The aorta is the largest artery in the body, carrying oxygenated blood from the heart to all organs. It runs from the chest to the abdomen, branching out to supply the brain, kidneys, intestines, and legs. A problem in the aorta therefore affects not just the heart but the entire body. Over time, sustained high pressure and atherosclerosis can weaken the wall, causing it to dilate or tear.
Aortic diseases fall into three main categories: aortic aneurysm (dilation), aortic dissection (tear), and aortic coarctation (congenital narrowing). Aneurysms generally progress silently over the years, while dissection is a sudden, life-threatening event. Trauma, infection, and genetic connective tissue disorders (e.g., Marfan syndrome) can also affect the aorta.
An aneurysm is defined as a dilation of the aortic wall exceeding 50% of the normal diameter. It progresses silently and is often discovered incidentally during an ultrasound or CT scan. When the dilation exceeds a certain size (generally 5–5.5 cm in the abdomen), the risk of rupture rises significantly. Rupture causes internal bleeding and carries a very high mortality rate.
Dissection occurs when the inner layer of the aortic wall tears and blood seeps between the layers, creating a second channel within the vessel. It begins with a sudden, stabbing pain in the chest or back. Pulse differences between limbs, fainting, stroke, or sudden death may follow. Without emergency surgery, the chance of survival is low.
Coarctation is a congenital narrowing of a segment of the aorta, usually near the top where it exits the heart. It is typically detected in childhood by a blood pressure difference (higher in the arms, lower in the legs). If untreated, cardiac hypertrophy and early heart failure may develop. Balloon angioplasty or surgical correction can provide permanent treatment.
The main causes are high blood pressure, smoking, high cholesterol, genetic predisposition, and atherosclerosis. Trauma, connective tissue disorders (Marfan, Ehlers-Danlos), advanced age, chronic inflammation, and infections also play a role. These factors weaken the aortic wall, eventually leading to dilation or tearing.
Aortic disease is more common in men over 60 and in smokers. Those with a family history of aneurysm, uncontrolled hypertension, or atherosclerosis are at high risk. Genetic connective tissue disorders such as Marfan or Turner syndrome can cause aortic problems at a younger age.
Some types are. Aortic dilation appears at an early age particularly in genetic syndromes that weaken connective tissue. If a first-degree relative has had an aneurysm, regular imaging screening should begin from age 40.
Aortic diseases are usually silent for a long time. A growing aneurysm may cause back, abdominal, or chest pain. When rupture occurs, the pain is sudden and unbearable, accompanied by sweating, low blood pressure, shortness of breath, and fainting.
Vessel diameter and structure are assessed by Doppler ultrasound, CT angiography, or MR angiography. An enlarged aortic shadow on a chest X-ray may provide a clue. When suspected, echocardiography is also used to examine the aortic segment at the heart outlet.
Rupture is the most serious complication. Clot formation, reduced blood flow to organs, kidney failure, and stroke may also occur. In dissection, vessels supplying the brain or legs can become blocked.
The treatment approach varies by disease type and stage. Blood pressure control and medication are sufficient for small aneurysms. Surgical repair or endovascular stent-graft (EVAR/TEVAR) is used for enlarged or high-risk aneurysms. Dissection requires emergency surgery.
A metal scaffold (stent) is placed inside the aorta via the groin artery. This stent seals the leaking area from within and restores normal blood flow. It is less traumatic than open surgery; patients are typically discharged within a few days.
Surgery is indicated when the aneurysm diameter exceeds the threshold (5–5.5 cm in the abdomen, 6 cm in the chest) or when the growth rate exceeds 0.5 cm per year. Emergency intervention is performed when dissection or rupture is suspected.
The first days are spent in intensive care. Blood pressure, cholesterol, and smoking control remain very important in the following weeks. Patients generally return to daily life within 2–3 weeks. Regular check-ups monitor the condition of the stent or graft.
Risk varies by the location of disease and the patient's general condition. In emergency dissection surgery, risk can reach 10–20%; for planned aneurysm repair it is below 3%. Success rates are high in experienced centers.
High blood pressure exerts continuous pressure on the aortic wall and accelerates dilation. After dissection in particular, a lifelong low blood pressure target is set (generally below 120/80 mmHg). Regular medication significantly reduces the risk of rupture.
Yes. The aortic valve and the ascending aorta are part of the same anatomical structure. When the aorta dilates, the valve may not close fully, leading to aortic regurgitation. For this reason, many patients undergo both aortic and valve repair in the same operation.
If a first-degree relative has had aortic disease, Doppler ultrasound or CT angiography screening should begin from age 40. For Marfan or similar syndromes, screening should start at an even younger age.
Smoking weakens the elastic fibers in the vessel wall and increases the risk of aneurysm formation. This habit must be completely stopped after treatment.
Light walking and low-intensity exercise are appropriate. However, heavy lifting, high-exertion activities, and sports that cause sudden pressure spikes (weightlifting, sprinting, diving, etc.) are strongly discouraged.
Salt, sugar, and saturated fats should be reduced; vegetables, fruits, fish, olive oil, and whole grains are preferred. Maintaining an ideal body weight is important as excess weight increases vascular pressure.
For small aneurysms, CT or ultrasound checks are done every 6–12 months. After surgery or stenting, checks are every 3 months in the first year, then annually.
Genetic factors cannot be eliminated, but risk can be greatly reduced. Keeping blood pressure controlled, living smoke-free, managing cholesterol, and attending regular check-ups can almost entirely prevent aortic rupture.
If sudden chest or back pain, fainting, shortness of breath, low blood pressure, sweating, or cold extremities occur, emergency services should be called immediately. These symptoms signal aortic dissection or rupture. Early intervention saves lives.
