An aortic aneurysm is a localized bulge or weakened area in the wall of the aorta, the body’s largest artery, which carries oxygenated blood from the heart. Aneurysms are classified by location: thoracic (TAA) in the chest or abdominal (AAA) in the abdomen. While the possibility of rupture is serious, many people can live a stable life with this condition through careful medical management and consistent monitoring. Small, stable aneurysms often produce no symptoms and are frequently discovered incidentally.
Surveillance and Monitoring
For small or slow-growing aortic aneurysms, the standard approach is “watchful waiting,” involving active surveillance by a medical team. The decision to monitor rather than operate hinges primarily on the aneurysm’s size, its rate of growth, and its specific location.
Regular imaging tests track the aneurysm’s diameter and ensure stability. For abdominal aneurysms, duplex ultrasound is often the preferred initial tool, providing accurate, non-invasive size measurements. These checks may be scheduled every six to twelve months, depending on the aneurysm’s size.
Computed tomography (CT) scans or magnetic resonance imaging (MRI) are also used, particularly for thoracic aneurysms or when a detailed view of the entire aorta is necessary. An accelerated growth rate, such as expanding by more than 5 to 10 millimeters per year, signals a change in stability that prompts discussion about intervention.
Strategies to Control Aneurysm Growth
Managing an aortic aneurysm without surgery requires reducing the mechanical stress placed on the weakened aortic wall. The most important controllable factor is blood pressure, as high pressure promotes expansion. Medications like beta-blockers are frequently prescribed because they lower blood pressure, reduce heart rate, and decrease shear stress on the aorta.
Cholesterol management, often involving statin therapy, is another component that mitigates the atherosclerotic disease contributing to aortic weakening. Strict adherence to prescribed medications for both blood pressure and cholesterol is essential. While non-surgical treatments cannot shrink an aneurysm, they are designed to slow its enlargement and lower the chance of complications.
Quitting all forms of tobacco use is the single most impactful action, as smoking is strongly linked to accelerated growth. Patients should also limit activities that cause sudden spikes in blood pressure, such as heavy weightlifting or intense straining. These modifications, combined with a heart-healthy diet, protect the integrity of the aorta.
When Medical Intervention Becomes Necessary
Surgical intervention is necessary when the risk of rupture surpasses the risk of the repair procedure itself. This decision is triggered by rapid growth, the onset of symptoms, or the aneurysm reaching a specific size threshold.
For abdominal aortic aneurysms (AAA), repair is generally recommended when the diameter reaches 5.5 centimeters in men, often with a slightly lower threshold for women. Thoracic aortic aneurysms (TAA) also typically require intervention at 5.5 centimeters, though this threshold may be lowered for individuals with connective tissue disorders. Surgery is also necessary if the patient develops symptoms such as persistent back or abdominal pain, which can indicate impending rupture.
Repair procedures fall into two main categories: Open Surgical Repair and Endovascular Aneurysm Repair (EVAR). Open repair replaces the damaged section of the aorta with a synthetic graft, requiring a larger incision. EVAR is a less invasive option that uses small groin incisions to insert a stent-graft, reinforcing the aortic wall from the inside. The choice depends on the aneurysm’s anatomy, the patient’s overall health, and its location.