Sudden severe tearing or ripping pain in the chest, back or abdomen is a medical emergency. Call an ambulance now. Aortic dissection can be fatal within hours. Do not drive yourself, do not wait to see if it passes, and do not contact us first.
The aorta is the main artery leaving the heart. When a section of its wall weakens it can stretch and balloon outward — an aneurysm — and if the wall tears, that is a dissection.
Most aneurysms are found by accident on a scan done for something else, and most are watched rather than operated on. The critical questions are how large it is, how quickly it is growing, and where it sits.
The aorta runs from the heart, arches over, and travels down through the chest and abdomen. Its wall has layers of elastic tissue designed for a lifetime of pressure. When those layers weaken, the pressure inside gradually stretches that segment outward.
Where it occurs matters. An aneurysm of the ascending aorta, immediately above the heart, behaves differently from one in the abdomen, and the treatments differ accordingly. Aneurysms in the ascending aorta are frequently associated with a bicuspid aortic valve or with connective tissue conditions such as Marfan syndrome.
An aneurysm itself usually causes no symptoms. The danger is what can happen to it. If the inner layer of the wall tears, blood forces its way between the layers and splits them apart — a dissection, which can obstruct branches supplying the brain, kidneys or limbs, and can rupture. If the wall gives way entirely, that is a rupture, and it is frequently fatal before help arrives.
This is why size thresholds exist. Repair is offered before the risk of rupture exceeds the risk of the operation — not because the aneurysm is causing trouble, but precisely so that it never does.
Untreated dissection of the ascending aorta carries a mortality that rises with every hour that passes. It is treated in the nearest capable hospital, wherever you happen to be — never by arranging travel. Nothing on this page applies to someone with sudden tearing chest or back pain. Call an ambulance.
Imaging is everything here. The measurements determine the recommendation.
A report saying 'dilated aorta' is not enough to advise you. We need the diameter in centimetres, the exact location, and ideally two scans at different dates so growth rate can be assessed. Growth is often more important than a single measurement. If you have a bicuspid aortic valve or a family history of aortic disease, say so — both lower the threshold at which repair is recommended.
Most aneurysms are monitored. Repair is offered when the risk of leaving it exceeds the risk of fixing it.
Regular imaging at intervals set by size and growth rate, with strict blood pressure control and beta blockade to reduce the stress on the aortic wall. Stopping smoking matters considerably. This is the correct management for the majority of aneurysms found incidentally, and it is not a delay tactic.
The affected segment is replaced with a synthetic graft. Where the aortic root is involved, the aortic valve may be replaced at the same time or, in suitable patients, preserved and resuspended inside the graft. It is major surgery with a recovery of several weeks, and it remains the standard for the ascending aorta and the arch.
A covered stent graft is delivered through the arteries in the groin and deployed to line the weakened segment from the inside. Recovery is far quicker and hospital stay much shorter. It requires suitable anatomy — particularly adequate landing zones above and below the aneurysm — and commits you to lifelong imaging surveillance of the graft.
Acute dissection of the ascending aorta requires immediate surgery. Dissection of the descending aorta is often managed medically with aggressive blood pressure control unless complications develop. Neither is a situation for planned international travel.
Ascending aorta and arch generally mean open surgery. Descending thoracic and abdominal aneurysms are frequently suitable for stent grafting. This is anatomy, not preference.
Repair is generally considered around 5.5 cm, and earlier where there is a bicuspid valve, a connective tissue disorder, rapid growth or a family history of dissection. Rapid enlargement can justify repair below the usual threshold.
Age, kidney function, lung disease and coronary disease all shape whether open repair is reasonable and whether a stent graft is the better route.
If your scan shows an aneurysm below the threshold and not growing, we will tell you that you do not need an operation and what surveillance interval is appropriate — even though that means no case for us.
A known aneurysm with new pain is treated as a possible dissection until proven otherwise. That means the nearest emergency department, immediately, not a flight.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Around 5.5 cm is the usual threshold for both ascending and abdominal aneurysms, but the figure is not fixed. It is lowered where there is Marfan syndrome or another connective tissue disorder, a bicuspid aortic valve, rapid growth, a family history of dissection, or where surgery is planned for another reason. Your own threshold should be stated explicitly by the surgeon assessing you.
For a stable aneurysm below threshold with well controlled blood pressure, generally yes. For a large aneurysm, one that is growing quickly, or one causing pain, flying should be discussed before it is booked. Any new pain in a known aneurysm needs assessing before travel, not after.
It can be. Aneurysms of the ascending aorta in particular are associated with bicuspid aortic valve and with connective tissue disorders such as Marfan and Loeys-Dietz syndromes, which run in families. If a close relative has had an aortic aneurysm or a sudden unexplained death, first-degree relatives should be screened with an echocardiogram.
Neither in general; location determines it. The ascending aorta and arch almost always require open surgery. Descending thoracic and abdominal aneurysms are often well suited to stent grafting, which has a much shorter recovery but commits you to lifelong imaging follow-up of the graft. Your CT scan gives the answer.
Control blood pressure rigorously — this is the single most important measure — take beta blockers if prescribed, stop smoking completely, and avoid heavy straining and maximal weight lifting. None of this reverses an aneurysm, but it slows growth and reduces the risk of dissection.
Yes. Bicuspid aortic valve is associated with dilatation of the ascending aorta, and the aorta should be imaged and monitored even when the valve itself is working reasonably. If a valve operation is being planned, the aorta should be measured as part of that planning, since both may need attention in one procedure.
Send the CT angiogram report with the diameter in centimetres, and any earlier scan for comparison. Growth rate matters as much as size.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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