Types of aortic aneurysms

Aneurysms can form anywhere along the aorta as either a symmetrical bulge around the aorta or an asymmetrical bleb. Fusiform aneurysms occur as a symmetrical bulge around the entire circumference of a section of the aorta. Saccular aneurysms form as a small blister or bleb on one side of the aorta. Many saccular aneurysms are either caused by trauma such as a motor vehicle accident or are the result of a penetrating aortic ulcer. Aneurysms are further classified based on their location along the aorta.

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*Thoracic aortic aneurysms are those that occur along the aorta above the diaphragm, the partition between the chest and abdomen, including the ascending aorta, the aortic arch, and the descending thoracic aorta. Up to 25 percent of aortic aneurysms are thoracic; of these, ascending aortic aneurysms are the most common, followed by descending thoracic aneurysms. Aneurysms along the aortic arch are rare and are the most complex to treat, largely because the arterial branches that supply blood to the brain and upper extremities are attached along the aortic arch. Thoracic aortic aneurysms are potentially the most lethal; as many as 1 out of every 5 people die within five years if a thoracic aneurysm is left untreated. Larger aneurysms are more dangerous, because of the increased risk of rupture or dissection.

• Abdominal aortic aneurysms are located along the segment of the aorta that extends beyond the diaphragm through the abdomen. About 75 percent of aortic aneurysms are located in the abdomen. They can affect anyone, but most are associated with smoking and high blood pressure and occur primarily in men over age 60.
• Thoraco-abdominal aortic aneurysms span both the thoracic and abdominal segments of the aorta. These aneurysms are relatively uncommon, and treatment can require replacement of the entire aorta. This involves reconnecting critical blood vessels that branch off the aorta along the lower descending thoracic aorta and upper abdominal aorta that supply blood to the spinal cord. Repair of thoraco-abdominal aortic aneurysms carries a significant risk of paraplegia and requires specific surgical expertise.