Causes
Aortic aneurysms may result from a variety of predisposing conditions.
Degenerative dilation of the aortic wall is the most common cause of aneurysm formation. While the causes are not well understood, in some patients the elastic aortic tissue weakens prematurely, leading to progressive aneurysmal change. This process is sometimes referred to as cystic medial degeneration.
Atherosclerotic disease may produce calcification in the wall of the aorta, and other blood vessels, which damages cells in the media, leading to subsequent dilatation. Poorly controlled hypertension, as it subjects the aortic walls to higher pressure, may also contribute to aneurysm growth. Atherosclerosis has been found to be related to such factors as elevated cholesterol levels, cigarette smoking, diabetes, poor physical conditioning, and genetic predispositions.
Genetic diseases, such as Marfan's Syndrome or Ehlers-Danlos Syndrome, may lead to progressive dilatation of all segments of the aorta due to abnormalities in collagen, one of the proteins that are vital to the integrity of the aortic wall.
Aortic dissections may result in chronic dilatation of the aorta over time. An aortic dissection is caused by a tear in the inner lining of the aorta which allows blood to track within the wall of the aorta. Dissections of the ascending aorta must be repaired immediately, but dissections of the descending aorta may heal with careful blood pressure control. However, since the wall of the aorta is weakened, it may progressively dilate over time.
Inflammatory conditions, such as Takayasu's arteritis, may produce aneurysmal changes of the aorta as one of their manifestations.
Trauma, for example from motor vehicle accidents, may damage the wall of the aorta, leading to late aneurysm formation.
Bicuspid aortic valves may produce chronic dilatation of the ascending aorta, and may require replacement of both the aortic valve as well as the ascending aorta.
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