Aortic Aneurysm — Symptoms, Risks and Treatment in Hyderabad
An aortic aneurysm is an abnormal bulging or dilatation of the aorta — the body's largest artery, carrying oxygenated blood from the heart to the rest of the body. An aneurysm forms when the aortic wall weakens and stretches under the pressure of blood flow. If untreated, it can progressively enlarge and ultimately rupture — a catastrophic, often fatal emergency. However, when detected early and monitored appropriately, aortic aneurysms are very manageable.
Types of aortic aneurysm
| Thoracic aortic aneurysm (TAA) | Affecting the aorta within the chest — the ascending aorta (above the heart), the aortic arch, or the descending thoracic aorta. Can be associated with bicuspid aortic valve, Marfan syndrome, and hypertension. |
| Abdominal aortic aneurysm (AAA) | The most common type — affecting the abdominal aorta below the renal arteries. Strongly associated with smoking, male sex, age above 65, and hypertension. |
| Thoracoabdominal aneurysm | Extending from the thoracic to the abdominal aorta — the most complex type requiring specialised repair. |
| Aortic dissection | A tear in the inner layer of the aorta — allowing blood to track between layers. A separate but related life-threatening emergency requiring immediate intervention. |
Symptoms
- Most aortic aneurysms are asymptomatic — discovered incidentally on CT or ultrasound performed for another reason
- Back or abdominal pain — a rapidly expanding or symptomatic aneurysm may cause dull pain in the back, abdomen, or flank
- Pulsatile abdominal mass — a throbbing sensation in the abdomen in large abdominal aortic aneurysms (AAA)
- Hoarseness or difficulty swallowing — from compression of adjacent structures by large thoracic aortic aneurysms
Ruptured aortic aneurysm — life-threatening emergency
Sudden severe tearing back or abdominal pain, sweating, collapse, and hypotension in a known aneurysm patient indicates rupture. This is immediately life-threatening. Call emergency services immediately. Mortality from ruptured aneurysm without emergency repair exceeds 90%.
Surveillance — when to watch and when to treat
| TAA below 45 mm | Annual CT surveillance. Aggressive blood pressure control (target below 130/80 mmHg). Beta-blockers for Marfan syndrome. |
| TAA 45–55 mm | 6-monthly CT surveillance. Intervention considered based on growth rate (above 5 mm per year), symptoms, and patient factors. |
| TAA above 55 mm | Intervention recommended — either open surgery or TEVAR depending on location and anatomy. |
| AAA below 45 mm | Annual ultrasound surveillance. |
| AAA 45–55 mm | 6–12 monthly ultrasound/CT surveillance. |
| AAA above 55 mm | Repair recommended — endovascular repair (EVAR) preferred for infrarenal AAA. TEVAR for thoracic aneurysms. |