An aortic aneurysm is a balloon-like bulge in the aorta, the body’s largest artery. It can form in the chest (thoracic) or abdomen (abdominal). While many aneurysms grow slowly without symptoms, a rupture—a tear in the weakened aortic wall—is a life-threatening emergency. The outlook varies significantly based on individual factors.
Key Factors Affecting Prognosis
Aneurysm size is a primary factor affecting prognosis, as rupture risk increases with diameter. For abdominal aortic aneurysms (AAAs), intervention is generally considered at 5.5 centimeters (cm) in men and 5.0 cm in women. Thoracic aortic aneurysms (TAAs) typically warrant intervention at 5.5 cm to 6.0 cm.
The aneurysm’s location also influences risk. Most aortic aneurysms are initially asymptomatic, but sudden, severe pain in the chest, back, or abdomen suggests rapid expansion or rupture, which carries a much poorer outlook. Conversely, an unruptured aneurysm, often discovered incidentally during imaging for other conditions, allows for planned management and better outcomes.
Individual patient health plays a considerable role in determining life expectancy. Older age and comorbidities like coronary artery disease, heart failure, chronic kidney disease, diabetes, and chronic obstructive pulmonary disease (COPD) can complicate treatment and recovery. Lifestyle factors, especially smoking, are strongly linked to aneurysm development, accelerated growth, and an increased risk of rupture.
Treatment Approaches and Their Impact
The approach to managing an aortic aneurysm directly impacts life expectancy. For smaller, asymptomatic aneurysms, watchful waiting is often employed. This involves regular imaging (ultrasound, CT scans, or MRI) to monitor the aneurysm’s size and growth rate, allowing for timely intervention.
When intervention becomes necessary, open surgical repair is a primary option. This invasive procedure replaces the affected section of the aorta with a synthetic graft. Successful open repair significantly reduces rupture risk and extends life expectancy, with 30-day mortality rates for non-ruptured abdominal aneurysms decreasing to 1.7% in recent years. This traditional method remains a durable option, showing excellent 10-year survival rates for patients under 75 years of age.
Endovascular aneurysm repair (EVAR for abdominal, TEVAR for thoracic) offers a less invasive alternative. It involves inserting a stent graft through small incisions to reinforce the aorta from within, often leading to quicker recovery and lower immediate surgical risks. Both open and endovascular repairs aim to prevent rupture, with the choice depending on aneurysm type, location, and patient health.
If an aneurysm ruptures, emergency intervention is immediately required. The survival rate for a ruptured aneurysm is dramatically lower compared to elective repairs, often as low as 10-50% even with surgery. This underscores the importance of early detection and planned treatment.
Ongoing Management and Long-Term Outlook
Following diagnosis or repair, continuous care is important for long-term outlook. Regular monitoring through imaging (CT scans or MRIs) is crucial to track aneurysm size, detect any potential growth, or assess the integrity of a repaired aneurysm. Adherence to follow-up appointments is important for positive outcomes.
Managing blood pressure is a top priority, as uncontrolled high blood pressure places increased stress on the aortic wall, elevating the risk of aneurysm expansion and rupture. Physicians typically aim for a systolic blood pressure target between 120-129 mmHg and a diastolic pressure below 80 mmHg, often prescribing medications. Controlling cholesterol levels is also beneficial, as lipid-lowering therapies can reduce overall cardiovascular risk, which commonly coexists with aneurysm disease.
Smoking cessation is the most impactful lifestyle change, as smoking significantly contributes to aneurysm growth and rupture, and quitting substantially improves prognosis. Adopting a healthy lifestyle, including a balanced diet, regular exercise, and maintaining a healthy weight, supports overall cardiovascular health. Remain vigilant for new or worsening symptoms like back or abdominal pain, as these could signal aneurysm expansion or rupture, requiring immediate medical attention. With proper diagnosis, timely treatment, and diligent ongoing management, many individuals with an aortic aneurysm can live full and active lives.