At the Supreme Vascular and Interventional Clinic in Singapore, Dr. Manish Taneja provides comprehensive vascular assessment and personalised treatment planning to help patients understand their diagnosis, evaluate available treatment options, and make informed decisions about their long-term vascular health.

What Is an Aortic Aneurysm?

The aorta is the main artery that carries blood from the heart to the rest of the body. An aortic aneurysm develops when a section of the artery wall becomes weakened and gradually enlarges or bulges.

As the aneurysm increases in size, the wall of the artery may become more fragile. Although many aneurysms remain stable for years, larger or rapidly growing aneurysms carry an increased risk of rupture or aortic dissection, both of which require urgent medical attention.

Because many aneurysms cause no symptoms until complications develop, appropriate surveillance and specialist evaluation are important for patients who have been diagnosed with an aneurysm or who have significant vascular risk factors.

Making Informed Decisions About Aortic Aneurysms

Being diagnosed with an aortic aneurysm often raises questions about whether treatment is necessary and what happens next. Fortunately, not every aneurysm requires immediate repair. Decisions are based on the aneurysm's size, location, growth over time, symptoms, overall health, and the balance between the risks and benefits of treatment.

Our Aortic Aneurysm Decision-Making Guide explains:

• When monitoring may be appropriate
• How aneurysm size influences treatment recommendations
• When endovascular aneurysm repair (EVAR) or surgery may be considered
• What imaging tests are used during follow-up
• How specialists develop personalised treatment plans
• What to expect before and after treatment

Whether you have recently been diagnosed or are considering a second opinion, understanding the decision-making process can help you participate confidently in your care.

Explore:

• Aortic Aneurysm Decision-Making Guide

Are These Serious Conditions?

In its early stages, when an AA is small, it does not pose an immediate health risk. In later stages, if the AA continues to grow, the walls of the aorta or iliac arteries can become thin and lose their ability to stretch. The weakened sections of wall may become unable to support the force of blood flow. Such an aneurysm can burst, causing serious internal bleeding and death. Aneurysm requires regular monitoring and follow-up using ultrasound or CT scan. 

Types of Aortic Aneurysms

Aortic aneurysms are classified according to the part of the aorta that is affected. There are 4 types of aortic aneurysms that we see in practice commonly

1. Abdominal aortic aneurysms
2. Thoracic aortic aneurysms
3. Thoraco-abdominal aortic aneurysms
4. Aortic dissections/ Dissecting aortic aneurysms

Abdominal Aortic Aneurysm (AAA)

An abdominal aortic aneurysm develops in the portion of the aorta that passes through the abdomen. This is the most common type of aortic aneurysm and is often associated with ageing, smoking, atherosclerosis, and other cardiovascular risk factors.

Many abdominal aneurysms produce no symptoms until they become large. Some patients may notice persistent abdominal discomfort, back pain, or a pulsating sensation within the abdomen.

Thoracic Aortic Aneurysm (TAA)

Thoracic aortic aneurysms occur within the chest. Depending on their location and size, they may affect nearby structures and occasionally cause chest pain, back pain, shortness of breath, hoarseness, or difficulty swallowing.

Because these aneurysms frequently remain silent, they are commonly detected during CT or MRI scans performed for unrelated reasons.

Thoracoabdominal Aortic Aneurysm

Some aneurysms extend across both the chest and abdomen. These complex aneurysms require careful assessment and individualised treatment planning because they involve a larger section of the aorta and may affect important branches supplying blood to major organs.

Signs & Symptoms of an Aortic Aneurysm

Unfortunately, in most cases patients have no symptoms of an AA, particularly when they are small. This is why imaging and routine surveillance are often essential following diagnosis. For people who do have symptoms, the most common one is pain. The pain can be in the abdomen, back or chest. It could be anything from a mild pain to a severe pain or tenderness in the mid to upper abdomen or lower back. Some patients feel the aneurysm as a pulsating or throbbing mass in their abdomen.

When symptoms do occur, they depend on the aneurysm's size and location.

Symptoms may include:

• Persistent abdominal pain
• Deep or persistent back pain
• Chest pain
• A pulsating sensation in the abdomen
• Shortness of breath
• Hoarseness
• Difficulty swallowing
• Pain that radiates to the back or flank

While these symptoms may have many possible causes, persistent or unexplained symptoms should always be assessed by a healthcare professional. AA is often discovered during an examination being done for other medical reasons. Most often, asymptomatic aneurysms are found incidentally during CT scan done for some other reason. 

Symptoms Requiring Emergency Medical Attention

Although uncommon, rupture or dissection of an aortic aneurysm is a medical emergency.

Seek immediate emergency care if symptoms develop suddenly, including:

• Severe chest pain
• Sudden severe abdominal pain
• Sudden tearing pain radiating to the back
• Collapse or fainting
• Severe dizziness
• Rapid onset of weakness or shock

Prompt emergency treatment is critical if rupture or dissection is suspected.

What Causes an Aortic Aneurysm?

Aortic aneurysms usually develop when the wall of the artery gradually weakens over time. Several medical conditions and lifestyle factors contribute to this process.

Common risk factors include:

• Ageing
• Smoking
• High blood pressure
• High cholesterol
• Atherosclerosis
• Family history of aortic aneurysms
• Connective tissue disorders affecting the blood vessels
• Previous vascular disease
• Male sex

Although some risk factors cannot be changed, controlling blood pressure, cholesterol, and smoking can help reduce the risk of aneurysm growth and future vascular complications. 

How Is an Aortic Aneurysm Diagnosed?

Diagnosing an aortic aneurysm involves understanding the location, size, shape, and growth pattern of the aneurysm, as well as assessing your overall vascular health.

Many aortic aneurysms are discovered incidentally during imaging performed for another medical reason. For patients with known risk factors, symptoms, or a family history of aortic disease, targeted vascular assessment may help identify an aneurysm before complications develop.

A specialist evaluation may include:

• Review of your symptoms and medical history
• Assessment of cardiovascular and vascular risk factors
• Physical examination where appropriate
• Review of previous imaging studies
• Recommendation of additional vascular imaging if required

The most appropriate imaging test depends on the location of the suspected aneurysm and the information needed to guide treatment decisions.

Imaging Tests Used to Evaluate Aortic Aneurysms

Ultrasound

Ultrasound is commonly used to assess abdominal aortic aneurysms (AAA). It is a non-invasive test that can measure the size of the aorta and help monitor changes over time.

Because ultrasound does not involve radiation, it is often used for surveillance of patients with smaller aneurysms.

CT Angiography (CTA)

CT angiography provides detailed images of the aorta and surrounding blood vessels. It helps specialists evaluate:

• The exact location of the aneurysm
• The aneurysm size and shape
• The involvement of important branch vessels
• Whether endovascular treatment may be suitable

CTA is commonly used when treatment planning is being considered.

Magnetic Resonance Angiography (MRA)

MRA uses magnetic fields to create detailed images of blood vessels. It may be considered in selected patients who require vascular imaging while reducing exposure to radiation.

Catheter Angiography

In selected cases, catheter angiography may be used to provide detailed information about the blood vessels. This technique may also be performed as part of an endovascular treatment procedure.

How Is an Aortic Aneurysm Treated?

Treatment for an aortic aneurysm depends on several factors, including:

• The aneurysm's location
• The size of the aneurysm
• How quickly it is growing
• Whether symptoms are present
• Your age and overall health
• Your individual risk factors

Not every aortic aneurysm requires immediate repair. Some smaller aneurysms can be safely monitored through regular imaging and specialist follow-up, while others may require treatment to reduce the risk of rupture or other complications.

The goal of treatment is to balance the risks of intervention with the risks associated with aneurysm progression.

When Is Monitoring Appropriate for an Aortic Aneurysm?

Many patients diagnosed with an aortic aneurysm do not require immediate treatment. Instead, they may enter a structured monitoring programme where the aneurysm is regularly assessed to determine whether it remains stable.

Monitoring may involve:

• Regular imaging scans
• Tracking changes in aneurysm size
• Reviewing symptoms
• Managing vascular risk factors
• Controlling blood pressure and cholesterol

The decision to continue monitoring or consider treatment depends on the complete clinical picture rather than a single measurement alone.

Factors that may influence treatment decisions include:

• Increasing aneurysm size
• Rapid growth over time
• Development of symptoms
• Location and anatomy of the aneurysm
• Overall health and surgical risk

Understanding these factors can help patients make informed decisions about their care.

For a more detailed explanation of how specialists determine the appropriate next step.

Explore:

• Aortic Aneurysm Decision-Making Guide

Endovascular Aneurysm Repair (EVAR)

When an aneurysm is small, periodic check-up with US or CT scan is required for monitoring. Once it becomes large in size, or is rapidly growing, it is at high risk of bursting needing treatment.

There are two types of treatment for AA:

• Endovascular or minimally invasive repair using special covered stents called stent grafts
• Open surgical repair

For suitable patients, aortic aneurysms may be treated using minimally invasive endovascular techniques. Stent grafts are much less invasive and safer treatment option. The procedure involves introducing the stent graft through a 1 cm incision in the groin without opening the abdomen. 

Endovascular aneurysm repair (EVAR) involves placing a specialised stent graft inside the weakened section of the aorta through small access points in the blood vessels, usually through the arteries in the groin. The stent graft creates a new pathway for blood flow while reducing pressure on the weakened aneurysm wall.

Potential advantages of endovascular treatment may include:

• Smaller incisions compared with open surgery
• Reduced recovery time for suitable patients
• Shorter hospital stays in many cases
• A minimally invasive approach

However, EVAR is not appropriate for every aneurysm. Treatment suitability depends on factors such as aneurysm location, anatomy, blood vessel structure, and overall patient health. A detailed vascular assessment is essential to determine whether endovascular treatment is the right option. Learn more about minimally invasive procedures.

Explore:

• Endovascular Treatment: A Complete Patient Guide

What are the Advances We Offer in the Supreme Vascular and Interventional Clinic?

• The stent grafts are introduced through small incisions in the groin with assistance of closure devices. This implies majority of patients walk home within 1-2 days of the procedure.
• Access and expertise with most different types of stent grafts including small profile devices.
• Simple straight forward aneurysms are treated using conscious sedation with no general anaesthesia required.
• Fenestrated/ branched custom made aortic stent grafts: Quite a few aneurysms are not suitable for standard stent grafts manufactured by different companies.

There are special custom made stent grafts that can be designed and made for patients based on their aneurysm anatomy. This includes aneurysms affecting aortic arch in the thorax or within the abdominal aorta. This implies that almost all patients with aortic aneurysm affecting any part of the aorta from the aortic arch and below can be treated using minimally invasive endovascular techniques without resorting to open surgery. Even extremely complex aneurysms are amenable to treatment using this technology.

Open Surgical Repair for Aortic Aneurysms

Open surgical repair remains an important treatment option for selected patients, particularly when an aneurysm's location, size, or anatomy makes endovascular treatment unsuitable.

During open repair, the weakened section of the aorta is replaced or reinforced using a surgical graft.

The choice between open surgery, endovascular treatment, or continued monitoring depends on an individual's circumstances and should be discussed carefully with a vascular specialist.

Living With an Aortic Aneurysm

Being diagnosed with an aortic aneurysm does not always mean immediate treatment is required. Many patients continue their daily activities while undergoing regular monitoring and managing their vascular health.

Long-term care may include:

• Regular follow-up imaging
• Blood pressure management
• Cholesterol control
• Smoking cessation
• Maintaining a healthy lifestyle
• Following specialist recommendations regarding exercise and activity

Because aortic aneurysms are often associated with broader vascular disease, ongoing care also focuses on reducing cardiovascular risk and protecting overall vascular health.

Patients should discuss any new symptoms, changes in health, or concerns about progression with their specialist.

Comprehensive Vascular Care Beyond Aortic Aneurysm Treatment

The aorta is part of a larger vascular system that supplies blood throughout the body. A diagnosis of aortic aneurysm may provide an opportunity to evaluate other aspects of vascular health, particularly in patients with risk factors such as hypertension, diabetes, smoking history, or cholesterol problems.

A comprehensive vascular assessment may consider:

• Circulation throughout the arterial system
• Cardiovascular risk factors
• Other vascular conditions
• Long-term prevention strategies

Understanding your overall vascular health can help support better long-term outcomes.

Explore:

• What Is Vascular Health?
• The Vascular System and Diseases
• Major Arteries of the Thorax and Abdomen
• Cholesterol Control and Vascular Health