Aortic disease is a form of peripheral artery disease that affects the aorta, the largest artery in the body. The most common problem is an aortic aneurysm, a bulging out of the artery wall that stretches like a balloon under the pressure of blood pumped from the heart. These bulges grow in size over time. Without treatment, they may eventually rupture, causing massive internal bleeding that usually results in death.
Women with large aortic aneurysms that are causing symptoms need immediate treatment to prevent if from bursting. You should learn to recognize the symptoms of aortic disease and talk to your doctor if you experience them. Common signs include:
- Deep, aching, or throbbing chest or abdominal pain that can spread to the back, buttocks, groin, or legs
- Cough, shortness of breath, or difficult or painful swallowing
- Abdominal pain or discomfort (can be constant or come and go)
- A pulsating feeling in the abdomen
- A feeling of fullness after minimal food intake
If you have any of these signs, you should undergo an evaluation for an aortic aneurysm, which consists of:
- A physical examination and medial history to check for signs of aortic disease and estimate your risk of developing the condition
- Imaging tests that produce pictures of the aorta and blood flow through it
Even if you do not have any symptoms, certain women at high risk for an aortic aneurysm should have a screening test so that it can be diagnosed and treated early. See Should I be tested for Aortic Disease to learn who should have a screening test.
If you are diagnosed with a small aortic aneurysm that does not require immediate treatment, the same tests used to diagnose the disease will be used to monitor your aneurysm and make sure it is not growing too large. See Monitoring an Aortic Aneurysm to learn more.
A medical history and physical examination are the first steps in evaluating women with signs or symptoms of aortic disease.
A medical history includes a complete review of any medical conditions you have, surgeries and other procedures you've had in the past, and any medications you are taking (including prescription drugs, over-the-counter medications, and dietary supplements). Recent weight loss (without trying to lose weight) or pain in your abdomen after eating can suggest that an aortic aneurysm is pressing against your stomach. If you have a family history of aortic aneurysm, you are more likely to develop one yourself.
During a physical examination for aortic aneurysm, your doctor will:
- Feel your abdomen and flank (your side between your ribs and hipbone) for pulsing that could be caused by an aneurysm, and to see if your aorta is larger than normal
- Measure your blood pressure – low blood pressure is a sign of an aortic aneurysm that has burst
- Listen with a stethoscope for a bruit (BROO-ee) caused by turbulent blood flow in blood vessels in the abdomen
Women with the classic symptoms of an aortic aneurysm that has ruptured—constant, severe abdominal and/or back pain (sometimes radiating to the groin, buttock, or legs), a pulsing mass in the abdomen, and low blood pressure—should undergo immediate surgery to diagnose and repair the aneurysm.
If any of the signs of aortic aneurysm are detected during the physical exam, or if you are at high risk for an aneurysm because of your family history, you will need an imaging test to look at the structure of the aorta and blood flow through it.
Although the physical exam can detect signs of a large aneurysm, most aortic aneurysms do not cause any symptoms. Because of this, they are often discovered on an imaging test for an unrelated condition (lung, heart, or urologic problems) such as a chest X-ray, CT scan, or ultrasound test.
Women with symptoms of aortic aneurysm will need an imaging test to confirm the diagnosis and determine the best treatment. An ultrasound test of the abdomen is usually the first test used to diagnose an aneurysm and determine its size and location because it is fast, accurate, and does not involve injected dyes or radiation like other tests.1 The abdominal ultrasound test may only use ultrasound images (called B-mode ultrasound), or it may include duplex ultrasound that creates images of the aorta and measures the speed and direction of blood flow. The ultrasound test is less useful for diagnosing aneurysms above the level of the kidneys, or aneurysms that affect the aorta in the chest (thoracic aortic aneurysms).2
If your doctor suspects you have an aneurysm in the upper part of the aorta, or if you are considering a procedure to repair an aortic aneurysm, you may need more detailed imaging tests to examine the aorta:
The CT angiogram is the "gold standard" test for evaluating aortic aneurysms and planning treatments. This test uses X-rays to produce images of the aorta and an injected dye to highlight blood flow. The CT angiogram is more accurate than an ultrasound for diagnosing and locating aneurysms above the level of the renal (kidney) arteries.3 A regular CT scan is normally performed first to create images of the aorta, followed by a CT angiogram to examine blood flow.4
The MR angiogram is an alternative to a CT angiogram for diagnosing aortic disease and planning treatments. This test uses a large magnet and radio waves to produce detailed images of the aorta, and an injected dye to produce images of blood flow.1
A contrast angiogram is an invasive test that uses a catheter (a long, thin tube inserted into an artery in your leg or arm) that injects a dye to trace blood flow. The test produces an X-ray movie of blood flow through the aorta, and can determine the location and size of an aneurysm, whether the aorta is narrowed by atherosclerosis, and if there are blood clots or tears (dissections) in the blood vessel wall.
Because it involves entering the body and therefore carries some risks, the contrast angiogram has mostly been replaced by the CT angiogram and MR angiogram for diagnosing and planning treatment in women with aortic aneurysms. However, it may still be used to plan treatments in women with complex or unusual aortic anatomy.5
If you have been diagnosed with an aneurysm that is large or fast-growing or causing symptoms, you will need to undergo a procedure to repair the aneurysm and prevent it from bursting. See Aortic Aneurysm Treatment Overview to learn more about who might need these procedures and what your treatment options are.
Women with smaller aortic aneurysms that have not yet caused any symptoms should have regular tests to monitor the aneurysm's size and see how quickly it is growing. Not all aneurysms will grow large enough to require repair, so regular testing can avoid unnecessary procedures and keep you safe by detecting aneurysms that have become large enough to burst. The diagram below outlines tests used to monitor aortic aneurysms and determine if you need treatment. Because women tend to have smaller aortas than men, some doctors may use lower size cutoffs for testing or aneurysm repair in women.
- Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. Mar 21 2006;113(11):e463-654.
- Lamah M, Darke S. Value of routine computed tomography in the preoperative assessment of abdominal aneurysm replacement. World J Surg. Oct 1999;23(10):1076-1080; discussion 1080-1071.
- Fillinger MF. Imaging of the thoracic and thoracoabdominal aorta. Semin Vasc Surg. Dec 2000;13(4):247-263.
- Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease. J Am Coll Cardiol. Apr 6 2010;55(14):e27-e129.
- Galt SW, Pearce WH. Preoperative assessment of abdominal aortic aneurysms: noninvasive imaging versus routine arteriography. Semin Vasc Surg. Jun 1995;8(2):103-107.