larger ones are repaired with endovascular (EVAR/stent-graft) or open surgery.
What Is an Aortic Aneurysm?
Weakening of the aortic wall causes it to widen. Most aneurysms cause no symptoms, so screening in at-risk people (older age, smoking, high blood pressure, family history) is important. A sudden, severe tearing pain may indicate rupture or dissection and is an emergency — call emergency services.
Treatment Options
- Surveillance — small, symptom-free aneurysms are monitored with imaging; blood pressure control and stopping smoking are important
- Endovascular repair (EVAR) — a stent-graft is placed through the groin artery, without open surgery, in suitable anatomy
- Open surgical repair — for selected cases
The right approach depends on the size, location and the patient’s overall condition.
Types of Aortic Aneurysm
- Abdominal aortic aneurysm: the most common type; it develops in the section of the aorta that runs through the abdomen.
- Thoracic aortic aneurysm: develops in the chest portion of the aorta and can sometimes cause chest or back pain, shortness of breath or hoarseness.
- Thoracoabdominal aneurysm: a more complex type that involves both the chest and abdominal segments of the aorta.
What Are the Symptoms?
The most insidious feature of an aortic aneurysm is that it usually progresses without any symptoms, and it is often discovered by chance on an ultrasound or CT scan performed for another reason. When symptoms do appear, they depend on the location of the aneurysm and may include:
- Persistent abdominal pain or ongoing lower-back pain
- A pulsating sensation in the abdomen, as if feeling the heartbeat there
- Chest or back pain, shortness of breath or hoarseness (in thoracic aneurysms)
- A feeling of fullness in the abdomen
Emergency warning: Sudden, severe abdominal, back or chest pain together with fainting, a drop in blood pressure and cold sweating may be signs of a ruptured aneurysm or an aortic dissection. This is a life-threatening situation – call your local emergency number immediately.
Risk Factors
- Older age (especially over 65) and male sex
- Smoking
- High blood pressure
- Chronic bronchitis or COPD – frequent, forceful coughing can raise pressure inside the abdomen and increase the risk of rupture
- Hardening of the arteries (atherosclerosis) and high cholesterol
- A family history of aneurysm and connective-tissue disorders such as Marfan syndrome
Diagnosis and Screening
An aortic aneurysm is most often detected easily with ultrasound. For a detailed assessment and surgical planning, computed tomography (CT) or CT angiography is used. Because the condition tends to progress silently, screening is important:
- Current guidance suggests a one-time screening ultrasound, particularly for people over 65 with a history of smoking
- People with high blood pressure and others at increased risk may benefit from a yearly ultrasound or CT assessment
- Once an aneurysm is found, it is followed with imaging at intervals based on its diameter
Treatment Methods in Detail
Treatment is planned according to the diameter of the aneurysm, how quickly it is growing, its location, whether it causes symptoms and the person’s overall health.
1. Surveillance (Monitoring)
Small, symptom-free aneurysms are usually monitored with regular imaging rather than operated on. In general medical practice, diameters above roughly 5-5.5 cm for abdominal aortic aneurysms and roughly 5.5-6 cm for thoracic aneurysms, along with rapid growth or symptoms, are considered important for surgery. During monitoring, controlling blood pressure and stopping smoking are essential.
2. Endovascular Repair (EVAR – Stent-Graft)
Through the artery in the groin and with imaging guidance, a stent-graft is placed in the aneurysm area to support the aorta from the inside. Compared with open surgery, it usually involves a smaller incision and a generally faster recovery; suitability depends on the anatomy of the vessel.
3. Open Surgical Repair
The aneurysmal segment of the vessel is removed and replaced with an artificial (graft) vessel. In suitable patients, minimally invasive open approaches may be preferred. The aim is to complete the procedure safely, without injuring the intestines, without the vessel tearing and without undue strain on the patient.
How Is the Treatment Decision Made?
Looking at the diameter of the vessel alone is not enough when deciding on treatment; the person’s chronic illnesses and lifestyle must also be taken into account. In conditions such as COPD or connective-tissue disease, the risk can be high even at smaller diameters, so earlier intervention may be needed when symptoms are present. Which method is appropriate – EVAR or open surgery – is specific to each patient and is determined by the physician.
Frequently Asked Questions
Does an aortic aneurysm cause symptoms?
Often not — it is usually silent. That is why screening in at-risk people is important.
How is it treated?
Small aneurysms are monitored; larger ones are repaired with endovascular (EVAR/stent-graft) or open surgery, depending on size and anatomy.
Is this medical advice?
No. This page is for information only; please consult a physician.
Which aneurysms are operated on?
In general, abdominal aortic aneurysms above about 5-5.5 cm and thoracic aneurysms above about 5.5-6 cm, as well as rapid growth or symptoms, may call for surgery. Smaller aneurysms are monitored, and the decision is individual.
Who should be screened?
Assessment with ultrasound is recommended especially for people over 65, those with a history of smoking, people with high blood pressure and those with a family history of aneurysm.
What causes an aortic aneurysm?
The main contributing factors are hardening of the arteries, high blood pressure, smoking, older age and genetic predisposition.
What is the most dangerous complication?
Rupture of the aneurysm is a life-threatening emergency that presents with sudden, severe abdominal or back pain and requires immediate care.
How is an aortic aneurysm monitored?
Aneurysms below a certain diameter are generally followed at regular intervals with ultrasound or CT, while risk factors are kept under control.
How is EVAR (the closed method) performed?
A stent-graft is placed inside the aorta through the groin artery and supports the aneurysm from within; it may be preferred when the anatomy is suitable.
Can an aortic aneurysm be prevented?
Controlling blood pressure, stopping smoking and screening for those in at-risk groups are important for early detection and prevention.
What is the difference between EVAR and open surgery?
In EVAR, a stent-graft is placed inside the vessel through the groin, with a smaller incision and a generally faster recovery. In open surgery, the aneurysmal segment is removed and replaced with a graft. Which is suitable depends on the vessel anatomy and the patient.
Video — Prof. Dr. Yusuf Kalko
Prof. Dr. Yusuf Kalko explains aortic rupture and aneurysm. (Video in Turkish.)
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This content is for information purposes only and does not replace a medical consultation. — Cardiovascular Surgeon Prof. Dr. Yusuf Kalko