What Causes An Aortic Aneurysm And Whos At Risk?

An aortic aneurysm is a bulge in the wall of your aorta, the body’s largest artery. It is a serious condition because if it ruptures, it can cause life-threatening internal bleeding. The main causes are a weakening of the artery wall from factors like high blood pressure, atherosclerosis (hardening of the arteries), and genetic conditions. People at highest risk are older adults, especially men over 65, smokers, and those with a family history of aneurysms.

What exactly is an aortic aneurysm?

Think of your aorta like a garden hose. Over time, a weak spot in the hose wall can balloon outward. That bulge is an aneurysm. It can happen in the chest (thoracic aortic aneurysm) or in the belly (abdominal aortic aneurysm). Abdominal ones are far more common.

Most aneurysms grow slowly and cause no symptoms. Many people live with them for years without knowing. The danger comes when the aneurysm gets large enough to rupture. A ruptured aortic aneurysm is a medical emergency with a very high death rate. The CDC reports that ruptured aortic aneurysms cause about 10,000 deaths each year in the United States.

What causes an aortic aneurysm and who’s at risk?

The direct cause is a breakdown of the proteins that give the aorta its strength and elasticity. This weakening allows the wall to stretch and bulge under the constant pressure of blood flow. Several things can start this process.

High blood pressure is the biggest driver. It puts constant extra force on the artery wall. Over years, this force wears down the wall’s structure. Atherosclerosis, or plaque buildup, also weakens the wall and is closely linked to aneurysms. Smoking is the most preventable cause. It directly damages the artery wall and speeds up both high blood pressure and atherosclerosis.

Some people are born with a higher risk. Genetic conditions like Marfan syndrome and Ehlers-Danlos syndrome cause weak connective tissue throughout the body, including the aorta. A bicuspid aortic valve, a common heart defect present from birth, also raises risk for thoracic aneurysms. Family history is a strong predictor. If a parent or sibling had an aneurysm, your own risk is significantly higher.

How do doctors find an aortic aneurysm?

Most are found by accident. A person gets an ultrasound or CT scan for another reason, and the aneurysm shows up. This is why screening is so important for high-risk people.

The U.S. Preventive Services Task Force recommends a one-time ultrasound screening for men aged 65 to 75 who have ever smoked. This simple, painless test can find an abdominal aortic aneurysm before it becomes dangerous. There is no routine screening for thoracic aneurysms, but if you have a strong family history or a genetic condition, your doctor may recommend imaging.

If an aneurysm is found, doctors measure its size. Size is the main factor in deciding what to do. Small aneurysms are watched. Large ones may need surgery. The growth rate matters too. An aneurysm that grows more than half a centimeter in six months is considered fast-growing and risky.

What are the symptoms of a growing or leaking aneurysm?

Most aneurysms give no warning. That is what makes them so dangerous. But as an aneurysm grows, some people do feel something.

For an abdominal aneurysm, symptoms can include a deep, constant pain in the belly or side. Some people describe a pulsing feeling near the navel. Back pain is also possible. For a thoracic aneurysm, symptoms might include hoarseness, trouble swallowing, or a cough. These happen because the bulge presses on nerves and other structures in the chest.

A leaking or rapidly expanding aneurysm causes sudden, severe pain. This is a rupture until proven otherwise. The pain is often described as a tearing or ripping sensation. It can come with dizziness, rapid heart rate, and loss of consciousness. If you or someone near you has these symptoms, call 911 immediately.

What can you do to lower your risk?

You cannot change your age, gender, or family history. But you can change the things that directly damage your artery walls. The most powerful step is to stop smoking or never start. Research published in the Journal of the American Heart Association shows that smoking accounts for up to 75% of all abdominal aortic aneurysms.

Controlling blood pressure is the next most important step. This means taking prescribed medications as directed and monitoring your numbers at home. A healthy diet low in sodium and saturated fat helps. Regular exercise keeps blood vessels flexible and strong. But check with your doctor before starting a new exercise program if you already know you have an aneurysm.

Managing cholesterol and diabetes also helps reduce atherosclerosis, which weakens artery walls. Some studies suggest that statin medications, which lower cholesterol, may slow aneurysm growth. The evidence is not conclusive yet, but the heart health benefits are clear.

Common misconceptions about aortic aneurysms

A big myth is that aneurysms only happen to old men. While men over 65 who smoke are the highest risk group, women get them too. Women are actually more likely to have a ruptured aneurysm found after death because their symptoms are often missed or attributed to other causes.

Another myth is that heavy lifting or intense exercise can cause an aneurysm to burst. There is no strong evidence that normal physical activity causes rupture. The risk comes from the aneurysm size and wall weakness, not from a single event. That said, if you have a known aneurysm, your doctor may advise against very heavy weightlifting. But daily walking, swimming, and moderate activity are generally safe and beneficial.

Some people believe that if you have no symptoms, you are fine. This is false. Most aneurysms are silent until they rupture. That is why screening is so important for those at risk. Waiting for symptoms is a dangerous strategy.

What treatments are available for an aortic aneurysm?

Treatment depends on size, location, and growth rate. For small aneurysms, doctors use a “watch and wait” approach. This means regular imaging every 6 to 12 months to track size. During this time, managing blood pressure and quitting smoking are the main actions.

For larger aneurysms, surgery is needed to prevent rupture. There are two main types. Open surgery involves removing the weakened section of the aorta and replacing it with a synthetic graft. This is a major operation with a recovery time of several weeks to months.

The less invasive option is endovascular aneurysm repair (EVAR). A surgeon threads a stent-graft through a small incision in the groin up to the aneurysm. The graft reinforces the weak wall from the inside. Recovery is faster, but not everyone is a candidate. The shape and location of the aneurysm must be suitable for this technique. A study in the New England Journal of Medicine found that EVAR has lower short-term risks but similar long-term survival rates compared to open surgery.

What to avoid if you have an aortic aneurysm

If you know you have an aneurysm, there are a few things to be careful about. Avoid smoking and tobacco of any kind. This is non-negotiable. Avoid heavy lifting that involves straining, like lifting more than 50 pounds. This is not a proven trigger for rupture, but it is a reasonable precaution.

Do not stop taking blood pressure medications without talking to your doctor. Sudden spikes in blood pressure are dangerous. Avoid activities that involve sudden, forceful movements or high impact, like competitive sports or heavy manual labor. But do not become inactive. Gentle, consistent movement is good for your heart and blood vessels.

Some people worry about flying or driving. There is no evidence that normal travel is risky for a stable, small aneurysm. But if you have a large aneurysm, your doctor may advise against long flights or heavy driving until it is treated.