Factors Influencing Aortic Aneurysm Outcomes

An aortic aneurysm refers to a balloon-like area of swelling in the body’s largest artery, known as the aorta. Aortic aneurysms typically occur either in the abdomen or the chest. If they become too large, aortic aneurysms can lead to life-threatening complications, including internal bleeding and sudden rupture. 

This article concerns the different types of aortic aneurysms, as well as the associated symptoms, causes, risk factors, and more.

Types of Aortic Aneurysm (and Resulting Effects)

Aortic aneurysms are bulges that develop in the aorta when the artery walls become weaker. The two types of aortic aneurysms are:

• Abdominal aortic aneurysm (AAA): Abdominal aortic aneurysms occur in the lower half of the body. These bulges develop in the part of the aorta that brings blood from the heart to the pelvic area, legs, and abdomen. If they burst, abdominal aortic aneurysms can be fatal. They are more common in men than in women. 
• Thoracic aortic aneurysm: Thoracic aortic aneurysms develop in the chest and upper torso. As with those that occur in the abdomen, aortic aneurysms in the chest can cause life-threatening internal bleeding if they rupture. Thoracic aortic aneurysms are somewhat less common than abdominal aortic aneurysms.
  

Emergency Ruptured or Dissected Aortic Aneurysm Symptoms

Aortic aneurysms can cause serious health complications like aortic dissection and ruptures.

Aortic dissection occurs when tearing in the artery walls causes blood to leak through. This can cause ischemia, which is a lack of blood flow to the rest of the body, including internal organs. Symptoms include:

• Sudden, severe chest pain that may radiate to the shoulder, back, neck, jaw, arms, legs, and/or stomach
• A feeling of impending doom
• Heart palpitations
• Weak pulse
• Low blood pressure
• Stomach pain
• Difficulty breathing and/or swallowing
• Nausea 
• Vomiting
• Light-headedness
• Excessive sweating
• Cold, clammy skin

The rupture of an aortic aneurysm can be fatal. Call 911 or go to the hospital if you have any symptoms of a burst aortic aneurysm, such as:

• Sudden, severe pain in the back or stomach
• Difficulty breathing
• Shock
• Fainting
• Dizziness
• Pale or discolored skin

Early Warning Symptoms and Signs

In many cases, aortic aneurysms don’t cause early warning signs. You may discover that you have an aortic aneurysm through routine screening or imaging tests done for another reason.

If you do have symptoms of an abdominal or thoracic aortic aneurysm, they may include:

• Persistent abdomen pain
• A palpable lump in the abdomen
• A pulsing sensation in the abdominal area
• Throbbing sensations in the back, side, legs, buttocks, or pelvic area
• Shortness of breath
• Swelling in the arms, neck, or face
• Pain when swallowing
• Hoarseness
• Feeling full or “stuffed” when you haven’t eaten much

Emergency Treatment

In the case of an aortic aneurysm rupture or dissection, you may need emergency surgery. Typically, you’ll first undergo computed tomography angiography (CTA) imaging to see what kind of surgery will be necessary. 

The two main types of surgery to repair an aortic aneurysm are:

• Open surgical repair, which involves the removal of the aneurysm through a large incision in your chest or stomach, followed by a graft in the affected area
• Endovascular aneurysm repair (EVAR), a less invasive surgical procedure that involves making a smaller incision and inserting a stent graft in the affected area via a long, thin tube called a catheter.
  

Treatment for Aortic Aneurysms That Do Not Rupture or Dissect

Depending on the size and location of your aortic aneurysm, your healthcare provider may recommend elective surgical repair and/or medication to lower the risk of rupture and dissection. 

Medications prescribed to prevent the aneurysm from growing include:

• Low-dose aspirin, which may be taken daily
• Cholesterol-lowering medications, such as statins
• Medications to lower blood pressure, such as beta-blockers or angiotensin converting enzyme (ACE) inhibitors
  

What Causes Aortic Aneurysm?

Aortic aneurysms have no single known cause. Sometimes, they result from a sudden trauma or acute injury, such as a car accident or a bacterial infection. 

Men over 65 have a higher chance of developing a thoracic or abdominal aortic aneurysm than others. If you have a family history of aortic aneurysms, you may be more likely to get one yourself. Certain lifestyle habits, such as smoking and using stimulants, are also risk factors. 

If you have any of the following medical conditions, you could be at risk of an aortic aneurysm:

• Kidney disease
• Hypertension (high blood pressure)
• Hypercholesterolemia (high cholesterol)
• Chronic obstructive pulmonary disease (COPD)
• Vasculitis
• Atherosclerosis (hardened arteries)
• Ehlers-Danlos syndrome (EDS)
• Marfan syndrome
• Turner syndrome
• Loeys-Dietz syndrome
• Bicuspid aortic valve (BAV)

Lowering Risk of Aortic Aneurysm

To lower your risk of developing an aortic aneurysm, your healthcare provider may recommend that you do the following:

• Quit smoking.
• Avoid stimulants.
• Prioritize getting a good night’s sleep.
• Take steps to manage stress, such as mindfulness techniques and deep breathing exercises.
• Exercise regularly.
• Work to lower your blood pressure and/or cholesterol if needed (i.e., by increasing your fiber intake and limiting your intake of refined sugar, trans fats, and saturated fats).
• Drink less alcohol.

If you already have high cholesterol or high blood pressure, follow your healthcare provider’s instructions to manage your symptoms. Take all of your prescribed medications as directed, and check in with your care team on a regular basis.

Survival Rates and Life Expectancy

When an aortic aneurysm ruptures, it is a life-threatening medical emergency. Some estimates suggest that only 20% of people survive after an abdominal aortic aneurysm bursts. 

However, if you seek treatment before an aortic aneurysm ruptures, your prognosis is significantly more positive. One study found that 65% of people who had undergone surgery to repair an aortic aneurysm before it ruptured survived more than five years later. Moreover, people who underwent surgery increased their chance of survival by 3 times, in comparison to patients who opted not to have surgery.

Follow-Up and Ongoing Monitoring

Your healthcare provider may recommend that you be screened for an aortic aneurysm (even if you have no symptoms) if you:

• Are a man between the ages of 65 and 75
• Have a family history of aortic aneurysms
• Smoke
• Have other risk factors, such as a comorbid (co-occurring) medical condition

If you have already been diagnosed with an aortic aneurysm, your clinician may recommend that you undergo ongoing monitoring to ensure that it doesn’t get bigger, to review your results after surgery, and/or to assess your need for surgery. This may include regularly scheduled imaging tests and follow-up appointments with your care team.

Summary

An aortic aneurysm is a swollen bulge that develops in the artery, or large blood vessel, that circulates blood between your heart and the rest of your body. There are two types: abdominal aortic aneurysms, which develop in the stomach, and thoracic aortic aneurysms, which develop in the chest area. 

If left untreated, aortic aneurysms can lead to fatal health complications, including rupture and internal bleeding. Seek emergency medical help if you develop any symptoms of a rupture or dissection, such as sudden severe pain, dizziness, or heart palpitations.