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Aortic Branch Aneurysms

By

Mark A. Farber

, MD, FACS, University of North Carolina;


Federico E Parodi

, MD, University of North Carolina School of Medicine

Last full review/revision Nov 2020| Content last modified Nov 2020
Click here for the Professional Version
Topic Resources

Aortic branch aneurysms are bulges (dilations) in the wall of the major arteries that come directly off of the aorta.

Risk factors for aneurysms include

Infection in tissues near an artery can cause an infected aneurysm (mycotic aneurysm). Autoimmune diseases Autoimmune Disorders An autoimmune disorder is a malfunction of the body's immune system that causes the body to attack its own tissues. What triggers autoimmune disorders is not known. Symptoms vary depending on... read more can cause inflammation in different arteries, leading to weakening of the arterial wall, and formation of aneurysms (inflammatory aneurysm).

Where Do Aortic Aneurysms Occur?

Aneurysms can develop anywhere along the aorta. Most develop in the abdominal aorta. The rest develop in the thoracic aorta, most commonly in the ascending aorta.

Where Do Aortic Aneurysms Occur?

Subclavian artery aneurysms

Aneurysms in the subclavian artery (located in the upper part of the chest under the collarbone) sometimes occur in people with an extra rib located in the neck area (cervical rib) or thoracic outlet syndrome Thoracic Outlet Syndromes (TOS) Thoracic outlet syndromes are a group of disorders caused by pressure on nerves, arteries, or large veins as they pass between the neck and chest. When pressure is put on the nerves, pain and... read more Thoracic Outlet Syndromes (TOS) .

Aneurysms in the arteries of the abdominal organs

Aneurysms in the arteries that deliver blood to the digestive tract (splanchnic arteries) are uncommon. However, aneurysms may occur in arteries that supply blood to other organs, including the

  • Spleen (splenic artery, about 60% )

  • Liver (hepatic artery 20%)

  • Intestine (superior mesenteric artery 5.5%)

  • Kidneys (renal arteries)

Hepatic artery aneurysms occur in more men than women. They may result from previous abdominal injury, use of illicit intravenous drug (such as heroin), damage to the wall of the artery, or inflammation of tissues around the artery.

Superior mesenteric artery aneurysms are relatively uncommon among aneurysms in the arteries that go to the abdominal organs. They may result from infections, atherosclerosis, and other disorders that weaken the arterial wall.

Renal artery aneurysms may dissect Aortic Dissection An aortic dissection is an often fatal disorder in which the inner layer (lining) of the aortic wall tears and separates from the middle layer of the aortic wall. Most aortic dissections occur... read more (the layers of the artery separate) or rupture, causing sudden blockage (occlusion) of blood flow to the kidneys and kidney failure.

Symptoms of Aortic Branch Aneurysms

Symptoms of aortic branch aneurysms vary depending on the organ that is deprived of blood. Regardless of location, infected or inflammatory aneurysms may cause pain in the area near the affected artery and symptoms of infection such as fever, weight loss, and a general feeling of illness. Furthermore, rupture of any type of aneurysm can cause rapid blood loss, pain at the site of the aneurysm, low blood pressure, and even death.

Most aneurysms in the abdominal aortic branches do not cause any symptoms unless they rupture. Rarely, people with splenic artery aneurysms will have abdominal pain, nausea, and vomiting. People with hepatic artery aneurysms will have abdominal pain or yellowing of the skin (jaundice) if the aneurysm compresses the tubes that transport bile from the gallbladder to the intestine (the biliary tract). People with superior mesenteric artery aneurysms will have abdominal pain and bloody diarrhea (ischemic colitis) Ischemic Colitis Ischemic colitis is injury of the large intestine that results from an interruption of blood flow. Abdominal pain and bloody stools are common. Computed tomography is usually done, and colonoscopy... read more Ischemic Colitis , and people with renal artery aneurysms will have high blood pressure, abdominal or flank pain, or blood in the urine.

Diagnosis of Aortic Branch Aneurysms

Treatment of Aortic Branch Aneurysms

  • Surgical repair of the aneurysm

  • Often endovascular stent graft repair

Treatment is surgical repair of the aneurysm in which an artificial artery made of synthetic material (graft) is placed inside the aneurysm. The old arterial wall (aneurysm) is wrapped around the new graft.

Often, doctors do endovascular stent graft repair, which does not require surgery on the abdomen. To do an endovascular stent graft repair, doctors thread a long, thin wire through the large artery in the groin (femoral artery) and up to the aneurysm. Then they slide the stent graft, which is a thin tube like a collapsible straw, over the wire and inside the aneurysm. Then the stent graft is opened, forming a stable channel for blood flow.

The decision to repair aneurysms that are not causing symptoms is based on the risk of rupture, extent and location of the aneurysm, and the risks caused by other conditions the person may have. For splanchnic aneurysms, risk of rupture and death is high, particularly for women of childbearing age and for people with hepatic aneurysms, so aneurysms in these people are usually repaired even if they are not causing symptoms.

Surgery for subclavian artery aneurysms may involve removal of a cervical rib (if present) from the upper chest before repair and replacement.

Treatment of infected (mycotic) aneurysms is antibiotic therapy appropriate for the specific infectious organism. Generally, these aneurysms must also be surgically repaired once the infection has been treated.

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