Most people with an aortic aneurysm do not know they have one. The aorta, the body's largest artery, running from the heart through the chest and abdomen, can develop a bulge in its wall over years without causing any noticeable symptoms. No pain. No warning. Just a gradually enlarging weak spot in a vessel that carries the full output of the heart.

The risk is to rupture. And when an aortic aneurysm ruptures, the outcome is life-threatening without immediate surgical intervention.

This is why timely diagnosis and planned aortic aneurysm treatment are so important, because treating a known aneurysm before it ruptures is fundamentally different from managing an emergency rupture.

What is an aortic aneurysm?

An aortic aneurysm forms when a section of the aortic wall weakens and expands outward. The bulge grows gradually, sometimes over years, as blood pressure continues to act on the weakened wall.

The primary danger is rupture or dissection. A ruptured aneurysm causes massive internal bleeding. A dissection, where blood tears through the inner layer of the aortic wall, can cut off blood supply to organs within minutes.

Not all aneurysms require immediate surgery. But all require specialist evaluation to determine the appropriate management plan.

Types of aortic aneurysm

Abdominal aortic aneurysm (AAA) occurs in the section of the aorta passing through the abdomen. It is one of the more common types and is frequently detected incidentally on imaging performed for another reason. Abdominal aortic aneurysm treatment depends on diameter, growth rate, and anatomical suitability for repair.

A thoracic aortic aneurysm affects the chest portion of the aorta, including the ascending aorta, the aortic arch, and the descending thoracic aorta. Thoracic aortic aneurysm treatment is guided by the specific segment involved, size thresholds, and whether an underlying connective tissue condition is present.

A thoracoabdominal aortic aneurysm spans both the chest and abdominal portions. This is among the most complex to repair and requires highly specialised planning and surgical expertise.

Aortic aneurysm symptoms

Most aneurysms are silent. When aortic aneurysm symptoms do occur, they reflect the aneurysm pressing on adjacent structures:

Abdominal or back pain: a deep, persistent ache in the abdomen or lower back in AAA.
Chest or back pain: in thoracic aneurysms, sometimes with hoarseness or difficulty swallowing if the aneurysm presses on nearby structures.
A pulsating sensation in the abdomen: sometimes noticed by the patient or felt on examination.
Breathlessness in selected thoracic cases.

Emergency symptoms - seek immediate care:

Sudden, severe chest, back, or abdominal pain, different in character from any pain before.
Fainting, dizziness, or rapid heartbeat.
Sweating and shock-like symptoms.
Weakness or collapse.

Aortic aneurysm causes and risk factors

Aortic aneurysm causes involve a combination of mechanical, vascular, and lifestyle factors:

Long-standing high blood pressure, the primary driver of aortic wall stress.
Atherosclerosis, plaque buildup that weakens and stiffens the arterial wall.
Smoking, one of the strongest modifiable risk factors, especially for AAA.
Age-related changes in aortic wall elasticity.
Family history of aneurysm.
Genetic connective tissue conditions, including Marfan syndrome and Ehlers-Danlos syndrome.
Previous aortic injury or infection in rare cases.

Key risk factors:

Age over 65.
Male sex, AAA is significantly more common in men.
Smoking history.
High blood pressure and high cholesterol.
Existing coronary artery disease or peripheral vascular disease.

People with multiple risk factors should discuss aortic screening with a doctor, particularly men over 65 who have ever smoked.

How is an aortic aneurysm diagnosed?

Ultrasound: the primary tool for abdominal aortic aneurysm screening; quick, non-invasive, widely available.
CT angiography: the definitive test for measuring exact aneurysm dimensions, anatomy, and suitability for endovascular repair.
MRI: used in selected patients, particularly where CT contrast is not suitable.
Echocardiography: for aneurysms of the aortic root or ascending aorta.
Blood pressure and cardiovascular risk assessment: always performed alongside imaging.

Aortic aneurysm treatment options

The right treatment is determined by aneurysm size, location, growth rate, symptoms, and the patient's overall health.

Surveillance monitoring

Small, asymptomatic aneurysms are often managed with regular imaging, typically ultrasound or CT, to track size over time. During surveillance, blood pressure and risk factor control are prioritised.

Medicines and lifestyle management

Medicines do not shrink an aneurysm, but they reduce the risk factors that cause it to grow:

Blood pressure control, keeping systolic pressure well managed reduces wall stress.
Smoking cessation, the most impactful modifiable step.
Cholesterol management.
Diabetes control where applicable.
Heart-healthy diet and appropriate physical activity.

Endovascular aneurysm repair (EVAR and TEVAR)

For suitable patients, endovascular repair delivers a stent graft into the aorta through blood vessels, most accessed through the groin. This is less invasive than open surgery and generally offers a shorter hospital stay and faster recovery.

EVAR: endovascular aneurysm repair, for abdominal aortic aneurysms with appropriate anatomy.
TEVAR: thoracic endovascular aortic repair, for selected descending thoracic aortic aneurysms.

Not every aneurysm is anatomically suitable for endovascular repair. CT angiography determines this before treatment is planned.

Open aneurysm repair surgery

Open surgery replaces the weakened aortic segment with a surgical graft through a chest or abdominal incision. It remains the treatment of choice for aneurysms not suitable for endovascular repair, including many thoracoabdominal aneurysms and selected complex cases.

Recovery after open aortic aneurysm surgery is longer than after endovascular repair, but the durability of open repair is well established.

Aortic aneurysm recovery

After endovascular repair (EVAR or TEVAR):

Hospital stay is typically two to four days for uncomplicated cases.
Wound care at the groin access sites.
Avoid heavy lifting for several weeks.
Follow-up CT imaging at defined intervals, this is essential, not optional.
Gradual return to normal activities as advised.

After open surgery:

Longer hospital stays, typically five to ten days.
Pain management and breathing support in the early days.
Wound care and activity restrictions for several weeks.
Structured physiotherapy and rehabilitation.
Regular specialist follow-up.

During surveillance (non-surgical management):

Regular CT or ultrasound scans at intervals guided by aneurysm size.
Consistent blood pressure control.
Lifestyle modification ongoing.
Prompt reporting of any new chest, back, or abdominal symptoms.

Can an aortic aneurysm be prevented?

Not all aneurysms can be prevented, particularly those linked to genetic conditions or age-related arterial change. But many modifiable risk factors significantly influence both development and growth rate:

Stop smoking, this single step has the most evidence behind it.
Control blood pressure consistently.
Manage cholesterol and diabetes.
Maintain a healthy weight.
Attend screening if risk factors are present.

When to see a vascular specialist

See a vascular specialist without delay if:

An aortic aneurysm has been found on imaging and has not yet been evaluated by a specialist.
There is a family history of aortic aneurysm.
Persistent chest, back, or abdominal pain is present alongside vascular risk factors.
Surveillance imaging shows the aneurysm is growing.
Any new or sudden severe pain develops.

Aortic aneurysm care at Narayana Health

Narayana Health provides comprehensive aortic aneurysm treatment, from diagnosis through surveillance, endovascular repair, and open surgery, with experienced vascular surgeons, cardiac specialists, interventional radiologists, anaesthetists, and critical care teams coordinating every aspect of care.

Why choose Narayana Health:

Experienced specialists in abdominal aortic aneurysm treatment and thoracic aortic aneurysm treatment.
Advanced CT angiography and ultrasound imaging for accurate diagnosis and treatment planning.
EVAR and TEVAR endovascular aneurysm repair in suitable patients.
Open aneurysm repair surgery for complex cases.
Emergency and planned aortic treatment capability.
Structured long-term follow-up after all forms of aneurysm repair.

Conclusion

An aortic aneurysm that is known, monitored, and treated at the right time is a very different situation from one that ruptures without warning.

Early detection through imaging, careful surveillance, timely intervention with EVAR, TEVAR, or open surgery when indicated, and consistent long-term follow-up, together, these represent what modern aortic aneurysm treatment can achieve.

If you have been told you have an aortic aneurysm, have risk factors that have not been assessed, or experience symptoms that could indicate aortic disease, the vascular specialist team at Narayana Health is here to help. Call us today at 08068617735.