This content is for general education only and is not medical advice. Always consult your physician for diagnosis and treatment decisions.
Aortic Aneurysm & Dissection
An aortic aneurysm is a balloon-like enlargement of the body’s main artery; a dissection is a tear within its wall. Both are silent until they become emergencies, which is why screening, surveillance, and timely repair are life-saving.
Overview
The aorta carries the entire cardiac output from the heart through the chest and abdomen. When its wall weakens — through age, atherosclerosis, high blood pressure, smoking, or inherited tissue disorders — a segment can dilate into an aneurysm. Rupture risk rises with diameter and growth rate. A dissection occurs when blood enters a tear in the inner layer and splits the wall into two channels, which can cut off branch arteries or rupture. Most abdominal aneurysms are found incidentally or by screening ultrasound and are monitored until they reach a size threshold where repair is safer than surveillance.
Signs & Symptoms
- Usually none — most aneurysms are silent until large
- A pulsating sensation in the abdomen
- Deep, constant abdominal or back pain can signal expansion
- Sudden tearing chest or back pain suggests dissection — an emergency
- Sudden severe abdominal pain with collapse suggests rupture — call an ambulance
How It Is Diagnosed
Abdominal ultrasound is the screening and surveillance workhorse. CT angiography measures the aneurysm precisely, maps branch vessels, and is essential for planning repair. Echocardiography and MRI evaluate the thoracic aorta. Surveillance intervals depend on diameter and growth rate.
Treatment Options
Surveillance and medical therapy
Small aneurysms are monitored with scheduled imaging while blood pressure control, statins, and smoking cessation slow growth — many never need repair.
Endovascular aneurysm repair (EVAR/TEVAR)
A fabric-covered stent graft delivered through the femoral arteries relines the aorta from within, excluding the aneurysm sac from pressure. Recovery is measured in days; lifelong imaging follow-up checks the seal.
Branch-preserving endovascular techniques
When the aneurysm involves segments with critical side branches, fenestrated grafts or flow-modulating stents maintain branch perfusion while treating the diseased segment — planned case by case in specialized centers.
Open surgical repair
Replacing the diseased segment with a sewn-in graft remains the durable standard for suitable patients, particularly younger patients or anatomy unsuitable for endovascular repair.
When to See a Doctor
If you are over 65, have ever smoked, or have a family history of aneurysm, ask about screening ultrasound. Known aneurysm patients should never miss surveillance imaging. Sudden severe chest, back, or abdominal pain is an emergency.
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Frequently Asked Questions
At what size does an aneurysm need repair?+
Repair is generally considered when rupture risk exceeds procedural risk — determined by diameter, growth rate, sex, and anatomy. Your vascular team applies current guideline thresholds to your individual case rather than a single universal number.
What is the difference between EVAR and open repair?+
EVAR relines the aorta through groin punctures with a stent graft — faster recovery, but requiring lifelong imaging surveillance. Open repair replaces the segment surgically — a bigger operation with a very durable result.
Can an aneurysm shrink?+
After successful endovascular exclusion, the sac often stabilizes or shrinks over time because it is no longer pressurized. Without repair, aneurysms do not shrink; medical therapy only slows expansion.
Is an aortic dissection survivable?+
Yes — with immediate diagnosis and treatment. Dissections involving the ascending aorta need emergency surgery; many descending dissections are managed with blood-pressure control and, when complicated, endovascular stent grafting.
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