Ascending Aortic and Arch Aneurysms

Ascending aortic and aortic arch aneurysms are bulges in the portion of your aorta closest to your heart.

The ascending aorta begins at your heart's left ventricle and extends to your aortic arch, or the bend in your aorta. The arch of your aorta has branches that supply blood to your head and arms. Without close monitoring and treatment, these aneurysms can rupture and cause life-threatening bleeding.

UPMC treats a full range of disorders and diseases affecting the aorta, such as ascending aortic and aortic arch aneurysms and aortic dissection. Depending on the severity of your condition, our experts may recommend surgical repair or stenting for treatment.

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• What Are Ascending Aortic and Aortic Arch Aneurysms?
• What Are the Symptoms of Ascending Aortic and Aortic Arch Aneurysms?
• How Do You Diagnose Ascending Aortic and Aortic Arch Aneurysms?
• How Do You Treat Ascending Aortic and Aortic Arch Aneurysms?

What Are Ascending Aortic and Aortic Arch Aneurysms?

Ascending aortic and aortic arch aneurysms are bulges in the portion of your aorta closest to your heart.

The ascending aorta begins at your heart's left ventricle and extends to your aortic arch, or the bend in your aorta. The arch of your aorta has branches that supply blood to your head and arms.

• An ascending aortic aneurysm is located above the heart and can cause the aortic valve to leak.
• An aortic arch aneurysm is a bulge in the bend of your aorta and can impact the blood vessels that supply your head and neck.

How common are ascending aortic and aortic arch aneurysms?

Ascending aortic aneurysms are the second most common aortic aneurysms, normally found in people in their 60s and 70s. However, if you are predisposed to developing aneurysms, this can happen when you are younger. Aortic arch aneurysms are less common.

What causes ascending aortic and aortic arch aneurysms?

Aortic aneurysms occur because of molecular and connective tissue changes in the wall of the aorta. These changes sometimes cause the aorta to narrow or become blocked, and at other times, cause a breakdown of the muscular layer in the aorta, resulting in aneurysms.

What are ascending aortic and aortic arch aneurysm risk factors and complications?

Ascending aortic and aortic arch aneurysm risk factors

Risk factors for ascending aortic and aortic arch aneurysms include:

• Age.
• History of high blood pressure.
• Connective tissue disorders.
• Heart murmurs.

Complications of ascending aortic and aortic arch aneurysms

Aortic aneurysms are dangerous because they may overstretch the aorta, causing it to burst or rupture.

How serious is an aneurysm in the ascending aorta?

Because the aorta is the body's main supplier of blood, a ruptured aneurysm can cause life-threatening bleeding, which may require immediate surgical attention, such as aortic repair.

How can I prevent ascending aortic and aortic arch aneurysms?

You may not be able to control some of your aortic aneurysm risk factors. However, preventing heart disease and chronic conditions can reduce the risk that you will develop an aortic aneurysm. You may be able to reduce your risk of developing aortic aneurysm by:

• Eating a diet that is rich in fruits, vegetables, and whole grains.
• Exercising and maintaining a healthy weight.
• Maintaining normal blood pressure and cholesterol levels.
• Avoiding smoking.
• Limiting alcoholic beverages.

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What Are the Signs and Symptoms of Ascending Aortic and Aortic Arch Aneurysms?

In most cases, doctors discover ascending aortic and aortic arch aneurysms during exams or tests for other medical problems.

Most people with ascending aortic and aortic arch aneurysms do not have any symptoms. Some may experience:

• Dull, vague chest pain.
• Shortness of breath.
• Hoarseness.
• Dry cough.

When should I see a doctor about my ascending aortic or aortic arch aneurysm symptoms?

Aortic aneurysms can cause life-threatening bleeding if they rupture. If you experience symptoms of an aortic rupture, you should dial 911.

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How Do You Diagnose Ascending Aortic and Aortic Arch Aneurysms?

Our experts use leading-edge technology and techniques to diagnose and treat ascending aortic and aortic arch aneurysms.

What to expect during your visit

If your UPMC doctor suspects an ascending aortic or aortic arch aneurysm during a physical exam, he or she will confirm the diagnosis by ordering imaging tests.

Tests to diagnose ascending aortic and aortic arch aneurysm

Your doctor may order several tests to diagnose an ascending aortic or aortic arch aneurysm, including:

• Chest x-ray — A chest x-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An x-ray can show enlargement in any area of the heart.
• Echocardiogram (ECHO) — This noninvasive ultrasound test uses sound waves to evaluate your heart's chambers and valves. The ECHO sound waves create an image on a monitor as an ultrasound transducer is passed over your heart.

Additional tests to determine the size and extent of the aneurysm, include:

• CT scans — A CT scan is a test that creates images of your heart.
• MRI scans — MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within your body.
• CT angiogram — A CT angiogram is an imaging test that examines the arteries that supply your heart muscle. It uses a powerful X-ray machine to produce images of your heart and heart vessels.

At what size does an ascending aortic aneurysm need surgery?

Diagnosing an ascending aortic or aortic arch aneurysm and developing appropriate treatment recommendations may depend on the size of your aneurysm. Your care team will follow evidence-based guidelines to determine whether surgery is the best option for you.

Ascending aortic and aortic arch aneurysm prognosis

Your prognosis with ascending aortic or aortic arch aneurysm depends on the size and extent of your aneurysm. Aortic aneurysm rupture, for example, is a serious, life-threatening condition with a low survival rate. However, if your aneurysm has not ruptured, your doctor may be able to provide surgical treatment that reduces the risk of aortic rupture.

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How Do You Treat Ascending Aortic or Aortic Arch Aneurysm?

Aneurysms in the ascending aorta and aortic arch usually require immediate surgery. If the aneurysm has not ruptured, your vascular surgeon may recommend surgery or implanting a stent to help reduce the chance of rupture.

UPMC offers a full range of state-of-the-art treatment strategies for aortic aneurysms. Our cardiothoracic surgeons routinely perform:

• Minimally invasive aortic aneurysm repairs.
• Aortic root reconstructions that preserve the aortic valve.
• Complex valve repair techniques.

Treatment strategies for ascending aortic and aortic arch aneurysms include:

Aortic aneurysm repair

Aortic aneurysm repair is a surgical treatment that involves removing the portion of the aorta that contains the aneurysm and replacing it with a mesh graft. During an aortic aneurysm repair, the aortic valve may also be affected and need to be reconstructed, replaced, or repaired.

Stenting

Stenting includes inserting a stent-graft — a polyester tube covered by a tubular metal web — through a small incision in the upper thigh into the aorta. This is done through an X-ray, which helps guide the stent-graft through the aorta to the aneurysm site.

After the stent is in place, blood flows through the stent-graft instead of into the aneurysm, eliminating the chance of rupture.

Aortic root reconstructions that preserve the aortic valve

This procedure removes the diseased portion of the aorta while preserving the aortic valve. The aortic root is replaced with a graft and the aortic valve is placed within the graft.

Aortic root repair with valve repair

This procedure combines replacing the aortic root with a graft and the aortic valve with a mechanical or biological valve.

How effective is treatment?

Surgical treatment for aortic aneurysms can reduce the chances of a life-threatening aortic rupture. However, you may need to take precautions — such as avoiding heavy lifting or strenuous activity — to further reduce your risk.

What is the life expectancy of someone with an ascending aortic aneurysm?

Your life expectancy depends on whether you receive early, effective treatment, as well as the size and extent of your aneurysm. Your doctor will discuss your life expectancy with you.

By UPMC Editorial Staff. Last reviewed on 2024-10-01.