What is an ascending aortic aneurysm?

The aorta is the largest blood vessel in the body. It leaves the heart and forms an arch.

The arch’s downward portion, called the descending aorta, is connected to a network of arteries that supplies most of the body with oxygen-rich blood. The upward part of the arch, which is the section closest to the heart, is called the ascending aorta.

The part of the aorta in the chest is called the thoracic aorta. The portion further down in your trunk is called the abdominal aorta.

An aneurysm is a bulge that forms in the wall of an artery. It happens when the artery wall weakens. Aneurysms anywhere in the body are dangerous because they can rupture and cause massive internal bleeding. An ascending aortic aneurysm is especially serious. A rupture in this part of the body can be life-threatening.

ascending aortic aneurysm
ascending aortic aneurysm

Symptoms

Some ascending aortic aneurysms never rupture or cause any noticeable symptoms. They’re often discovered by accident, when a chest X-ray or other screening reveals a bulge in the aorta.

If symptoms are present, they may include:

  • dull pain or tenderness in the chest
  • cough or hoarseness
  • shortness of breath
  • pain in the back, jaw, or neck

If the aorta ruptures, you’ll feel a sudden, sharp pain in your chest that extends to your back, between your shoulder blades.

Causes and risk factors

It’s still not well understood why some people develop an aortic aneurysm while others don’t. Different factors may increase your risk, including:

Heart disease: The most common cause of aortic aneurysms is atherosclerosis, also known as hardening of the arteries. You’re also at higher risk of an ascending aortic aneurysm if you have aortic valve disease. The aortic valve releases blood from the heart into the aorta. Most people have an aortic valve with three flaps or leaflets that open and close with each heartbeat. If you were born with a bicuspid valve (aortic valve with two flaps), you have a higher risk of an ascending aortic aneurysm.

Older age: An ascending aortic aneurysm usually forms in people in their 60s and 70s.

Family history: About 20 percent of all thoracic aneurysms develop in people with a family history of thoracic aneurysms. These cases tend to develop in younger people.

Genetics: Certain inherited conditions are linked to a higher risk of ascending aortic aneurysms, including:

These are called connective tissue disorders, and they can lead to many complications in addition to aortic aneurysms.

Infection: Sometimes, certain infections can also weaken artery walls, including those in the aortic arch. These infections include syphilis and salmonella.

How it’s diagnosed

An ascending aortic aneurysm is often found during a routine checkup or an examination ordered for another condition. For example, a chest X-ray can show a bulging aorta. Other imaging tests that can detect an aortic aneurysm include:

  • An echocardiogram, which uses sound waves to create images of the heart. It can also show a change in the aorta.
  • A CT scan, which creates layered images of the heart or other internal organ. Sometimes, doctors insert a dye into an artery to reveal possible blood flow problems on the CT scan.
  • Magnetic resonance angiography (MRA), which is a type of magnetic resonance imaging (MRI). It uses a dye injected into your blood vessels to make them easier to see. This test uses a magnetic field and radio waves to create images of the body part being examined.

Once an aneurysm is discovered, the decision to treat it usually depends on its size or rate of growth. Usually, surgical repair is necessary once an aneurysm reaches 5 centimeters (cm) in diameter.

Treatment options

An aneurysm that is less than 5 cm may be monitored without surgery. However, your doctor may recommend surgical repair of a small aneurysm that’s growing more than 0.5 cm per year. Likewise, a small aneurysm that’s causing symptoms should also be repaired.

If you have Marfan’s syndrome, your ascending aortic aneurysm should be repaired once it reaches 4.5 cm in diameter. An aneurysm that size should also be repaired if you’re going to have aortic valve surgery.

Methods of treatment include the following.

Watch-and-wait

If you and your doctor agree that a watch-and-wait approach is best, you may be placed on medications to help lower your blood pressure and cholesterol.

Medications to bring down your blood pressure include beta blockers, which also slow your heart rate, and angiotensin receptor blockers (ARBs). ARBs are also prescribed to people with Marfan’s syndrome regardless of their blood pressure.

Statins are medications that can help lower your LDL cholesterol.

Open surgery

In this procedure, a surgeon opens up your chest and replaces the damaged portion of your aorta with a synthetic tube called a graft. In some cases, they also replace the aortic valve with a synthetic valve.

Endovascular surgery

In this procedure, the weakened portion of the aorta remains in place. Your doctor inserts a tiny, flexible catheter into an artery in your leg and guides the tube up to your aorta. The catheter then deploys a graft that surrounds the vulnerable part of the aorta to strengthen it.

Emergency surgery

Emergency surgery can sometimes be done to repair an aneurysm that ruptures, though it must be done fast. The risk of a fatal bleeding event is high if bleeding is not treated promptly. Even with surgery, there’s a high risk of complications following a rupture.

What’s the outlook for an ascending aortic aneurysm?

Open surgery to repair an aneurysm can require a recovery time of about a month. Your age and overall health are also factors that affect your recovery speed. The recovery time for a less-invasive endovascular procedure is shorter than for an open surgery. However, regular monitoring must be done to look for leaks through the graft.

If you have an aneurysm, be sure to follow your doctor’s advice about medications and follow-up exams. An aneurysm can grow without you knowing it, so don’t take any chances. Untreated, a rupture can be fatal.

And if surgical repair is advised, don’t put it off. The long-term outlook for someone with an ascending aortic aneurysm is good if it’s repaired before it ruptures. Elective surgery to repair an aneurysm has only a 5 percent mortality rate.