A thoracic aortic aneurysm is a weakening in the wall of the aorta, the main artery that transports oxygen-rich blood from the heart to the rest of the body. Often resembling an abnormal bulge or ballooned area, the aneurysm develops in the chest (thoracic) segment of the aorta, a cane-shaped blood vessel that extends from the left ventricle of the heart to the pelvis. A thoracic aortic aneurysm can affect heart function by placing excess strain on the heart muscle, forcing it to work harder to pump blood through the damaged vessel.

Over time, the weakened part of the aorta can stretch, widen and grow, disrupting blood flow to vital organs and tissues and possibly causing life-threatening internal bleeding. If left untreated, a thoracic aortic aneurysm can also rupture or tear, potentially leading to heart failure or other serious complications. When combined with early detection and treatment, a general understanding of thoracic aortic aneurysms can help protect heart health and save lives.

What Are the Types of Thoracic Aortic Aneurysms?

Thoracic aortic aneurysms are classified based on their location within the aorta. The main types are:

• Ascending aortic aneurysm – The weakening occurs in the upper portion of the aorta, a straight segment that extends from the heart to the aortic arch.
• Aortic arch aneurysm – The aneurysm involves the curve of the aorta, where the artery branches away from the chest to supply oxygenated blood to the head, neck and arms.
• Descending aortic aneurysm – The damage affects the lower section of the aorta, where the artery travels downward from the back of the chest to the pelvis.

What Causes a Thoracic Aortic Aneurysm and What Are the Risk Factors?

A thoracic aortic aneurysm can develop due to various conditions that gradually weaken the strength and integrity of the aortic wall. For instance, in young people, the cause is often related to a genetic condition, such as:

• Marfan syndrome – Caused by a mutation in the FBN1 gene, this rare genetic disorder affects the production of fibrillin, an essential protein for the strength and elasticity of connective tissue. In the aorta, Marfan syndrome can lead to a thinning and weakening of the aortic wall, significantly increasing the risk of thoracic aortic aneurysms and dissections, especially in the ascending aorta.
• Vascular Ehlers-Danlos syndrome (vEDS) – Caused by a mutation in the COL3A1 gene, this rare genetic disorder affects the production of type III collagen, which is critical for blood vessel integrity. As a result, the walls of the aorta and other arteries can become fragile and prone to rupture, aneurysm formation and spontaneous dissection, even without significant external stress.
• Loeys-Dietz syndrome (LDS) – Caused by a mutation in the genes involved in the TGF-β signaling pathway, this inherited condition can cause abnormalities in connective tissue. In the aorta, LDS can weaken the aortic wall, increasing susceptibility to aneurysms, dissections and ruptures. Aneurysms in LDS often develop at a younger age and progress more rapidly than in other conditions.
• Turner syndrome – A chromosomal disorder in which one of the X chromosomes is partially or completely missing, Turner syndrome is associated with structural abnormalities of the aorta, such as aortic coarctation (narrowing of the aorta) and bicuspid aortic valve. These abnormalities can lead to increased stress on the aortic wall, raising the risk of aortic aneurysms and dissections.

Other possible genetic causes of a thoracic aortic aneurysm include:

• Bicuspid aortic valve – Sometimes, the aortic valve, which regulates blood flow from the heart’s left ventricle to the aorta, has two leaflets (cusps) instead of the normal three at birth. This abnormal valve structure can lead to issues such as restricted blood flow (aortic stenosis) or blood leaking backward into the heart (aortic regurgitation). Over time, a bicuspid aortic valve may also increase the risk of developing complications, such as aortic aneurysms or infections of the valve (endocarditis).
• Family history – Certain genes passed down from parent to child can influence traits such as cholesterol levels, blood pressure and the structure or function of the heart and blood vessels, making an individual more susceptible to heart disease and thoracic aortic aneurysms.

Several factors can increase the risk of developing a thoracic aortic aneurysm. These include:

• Advanced age – The risk of cardiovascular disease increases with age, particularly after 65.
• Atherosclerosis – Often associated with aging, atherosclerosis is a buildup of fatty deposits (plaque) on artery walls, which can harden the aorta and damage the aortic wall.
• Chest trauma – A severe injury to the chest, such as a direct blow sustained in a car accident or sports-related collision, can damage the aorta and contribute to aneurysm formation.
• Chronic hypertension – Long-term exposure to high blood pressure can strain and weaken the aortic wall, rendering it less able to withstand the pressure of the blood pumping through the aorta.
• Chronic inflammation – Conditions that involve blood vessel inflammation, such as giant cell arteritis and Takayasu arteritis, have been linked to thoracic aortic aneurysms.
• Degenerative changes – Ongoing wear and tear can slowly break down the elastic fibers of the aortic wall, causing them to become inflexible, brittle and susceptible to damage.
• Smoking – The strongest risk factor for aortic aneurysms, tobacco use can damage the blood vessels, accelerate aortic wall weakening and lead to rupture.

What Are the Warning Signs and Symptoms of a Thoracic Aortic Aneurysm?

Although many thoracic aortic aneurysms develop “silently,” start small and stay small, symptoms may become apparent as an aneurysm grows and begins to exert pressure on nearby structures. Possible warning signs include:

• Coughing or vocal hoarseness – A growing aneurysm may compress the windpipe (trachea) or vocal cords, leading to persistent coughing or a weak, scratchy voice.
• Difficulty swallowing – An aortic aneurysm can press on the esophagus.
• Discomfort – A common sign of a thoracic aortic aneurysm is aching or throbbing pain felt deep in the chest or back, which may radiate downward.
• Shortness of breath – A bulging aneurysm can constrict the lungs or airways, leading to difficulty breathing.

In severe cases, a ruptured aneurysm may cause sudden, severe chest or back pain, rapid heartbeat, low blood pressure and/or loss of consciousness. These symptoms signal a medical emergency that requires an immediate call to 911.

How Is a Thoracic Aortic Aneurysm Diagnosed?

The diagnostic process for a thoracic aortic aneurysm typically involves a medical history review and physical examination followed by one or more advanced imaging tests, such as a:

• Chest X-ray – Although sometimes used in an initial evaluation, a chest X-ray is not a definitive diagnostic test for this purpose. However, it may reveal indirect indications of an aneurysm that warrant follow-up, such as a widening of the area between the lungs (mediastinum), abnormal aortic contour or displacement of a nearby structure, such as the trachea or esophagus.
• Echocardiogram – Using sound waves, this imaging test can help a physician visualize the flow of blood through the heart and blood vessels, including the aorta.
• Computed tomography (CT) scan – The most common imaging tool used for evaluating aortic aneurysms, a CT scan can provide detailed cross-sectional views of internal bodily structures, including the aorta. A contrast dye may be intravenously administered to help the arteries show up more clearly in the images.
• Magnetic resonance imaging (MRI) scan – Often useful for monitoring the progression of an aortic aneurysm over time, a cardiac MRI scan can provide high-definition images of the aorta without exposing the patient to radiation. For this reason, it may be a good option for a patient who needs frequent aneurysm imaging tests.
• Transesophageal echocardiography (TEE) – This highly sensitive, minimally invasive imaging technique involves inserting an ultrasound transducer through the mouth and guiding it down the throat and into the esophagus to gain a clear view of the aorta.

These imaging tests can help a physician assess the location, size and severity of a thoracic aortic aneurysm, providing important information that can be used to guide treatment decisions. Because many aneurysms are “silent,” early detection often occurs incidentally during an imaging procedure performed for an unrelated reason.

How Is a Thoracic Aortic Aneurysm Treated?

Treatment for a thoracic aortic aneurysm can vary depending on its size, location, growth rate and risk of complications, such as rupture. Common options include:

• Lifestyle modifications – To slow the growth of a small, stable aneurysm, the patient may be advised to manage their blood pressure by following a heart-healthy diet, exercising regularly and quitting tobacco.
• Medical management – A physician may prescribe ACE inhibitors or beta blockers to lower blood pressure and reduce stress on the aortic wall. The physician may also recommend regular follow-up and imaging tests to monitor the size and progression of the aneurysm.
• Surgical repair – To reinforce the weakened aortic wall, a surgeon may perform an thoracic endovascular aortic repair (TEVAR), which involves guiding a catheter through the femoral artery to place a stent graft inside the aorta, or open surgery, which involves making an incision in the chest to replace the damaged section of the aorta with a synthetic graft.

What Are the Possible Complications and Long-Term Effects of a Thoracic Aortic Aneurysm?

If not managed effectively, a thoracic aortic aneurysm can lead to several potentially serious complications. These include:

• Aortic dissection – The aortic wall layers may split, disrupting blood flow and risking organ damage.
• Aortic rupture – A life-threatening tear may develop in the aorta, causing severe internal bleeding.
• Blood clotting – Small blood clots can form within an aortic aneurysm, break free from the inner wall and travel through the bloodstream, causing a blockage in a blood vessel in another part of the body.
• Organ damage – Reduced blood flow to vital organs can lead to organ dysfunction and failure.

The long-term effects of an aortic aneurysm can vary depending on its size, location and response to treatment. To reduce the risk of complications, many patients require lifelong management, including blood pressure and cholesterol control, periodic imaging tests and sustainable lifestyle changes. Early detection and appropriate treatment are essential to achieve the best possible outcome and quality of life.

How Can Thoracic Aortic Aneurysms Be Prevented?

Not all aneurysms can be prevented because certain contributing factors are uncontrollable. That said, there are several potentially effective strategies for maintaining a healthy cardiovascular system and reducing the risk of developing a thoracic aortic aneurysm. Key preventive measures include:

• Avoiding tobacco use – Quitting smoking (or not starting) can protect blood vessel health and help prevent aortic damage.
• Getting regular exercise – Engaging in moderate physical activity every day can support overall cardiovascular health.
• Having routine medical checkups – Screening for risk factors, such as hypertension, high cholesterol, atherosclerosis and certain genetic conditions, can help identify any warning signs and address issues early.
• Lowering cholesterol levels – Following a heart-healthy diet and using prescribed medications (if necessary) can help prevent atherosclerosis, a key risk factor for aneurysms.
• Managing blood pressure – Keeping blood pressure levels under control can reduce the strain on the aortic wall.
• Receiving genetic counseling – Individuals with a family history of aneurysms or connective tissue disorders may benefit from specialized screening and management services.

Life After a Thoracic Aortic Aneurysm

Life after a thoracic aortic aneurysm typically involves ongoing care and important lifestyle adjustments to maintain cardiovascular health and prevent complications. The patient will need to work closely with their healthcare team to develop a personalized care plan, which may include regular follow-up visits and imaging tests, such as CT or MRI scans, to monitor the size and progression of the aneurysm. These evaluations are critical for detecting any changes or new issues early, ensuring prompt and effective management.

Lifestyle changes may involve adopting a heart-healthy diet, engaging in an appropriate exercise program and avoiding strenuous physical exertion that could strain the aorta. Managing risk factors—such as controlling high blood pressure and cholesterol levels, quitting smoking and addressing underlying conditions, such as diabetes—is also essential to reduce the risk of further complications. Aortic aneurysms cannot be directly prevented with medication; however, medication may be prescribed to help lower blood pressure or otherwise reduce the strain on the aorta.

With consistent monitoring, proper medical care and a commitment to maintaining a healthy lifestyle, many patients can successfully return to daily activities, enjoy a good quality of life and reduce the likelihood of future complications. Education about the condition and adherence to the treatment plan both play a key role in achieving long-term success.

Benefit From World-Class Care at TGH

The multidisciplinary team at Tampa General Hospital’s Heart and Vascular Institute delivers comprehensive, personalized care for patients with cardiovascular conditions. We are proud to offer advanced treatment options for thoracic aortic aneurysms, including TEVAR. Recognized for excellence, TGH is ranked among the nation’s best hospitals for heart and vascular care by U.S. News & World Report for 2024-25.

As a leading academic health system, Tampa General collaborates with the University of South Florida (USF) Health Morsani College of Medicine on innovative research and groundbreaking clinical trials. We are also trusted to manage some of the nation’s most complex cardiac cases, all while maintaining a strong focus on patient safety and comfort.

If you would like to request a consultation with a specialist on our team, please contact us at (800) 844-3900 or email us at AorticDiseaseProgram@tgh.org.