Aortic Diseases (Aneurysm and Dissection)

The aorta is the body's main artery, running from the heart through the chest and abdomen. Aortic diseases include aneurysm, a gradual ballooning of the wall; dissection, a tear that lets blood split the layers of the wall; and narrowing such as coarctation, along with inflammation of the aorta.

Aneurysms usually cause no symptoms and are found by chance or screening. Their danger is rupture or dissection, which are life-threatening. The goal of care is to monitor size, control blood pressure and repair the aorta electively before it reaches a dangerous diameter.

Symptoms

• Most aneurysms: no symptoms at all
• A pulsating feeling in the abdomen, or deep persistent back or abdominal ache
• Hoarseness, cough or difficulty swallowing from a large chest aneurysm
• Dissection: sudden, severe tearing or ripping pain in the chest or between the shoulder blades
• Collapse, stroke-like symptoms or a cold painful limb during dissection
• Coarctation: high blood pressure in the arms with weak leg pulses, often found in younger people

Causes and risk factors

Abdominal aortic aneurysm is linked to smoking, age over 65, male sex, high blood pressure and family history. Thoracic aneurysms more often have a genetic basis: Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, familial thoracic aneurysm, or a bicuspid aortic valve. Long-standing high blood pressure is the main driver of dissection. Rarer causes include vasculitis such as giant cell or Takayasu arteritis, infection and trauma.

How it is diagnosed

• Abdominal ultrasound: Simple screening and surveillance test for abdominal aneurysm.
• Echocardiography: Measures the aortic root and ascending aorta and checks the aortic valve.
• CT angiography: The main test for precise sizing and for planning repair; also the emergency test for dissection.
• MR angiography: Radiation-free alternative for long-term surveillance in younger people.
• Genetic testing and family screening: When a thoracic aneurysm appears young or runs in the family.

Treatment options

• Surveillance: Repeat imaging every 6 to 24 months depending on size and growth rate.
• Blood pressure and risk factor control: Beta blockers or ARBs, statins and stopping smoking slow growth and lower risk.
• Endovascular repair (EVAR or TEVAR): A fabric-covered stent graft placed through the groin arteries to line the aneurysm; shorter recovery, but needs lifelong imaging follow-up.
• Open surgical repair: Replacement of the diseased segment with a synthetic graft; more durable, bigger operation. Aortic root surgery may spare or replace the valve.
• Emergency surgery for type A dissection: Dissection of the ascending aorta needs immediate surgery at the nearest capable hospital.
• Medical management of type B dissection: Tight blood pressure control, with stent grafting if complications develop.

When it is urgent

Sudden severe chest, back or abdominal pain, especially tearing in character or with fainting, weakness of a limb or breathlessness, is an emergency. If you have a known aneurysm and develop new pain, call your local emergency number immediately. Minutes matter in rupture and dissection, and travel is out of the question.

Travelling to Türkiye for treatment

Elective repair of an aneurysm that has reached the treatment threshold, typically about 5.5 centimetres for the abdominal and ascending aorta in men and somewhat less in women and in genetic conditions, can be planned abroad, with 10 to 14 days for endovascular repair and about 3 weeks for open surgery. Discuss flying with a large aneurysm with your own specialist first. Lifelong scan follow-up after stent grafts must be arranged at home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions