Aortic Aneurysm

	Aortic aneurysm Do I need surgery? If you have an aortic aneurysm, surgery should be considered if you have pain, the aneurysm is enlarging, or the size is larger than 5 cm. Surgery or endovascular repair is safest before the aneurysm ruptures.

An aortic aneurysm is dilation (enlargement) of the aorta, the large blood vessel arising from the heart and coursing down through the chest. This enlargement weakens the wall of the aorta and can result in tearing (dissection) or rupture.

Aneurysms are associated with:

• hypertension (high blood pressure)
• atherosclerosis
• coronary artery disease
• bicuspid aortic valve
• connective tissue disorders (Marfan syndrome)
• family history of aneurysm

Aortic aneurysms are classified by location in the body. Thoracic (chest) aneurysms can be ascending (just above the heart) or descending (in the back of the chest, near the spine). Abdominal aneurysms are located in the belly, below the diaphragm. Aneurysms that extend from the chest into the abdomen are termed thoracoabdominal aneurysms.

Abdominal aneurysms can be detected by physical examination, ultrasound, or CT scanning. Thoracic aneurysms are more difficult to detect, and require CT scanning or MRI for accurate diagnosis.

Treatment of aortic aneurysm requires control of blood pressure and regular imaging to monitor for continued enlargement. When an aneurysm approaches 5 cm in diameter, surgery is generally recommended. Patients with connective tissue disorders or a family history of aneurysm rupture or dissection should consider early surgery.

Surgical repair of aortic aneurysm typically involves excision of the aneurysm and replacement with a synthetic graft. Some aneuryms may be suitable for endovascular repair, during which a synthetic stented graft is placed inside the aneurysm using a catheter inserted through the blood vessels of the groin.