Aortic Aneurysm

An aneurysm is a bulge that occurs in a blood vessel. If that bulge occurs in the aorta, the largest blood vessel in your body, it is called an aortic aneurysm. Aneurysms can be life-threatening if they rupture and bleed inside the body.

At the University of Michigan Health Frankel Cardiovascular Center, our skilled cardiologists, surgeons and other specialists offer treatment options for all types of aortic aneurysms. Our team-based approach focuses on making sure you and your family understand your options. We work with you to decide which treatment is best for you.

Nationally Recognized for Aortic Aneurysm Care

Our program received a score of “high performing” (the highest possible) for abdominal aortic aneurysm repair from U.S. News & World Report. This score is based, in part, on:

  • High volume of procedures: Higher volumes are important because more experience leads to better results. We have excellent outcomes for complex cases.
  • Outstanding patient experience: Our patients consistently give us excellent ratings for the quality of care we provide. We put patients at the center of our work.
  • More nursing staff: We have more nurses per patient to ensure patient safety and provide better patient care. Our team also includes special nurses who help coordinate your care while you’re a patient at the Frankel Cardiovascular Center.

Types of Aortic Aneurysms

An aneurysm can occur anywhere along the aorta:

  • Aortic root: This is where the aorta begins. It meets the heart at the left ventricle, which is the main pumping chamber of the heart.
  • Ascending aorta: This is the short section that ascends toward the head.
  • Aortic arch: The arch is a 180-degree curve. Here, blood vessels branch off to the head and arms.
  • Descending aorta: The descending aorta travels the length of the torso. Along the way, branching blood vessels feed fresh blood to the body.

Aortic aneurysms are classified by their location:

Causes of Aortic Aneurysm

Aortic aneurysms can be caused by:

  • Atherosclerosis (hardening of the arteries)
  • High blood pressure
  • Infections
  • Smoking
  • Traumatic injuries

Aortic aneurysms can also run in families. You may be at higher risk if you have a family member with the condition.

Aortic aneurysms may also be associated with certain inherited diseases. For example, people with bicuspid aortic valve or connective tissue disorders such as Marfan syndrome are at higher risk.

Our Comprehensive Aortic Program offers genetic counseling to patients and screening of your first-degree relatives. If an aneurysm is identified in a family member, we can provide treatment to avoid a life-threatening rupture.

Symptoms of Aortic Aneurysm

Symptoms of a thoracic aneurysm may include:

  • Chest, neck, jaw, or upper back pain
  • Difficulty breathing or swallowing
  • Hoarseness or coughing

Symptoms of an abdominal aneurysm may include persistent pain in the abdomen, back or groin.

With both types of aneurysms, people often do not experience any symptoms until a rupture occurs. Then, a sudden, severe pain occurs near the location of the rupture.

Diagnosing Aortic Aneurysm

To diagnose an aortic aneurysm, your doctor will first review your medical and family history and conduct a routine physical exam. Your doctor may then order one or more cardiovascular diagnostic tests:

  • CT scan: This special type of X-ray provides cross-sectional images of your aorta.
  • Echocardiogram: This is a specialized ultrasound thatcaptures real-time images of your heart and thoracic aorta. In some cases, a small ultrasound probe may be guided down your esophagus. This is called a transesophageal echocardiogram and allows your doctor to see the thoracic aorta more clearly.
  • MRI: This test uses a magnetic field and radio waves to produce detailed pictures of your aorta. In some cases, the MRI technician may inject dye into a vein before the MRI to make your blood vessels more visible.
  • Ultrasound: This test uses sound waves to create a picture of your aorta. It is used to diagnose abdominal aortic aneurysms.

Screening Recommendations for Abdominal Aortic Aneurysm

Older men have a higher frequency of abdominal aortic aneurysm and are at higher risk of a dangerous rupture.

To help identify these men and treat them proactively, the U.S. Preventive Services Task Force has issued screening recommendations. All men aged 65 to 75 with a history of smoking should be screened for abdominal aortic aneurysms using an ultrasound test. Talk to your primary care provider about whether you should be screened.

Treating Aortic Aneurysm

Our specialists work with you to develop a customized treatment plan. The goal of the plan is to prevent a rupture and, if possible, slow the growth of the aneurysm.

A small aortic aneurysm may only need medication and monitoring. Others may require surgery. Our Comprehensive Aortic Program is one of the best in the nation for aortic repair. We offer a range of procedures, including minimally invasive, traditional surgical and hybrid:

Endovascular Aortic Aneurysm Repair

Endovascular repair is a minimally invasive alternative to open surgery for some patients. Surgeons use a thin tube (catheter) inserted into a blood vessel to place a stent graft inside the damaged section of aorta. Stent grafts, which are made of a fabric-covered metal mesh, provide long-lasting support.

Endovascular procedures we use to repair aortic aneurysms include:

  • Endovascular aortic repair (EVAR) and fenestrated endovascular repair (FEVAR), for abdominal aortic aneurysms. Our doctors use standard stent grafts during EVAR. For FEVAR, the stent grafts have holes, or fenestrations. The holes line up with arteries that branch off the aorta and allow blood to flow into those arteries. Read more about EVAR and FEVAR.
  • Thoracic endovascular aortic repair (TEVAR), for aorticaneurysms in the chest. Learn more about TEVAR.

Open Aortic Aneurysm Surgery

Several factors make the aorta challenging to repair, including its structure, branching arteries and proximity to nerves. Open surgical procedures require extensive skill, experience and teamwork

Our surgical teams are leaders in the field of aortic aneurysm repair. Some of the procedures we perform include:

Aortic arch replacement: When an aneurysm occurs within the aortic arch, our surgeons replace the damaged part of the arch with a graft. Because the arteries to the head branch off the aortic arch, we temporarily interrupt blood flow to the brain. Our team uses a technique called hypothermic circulatory arrest to cool the body and stop blood flow. This preserves brain function and prevents a stroke. The surgeons then reattach the blood vessels to the graft.

David procedure (valve-sparing aortic root replacement): If an aneurysm damages the aortic root but not the valve, our surgeons replace the root with a graft. Then they reimplant the healthy aortic valve. By sparing the valve, you don’t have to take blood thinners for the rest of your life.

Repair of the descending thoracic aorta: Open repair of a thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) is a highly complex surgery. The surgeon removes the aneurysm and replaces it with a graft. During repair of the descending thoracic aorta, our team freezes the nearby nerves using a special technique called cryoablation. This reduces pain and the need for narcotic pain medications.

Y-incision/rectangular patch aortic root enlargement: We are recognized worldwide for this procedure, which was developed at the Frankel Cardiovascular Center. When an aneurysm damages the aortic valve, the surgeon enlarges the aortic root and inserts a larger replacement valve. This results in better blood flow.

Hybrid Aortic Procedures

Our skilled surgical teams can sometimes minimize invasiveness by using a customized hybrid approach that combines open and catheter-based procedures. Hybrid procedures are useful when multiple areas of the aorta are involved. They allow one area to be reached with a catheter from a smaller surgical opening elsewhere.

Aortic Aneurysm Research

University of Michigan Health is known worldwide for cardiovascular research. Our faculty leads numerous research projects related to aortic disease. Their work furthers our understanding of the causes of aortic aneurysms and identifies new treatments for blood vessel repair.

Make an Appointment

To schedule an evaluation with a Frankel Cardiovascular Center physician, call 888-287-1082. Or visit the Make a Cardiovascular Appointment page to learn what to expect when you call us.

Physicians: To refer a patient, call M-Line at 800-962-3555.