Aortic Aneurysm
Aortic Aneurysm: A Complete Patient Guide
An aortic aneurysm is a permanent widening (dilatation) of the aorta, the main artery that carries blood from the heart to the rest of the body. The aorta is normally about 2 to 3 cm wide. An aneurysm is usually defined as an increase of at least 50% above the expected normal size. As the wall stretches, it becomes weaker, and a large aneurysm can tear (dissect) or rupture, which is life-threatening.
Aneurysms occur in two main places: the thoracic aorta in the chest (the aortic root and ascending aorta, the arch and descending aorta), and the abdominal aorta below the kidneys. Most aneurysms cause no symptoms and are found by chance on a scan, or through screening, which is why they are sometimes called a silent condition.
Abdominal aortic aneurysms (AAA) are most common in men over 65 who smoke or have smoked, and in the UK NHS screening with a single ultrasound scan is offered to men in the year they turn 65. Thoracic aneurysms are more often associated with high blood pressure, a bicuspid aortic valve and inherited connective tissue conditions such as Marfan syndrome.
The 2024 ESC guideline on peripheral arterial and aortic diseases emphasises surveillance, blood pressure and risk-factor control, and timely repair of aneurysms when they reach threshold sizes, which prevents most ruptures.
Most aortic aneurysms cause no symptoms until they enlarge significantly, tear or rupture.
Usually silent
The majority are found incidentally on a scan done for another reason, on an echocardiogram, or through screening. This is why surveillance matters in people at risk.
Possible symptoms of a growing aneurysm
Thoracic: chest, back or jaw pain, hoarseness, cough, difficulty swallowing, or breathlessness
Abdominal: a pulsating feeling in the abdomen, or a constant deep pain in the abdomen, back or side
Pain in the leg, or a cold painful foot, from clots
Emergency symptoms (dissection or rupture)
Sudden, severe, tearing or ripping pain in the chest, back or abdomen
Collapse, fainting, sweating, very pale skin and a fast pulse
Stroke symptoms, severe breathlessness, or leg weakness or numbness
An aneurysm develops when the wall of the aorta weakens and stretches under pressure. Several factors contribute.
Main risk factors
Smoking, the strongest modifiable risk, particularly for abdominal aneurysm
High blood pressure
Age, male sex and atherosclerosis (fatty build-up in the arteries)
Family history of aortic aneurysm or dissection, which raises risk significantly
High cholesterol and chronic lung disease
Inherited and structural causes
Bicuspid aortic valve, in which the aortic root and ascending aorta can enlarge
Genetic conditions such as Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome and familial thoracic aortic disease
Turner syndrome and some other congenital conditions
Other causes
Inflammatory diseases of the aorta (such as giant cell arteritis and Takayasu arteritis) and infection
Chest injury, and cocaine or stimulant use
Fluoroquinolone antibiotics (such as ciprofloxacin) are associated with a small increase in risk and should be avoided in people with aneurysm or at high risk, unless no alternative exists
Because aneurysms are silent, being aware of risk and screening is the best protection.
Arrange a prompt assessment if you have:
A known aneurysm or an enlarged aorta found on a scan, and symptoms or no recent follow-up
A close relative with an aortic aneurysm, dissection or sudden death
A bicuspid aortic valve, Marfan syndrome or another inherited connective tissue condition
Unexplained back, chest or abdominal pain, hoarseness or a pulsating lump in the abdomen
You are a man aged 65 or older who has not been screened
Call 999 immediately if you have:
Sudden severe tearing pain in the chest, back or abdomen
Collapse, fainting or feeling extremely unwell with severe pain
Severe pain with new weakness, numbness, speech or vision problems
Diagnosis is made by imaging the aorta, and the tests are repeated over time to track growth.
1. Ultrasound and echocardiogram
An abdominal ultrasound is the standard screening and surveillance test for abdominal aneurysm. An echocardiogram measures the aortic root and ascending aorta and checks the aortic valve and heart function.
2. CT or MRI angiography
CT angiography or MR angiography gives a precise 3D assessment of the whole aorta, its diameter, shape and growth, and is used for planning repair and for follow-up.
3. Measuring and comparing size
Size is measured consistently at the widest point, and compared with previous scans, adjusted for body size where relevant. Rapid growth is as important as absolute size.
4. Assessing the cause and family risk
Blood pressure, cholesterol and kidney function, a review of family history, and in selected people genetic testing and relative screening. An ECG and ECG reporting, and sometimes CT coronary angiography, assess the heart before surgery.
Treatment aims to prevent growth, dissection and rupture. Small aneurysms are watched and risk factors treated, and larger ones are repaired.
Surveillance and medical treatment
Regular scans at intervals set by the size, from yearly to every few years
Blood pressure control, often with beta-blockers, ARBs or ACE inhibitors, aiming for a target below 130/80 mmHg where possible
Statin and antiplatelet therapy where appropriate for atherosclerosis
Stopping smoking, which slows growth and reduces the risk of rupture
When repair is recommended
Abdominal aortic aneurysm: repair is generally recommended at a diameter of 5.5 cm in men and 5.0 cm in women, or if it grows rapidly or causes symptoms
Ascending aorta or root: repair is generally recommended at around 5.5 cm, at lower thresholds (typically 4.5 to 5.0 cm) with Marfan syndrome or other genetic conditions, a bicuspid aortic valve with risk features, or rapid growth, or when the aortic valve is being operated on
Individual factors, including body size, family history and the surgical team’s experience, shape the decision
Types of repair
Open surgery replaces the diseased aorta with a graft and remains the standard for many thoracic aneurysms
Endovascular repair (EVAR or TEVAR) places a stent graft through the groin arteries, with a quicker recovery, and is suitable for some anatomy, requiring lifelong surveillance
Emergency treatment
Aortic dissection and rupture need emergency surgery or stenting. Survival depends on how quickly treatment is delivered.
Attend all surveillance scans. They detect growth in time to plan repair.
Do not smoke, and keep your blood pressure well controlled, checking at home if advised.
Take your medicines (blood pressure tablets, statin) regularly.
Exercise: regular moderate aerobic exercise is encouraged. Avoid heavy straining and maximal isometric lifting, such as very heavy weights, and discuss sport with your cardiologist.
Medicines to avoid: fluoroquinolone antibiotics unless essential. Tell every doctor that you have an aneurysm.
Family screening: first-degree relatives should be offered scanning, and genetic counselling if an inherited cause is suspected.
Know the emergency symptoms and act immediately.
Driving: DVLA rules apply to large aneurysms. Discuss with your cardiologist.
Support is available from the British Heart Foundation, the NHS and Marfan Trust.
Small aneurysms are usually safe to watch, and the risk of rupture rises with size, which is why surveillance and timely repair work so well.
Planned (elective) repair has a low risk, whereas emergency repair for rupture carries a high mortality, so finding aneurysms early saves lives.
Screening programmes for abdominal aneurysm in men aged 65 have reduced deaths from rupture.
After repair, most people return to normal life, with continued follow-up of the aorta and risk-factor control.
Outlook depends on the size and location, the cause, associated heart and artery disease, and how well blood pressure and smoking are controlled.
An aortic aneurysm is a widening of the aorta, which weakens the wall and may tear or rupture.
Most cause no symptoms and are found by chance or screening.
Men are offered a one-off NHS ultrasound at 65 for abdominal aneurysm.
Smoking, high blood pressure, age, family history and inherited conditions raise risk, as does a bicuspid aortic valve.
Sudden tearing chest, back or abdominal pain is an emergency: call 999.
Diagnosis uses ultrasound, echocardiography, CT or MR angiography.
Small aneurysms are monitored with scans and treated with blood pressure control, statins and stopping smoking.
Repair is generally recommended at around 5.5 cm (5.0 cm for AAA in women), and at lower thresholds in genetic conditions.
Relatives may need screening.
Guidelines and sources
This page follows current UK and European guidance:
NICE NG156: Abdominal aortic aneurysm: diagnosis and management.
Mazzolai L et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. European Heart Journal 2024;45:3538-3700.
DVLA: Cardiovascular disorders: assessing fitness to drive (GOV.UK).
These are the questions patients most often ask about aortic aneurysm.
What is an aortic aneurysm?
A bulge or widening of the aorta, the main artery from the heart. It can occur in the chest (thoracic) or abdomen, and may tear or rupture if it becomes large.
What are the symptoms of an aortic aneurysm?
Usually none. A growing aneurysm can cause chest, back or abdominal pain, or a pulsating feeling in the abdomen. Sudden severe tearing pain is an emergency.
What size aortic aneurysm needs surgery?
Generally 5.5 cm for abdominal aneurysms in men (5.0 cm in women) and for ascending aortic aneurysms, with lower thresholds in genetic conditions or if growth is rapid. Your surgeon and cardiologist will individualise this.
Can an aortic aneurysm be treated without surgery?
Small aneurysms are managed with scans, blood pressure control, a statin and not smoking. Surgery or stenting is for aneurysms that reach threshold size, grow quickly or cause symptoms.
What causes an aortic aneurysm?
Smoking, high blood pressure, atherosclerosis, age and family history. Inherited conditions such as Marfan syndrome, and a bicuspid aortic valve, cause thoracic aneurysms.
Is an aortic aneurysm hereditary?
It can be. If a close relative has had an aortic aneurysm or dissection, your risk is higher and screening is recommended. Some inherited conditions are tested for with genetic tests.
Can I exercise with an aortic aneurysm?
Yes, moderate aerobic exercise is usually encouraged. Heavy lifting and straining should be avoided. Ask your cardiologist to advise you on your own limits.
Should I avoid certain antibiotics?
Fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin are linked to aortic aneurysm and dissection, and should be avoided in people with aneurysm unless there is no alternative. Always tell prescribers.
Can I have a private aortic scan or heart assessment?
Yes. A telephone, video or face-to-face consultation in Peterborough or Corby can review your risk, with echocardiography to measure the aortic root and ascending aorta, and cardiac MRI or CT arranged where needed.
- How big is my aorta, and how quickly is it growing?
- How often do I need scans, and which type?
- What is my blood pressure target?
- At what size would I need surgery, and which type?
- Is there an inherited cause, and should my family be screened?
- How much exercise is safe for me?
- Which medicines should I avoid?
- What symptoms should make me call 999?
- Can I lift weights, strain or travel, including flying?
- How can I reduce the chance of it growing, for example by stopping smoking?
A normal aorta (A), a thoracic aortic aneurysm (B) and an abdominal aortic aneurysm (C).
Image: National Institutes of Health (NHLBI), Aortic aneurysm, Wikimedia Commons. Public domain.
An abdominal aortic aneurysm: a weakened, bulging section of the aorta.
Image: Blausen.com staff (BruceBlaus), Blausen 0001 AbdominalAorticAneurysm 01, Wikimedia Commons. Licensed under CC BY 3.0.
Where aortic aneurysms occur
Aortic root and ascending aorta: the first part, leaving the heart. Often linked to a bicuspid valve or inherited conditions.
Aortic arch and descending aorta: carry blood to the head, arms and body, and often relate to atherosclerosis and high blood pressure.
Abdominal aorta: below the kidneys, where most aneurysms occur, particularly in older men who smoke.
Dissection: a tear in the inner wall allows blood to split the layers of the aorta, a life-threatening emergency.
If you have an enlarged aorta, a family history of aortic aneurysm or dissection, or a bicuspid aortic valve, you may benefit from a telephone consultation or video consultation, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment. Sudden severe tearing pain needs a 999 call.
Investigations such as echocardiography, cardiac MRI and ECG reporting may be recommended.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.