Aortic Aneurysm & Dissection

What is an aortic aneurysm?

An aortic aneurysm is a balloon-like enlargement of the aorta, the main artery carrying blood from the heart. Most abdominal aortic aneurysms cause no symptoms until they rupture — a life-threatening emergency. The goal of modern vascular care is to find aneurysms early and repair them electively, before rupture can occur.

Who should be screened?

Men over 65, smokers and ex-smokers, and anyone with a family history of aneurysm benefit most from screening. Screening is a quick, painless abdominal ultrasound scan.

Monitoring and treatment

Small aneurysms are monitored with regular ultrasound surveillance. For abdominal aneurysms, repair is generally considered from around 5.5 cm in men and 5.0 cm in women, or earlier when an aneurysm is enlarging quickly, causing symptoms, or has higher-risk anatomy — the threshold is individualised, not a single number.

• Endovascular aneurysm repair (EVAR / TEVAR) — a stent graft is delivered through small punctures in the groin and positioned inside the aneurysm, relining the aorta from within. Most patients go home within a few days.
• Complex endovascular repair — fenestrated, branched and physician-modified endografts extend keyhole repair to aneurysms involving branch arteries.
• Open surgical repair — replacement of the aneurysm with a fabric graft, still the right operation for selected patients.

Aortic dissection

A dissection is different from an aneurysm: a sudden tear in the aorta's inner layer, classically felt as abrupt, severe chest or back pain. It is an emergency. Depending on the segment involved, treatment ranges from strict blood-pressure control to emergency stent-graft repair (TEVAR) sealing the tear from within. Survivors of dissection need lifelong imaging surveillance, because the weakened aorta can enlarge over the years that follow.

The key message

An aneurysm found on time is a manageable condition. If you have risk factors and have never had your aorta scanned, a screening ultrasound is a quick, painless check that is easy to arrange.