Quick answer
What Is Aortic Aneurysm?
An aortic aneurysm is a localized widening of the aorta, the main artery leaving the heart, caused by a weakened wall. It can occur in the chest or abdomen, usually causes no symptoms, and needs monitoring because it can tear or rupture.
SourcesSigns That Need Urgent Help
- Sudden, very severe pain in the chest, back, or abdomen
- Tearing pain that spreads to the back or flank
- Fainting, severe dizziness, or appearing confused
- Pale, cold, sweaty skin and a rapid pulse
- Severe shortness of breath that comes on suddenly
- Sudden weakness on one side of the body or difficulty speaking
If these signs appear, go to the nearest emergency department right away or call Heart Attack Center 1500 258.
01 / Understanding the condition
About Aortic Aneurysm
The aorta is the main artery leaving the heart. It rises briefly, arches in the chest, then runs down through the chest and abdomen before branching into both legs. In adults, the aorta is usually about 2 to 3 cm in diameter. An aortic aneurysm occurs when part of the aortic wall weakens and widens permanently, usually to about one and a half times its normal size or more.
Types by Location
A thoracic aortic aneurysm is located in the chest, including the aortic root, ascending aorta, aortic arch, and descending aorta. An abdominal aortic aneurysm is located in the abdomen, usually below the branches of the kidney arteries, and is the more common type. Widening that extends from the chest to the abdomen is covered on the Thoracoabdominal Aortic Aneurysm page. Causes, tests, and size thresholds for treatment differ by location, so each type has its own page.
How an Aortic Aneurysm Forms
In the abdominal aorta, widening is usually linked to age, smoking, and atherosclerosis, which trigger inflammation and damage the elastic fibers of the aortic wall. In the thoracic aorta, especially the aortic root and ascending aorta, inherited factors play a larger role, for example a bicuspid aortic valve, Marfan syndrome, or a family history. High blood pressure increases the strain on the wall at every location.
Why It Needs Monitoring
The majority of aortic aneurysms grow slowly, by a few millimeters per year, and cause no symptoms. The risk of tearing or rupture increases as the diameter and growth rate increase. For this reason, your doctor monitors its size with ultrasound, CT, or MRI at regular intervals. Repair with open surgery or stent graft placement is considered when the aneurysm reaches a certain size threshold, grows quickly, or causes symptoms. This threshold differs for the thoracic and abdominal aorta, and is lower in connective tissue disorders.
Living with an Aortic Aneurysm
Many people with a small aortic aneurysm continue their usual activities with regular monitoring. The important steps are to stop smoking, control your blood pressure, stay active with light to moderate exercise, and avoid very heavy lifting. Because aortic aneurysms often occur together with coronary artery disease and narrowing of other arteries, your doctor also assesses and cares for your heart and blood vessels as a whole.
02 / Understanding the condition
Types and Related Conditions
The following conditions belong to the Aortic Aneurysm group. Open each one for a full explanation.
03 / Understanding the condition
Symptoms to Recognize.
Common Symptoms
Aortic aneurysms usually cause no symptoms and are found during tests done for other reasons. The following symptoms may appear as the aneurysm enlarges.
- A pulsing feeling in the abdomen, especially around the navel
- Persistent dull pain in the abdomen, flank, or lower back
- Persistent chest or upper back pain
- Hoarseness that does not improve
- Coughing, shortness of breath, or difficulty swallowing due to pressure in the chest
04 / Understanding the condition
What Causes This Condition?
- Atherosclerosis and aging, which damage the elastic fibers of the aortic wall
- High blood pressure left uncontrolled for a long time
- Bicuspid aortic valve, an aortic valve with two leaflets from birth, which is often accompanied by widening of the thoracic aorta
- Inherited connective tissue disorders, such as Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome
- Inflammation of the aortic wall (aortitis), for example in Takayasu arteritis or giant cell arteritis
- Infection of the aortic wall, or a remnant of an old aortic tear (chronic dissection) that gradually widens
- Severe chest injury, for example from a traffic accident
05 / Understanding the condition
Who Is at Higher Risk?
Lifestyle
Smoking is the main risk factor for abdominal aortic aneurysm and speeds up its growth. The risk stays higher for years after quitting, so tell your doctor about any history of smoking.
Medical
High blood pressure, atherosclerosis, coronary artery disease, peripheral artery disease, and chronic obstructive pulmonary disease are often found together with aortic aneurysm.
Genetic
A history of aortic aneurysm or dissection in close family members, Marfan syndrome and other connective tissue disorders, and a bicuspid aortic valve.
Age
Abdominal aortic aneurysm is rare before age 60 and is found more often after age 65. Thoracic aortic aneurysm caused by inherited conditions can appear at a young age.
Other
Abdominal aortic aneurysm is more common in men, but in women it tends to grow faster and can rupture at a smaller size.
Groups at Higher Risk
- Men Aged 65 and Older Who Have Ever Smoked: A group with a higher risk of abdominal aortic aneurysm; guidelines recommend abdominal ultrasound screening.
- People with a Bicuspid Aortic Valve: Many people with a bicuspid valve develop widening of the ascending aorta, so the size of the aorta needs regular monitoring.
- People with Marfan Syndrome and Connective Tissue Disorders: The aortic wall is more fragile from a young age, so aneurysms can appear earlier and are treated at a smaller size. Covered on the Marfan Syndrome page.
- Close Relatives of People with Aortic Aneurysm: Parents, siblings, or children of people with an aortic aneurysm or dissection may be advised to have imaging tests.
- People with Hypertension and Atherosclerosis: High blood pressure and plaque in the blood vessels strain the aortic wall and are often found together with abdominal aortic aneurysm.
06 / Understanding the condition
How Is It Diagnosed?
Aortic aneurysms are often found by chance, for example during an abdominal ultrasound, echocardiography, or a CT scan done for another complaint. If an aneurysm is suspected, your doctor asks about smoking, blood pressure, and family history, then chooses tests based on its location. The abdominal aorta is measured with ultrasound, while the aortic root and ascending aorta are assessed with echocardiography. CT angiography gives detailed measurements along the entire aorta and is needed before repair. MRI is an option for repeated monitoring without X-rays.
Once an aneurysm is found, your doctor usually examines the entire aorta, because aneurysms can appear in more than one place. Follow-up scans are done at intervals matched to the size. In inherited conditions, close family members may be advised to be examined as well.
Vascular Ultrasound
Radiation-free abdominal ultrasound to measure the diameter of the abdominal aorta; used for screening and regular monitoring.
Echocardiography
Heart ultrasound to measure the aortic root and ascending aorta and to assess the aortic valve.
Aortic CT angiography: a CT scan with contrast dye to measure the aneurysm in detail from the chest to the pelvis and to plan the repair.
Aortic MRI or MR angiography: imaging without X-rays for repeated monitoring, especially in young people and in inherited conditions.
Chest X-Ray
A chest X-ray sometimes shows a widened aortic shadow, but a normal result does not rule out an aneurysm.
Aortic Angiography
A test using a catheter and contrast dye, usually when planning or performing stent graft placement.
07 / Understanding the condition
Treatment Options.
Treatment is decided by a doctor after an assessment. The categories below can help you follow the conversation with your doctor.
Regular Monitoring
Small aneurysms are rechecked with ultrasound, CT, or MRI. The intervals between scans become shorter as the size increases.
Quitting Smoking and Blood Pressure Control
Basic steps that help slow aneurysm growth and reduce the strain on the aortic wall.
Heart and Blood Vessel Protective Medicines
Your doctor may prescribe blood pressure medicines, statins, or antiplatelets to lower the risk of heart attack and stroke. The type and dose are determined by your doctor.
Stent Graft Placement
A metal-framed fabric tube is placed inside the aorta through an artery in the groin, if the shape of the aorta is suitable. Recovery is usually shorter, but lifelong follow-up imaging is needed.
Open Surgery
The widened section of the aorta is replaced with a synthetic tube through an incision in the chest or abdomen. The results are durable, with a longer recovery period.
08 / Understanding the condition
Complications to Watch For.
Aortic Rupture
A ruptured aneurysm causes severe bleeding inside the chest or abdomen and requires emergency surgery or stent graft placement.
Aortic Dissection
A tear in the inner layer of the aortic wall that lets blood flow between the layers of the wall. Covered on the Aortic Dissection page.
Blood Clots and Embolism
Clots inside the aneurysm sac can break loose and block arteries in the legs, kidneys, or intestines. Covered on the Arterial Embolism page.
Aortic Valve Leakage
Widening of the aortic root can pull on the aortic valve so that it does not close tightly, which is covered on the Aortic Regurgitation page.
Pressure on Nearby Organs
A large aneurysm can press on the nerve to the vocal cords, the airway, the esophagus, or the spine and cause symptoms.
09 / Understanding the condition
What Can You Do?
- Stop smoking; ask your doctor for help if it is hard to quit on your own
- Check your blood pressure regularly and reach your target together with your doctor
- Men aged 65 and older who have ever smoked are advised to have an abdominal ultrasound screening
- If a close family member has had an aortic aneurysm or dissection, ask whether you need to be checked
- Avoid very heavy lifting that makes you hold your breath and strain
- Tell every doctor who treats you about your history of aneurysm
10 / Understanding the condition
When Should You See a Doctor?
Because it often causes no symptoms, an aortic check is useful for people at risk even if they feel healthy. Sudden, very severe pain in the chest, back, or abdomen, especially with fainting or weakness, is an emergency sign: go to the nearest emergency room right away. Make a consultation appointment if you:
- Are a man aged 65 or older who has ever smoked
- Have a close family member with an aortic aneurysm or dissection
- Have been diagnosed with a bicuspid aortic valve, Marfan syndrome, or another connective tissue disorder
- Feel a pulsing in your abdomen or have persistent chest, back, or abdominal pain
- Have been told you have a widened aorta based on an ultrasound, CT, or echocardiography result
Don't Wait in an Emergency.
If symptoms are severe or come on suddenly, go to the nearest emergency department right away or call Heart Attack Center 1500 258, rather than waiting for an appointment.
11 / Common questions
Questions You May Have.
Frequently asked questions about aortic aneurysm.
What size of aortic aneurysm needs repair?
For the abdominal aorta, repair is generally recommended when the diameter reaches about 5.5 cm in men or 5.0 cm in women. For the thoracic aorta, the threshold is generally about 5.5 cm, and it may be smaller in Marfan syndrome, a bicuspid valve with additional risk factors, or a family history of dissection. An aneurysm that grows quickly or causes symptoms may be repaired earlier. The final decision is tailored to your condition.
Can an aortic aneurysm be treated with medicine alone?
No medicine has yet been proven to shrink an aortic aneurysm. Blood pressure medicines, statins, and other drugs are given to reduce the strain on the aortic wall and lower the risk of heart attack and stroke, which often accompany aneurysms. In Marfan syndrome, certain medicines are used to help slow the widening. Once an aneurysm reaches the size threshold for repair, a stent graft or surgery is still needed.
What is the difference between a stent graft and open surgery?
A stent graft is placed from inside the blood vessel through an artery in the groin, so the incision is small and recovery is shorter. However, patients need regular follow-up imaging and sometimes need additional procedures. Open surgery replaces part of the aorta with a synthetic tube through an incision in the chest or abdomen. Recovery takes longer, but repeat procedures are rarely needed. The choice depends on the shape of your aorta, your age, and your health.
How often does an aortic aneurysm need to be rechecked?
The interval depends on its size and location. As a guide, an abdominal aortic aneurysm measuring 3 to 3.9 cm is generally rechecked every three years, one measuring 4 to 4.9 cm every year, and larger ones every three to six months. A thoracic aortic aneurysm is usually rechecked six months after it is found, then every year if it is stable. Your doctor may change the schedule if the aneurysm grows faster.
Can people with an aortic aneurysm exercise?
Generally yes, and it is encouraged, at light to moderate intensity such as walking, leisurely cycling, or swimming. Avoid heavy lifting, contact sports, or movements that make you hold your breath and strain, because they can raise blood pressure suddenly. Safe limits differ for each person, especially if the aneurysm is large or there is a connective tissue disorder, so discuss this with your doctor.
Does my family need to be checked?
This should be considered if a thoracic aortic aneurysm appears at a young age, is linked to a genetic disorder, or affects more than one family member. Guidelines also suggest aortic imaging for close relatives of people with a bicuspid aortic valve accompanied by aortic widening. Abdominal aortic imaging may also be considered for siblings of people with an abdominal aortic aneurysm. Your doctor may suggest echocardiography, ultrasound, or genetic counseling.
Sources and Medical Review
Translated from the Indonesian edition medically reviewed by dr. Suko Adiarto, Sp.JP(K), Ph.D..
Sources as cited in the Indonesian edition.
- Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334-e482.
- Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024;45(36):3538-3700.
- Czerny M, Grabenwöger M, Berger T, et al. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg. 2024;65(2):ezad426.
- Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2024;67(2):192-331.
- US Preventive Services Task Force, Owens DK, Davidson KW, et al. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;322(22):2211-2218.
Doctors Who Treat This Condition
dr. Suko Adiarto, Sp.JP(K), Ph.D.
Interventional Cardiology
Vascular Diagnostic and Therapeutic Center +1 center
Clinical focusCoronary Intervention · Peripheral Vascular Intervention
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dr. Widya T. Suwatri, Sp.BTKV, Subsp. JD(K)
Adult Cardiac Surgery
Advanced Cardiovascular Surgical Care +1 center
Clinical focusMinimally Invasive Cardiac Surgery · Coronary Artery Bypass Surgery
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dr. Emanoel Oepangat, Sp.JP(K)
Interventional Cardiology
Vascular Diagnostic and Therapeutic Center +1 center
Clinical focusCoronary Intervention · Peripheral Vascular Intervention
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