The aorta is the body’s largest artery. It carries oxygen-rich blood from the heart to the rest of the body. Shaped like a candy cane, this blood vessel originates in the heart’s left ventricle, or upper chamber, and then curves upward into the chest before bending downward into the abdomen, where it splits into two arteries that carry blood to each leg. Other arteries branch off from parts of the aorta to carry blood to the upper body and to organs such as the kidneys, stomach, and intestines.
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The wall of the aorta is composed of three layers. If the middle layer of the aortic wall—which consists of smooth muscle and elastic tissue—weakens and stretches, blood pumping through it can lead to a bulge, or aneurysm.
Small aneurysms generally do not cause problems, but larger ones can cause blood to clot or an artery to rupture or tear, known as dissection. This is a life-threatening event that requires immediate surgery.
Doctors at NYU Langone diagnose and classify aortic aneurysms according to the location, size, and shape of the bulge. There are three types of aneurysms based on their location on the aorta: thoracic, abdominal, and thoracoabdominal.
An aortic aneurysm that develops in the chest is called a thoracic aortic aneurysm. Many people with a thoracic aortic aneurysm have no symptoms. Thoracic aortic aneurysms are further classified by their location within the chest.
The aortic root is located where the aorta attaches to the heart. It includes the aortic valve, which prevents blood from flowing backward into the heart, and openings to the coronary arteries, which supply oxygen-rich blood to the heart. An aortic root aneurysm can lead to a dissection or rupture of the aorta, and also can cause damage to the heart’s aortic valve. This is particularly true in people who have Marfan syndrome or other genetic connective tissue disorders that weaken the aorta. Valve-sparing aortic root aneurysm replacement, which is performed by our highly experienced team at the Center for Complex Aortic Disease, replaces the damaged section of the aorta while preserving the aortic valve.
The ascending aorta is the portion that extends upwards from the aortic root toward the curved part of the aorta. People with an ascending aortic aneurysm typically do not experience symptoms, but those who do may feel a dull chest pain.
The aortic arch is the curved part of the aorta. It includes connections to arteries that supply oxygen-rich blood to the upper body, including the arms, brain, and neck. Though most people with aortic arch aneurysm do not notice symptoms, some may experience a dull chest pain, shortness of breath, and a hoarse voice. Treatment requires collaboration by cardiac and vascular surgeons, who replace the affected vessels or use a stent graft to place a synthetic tube that strengthens the arterial wall.
The descending thoracic aorta begins at the bottom of aortic arch and extends downward to the abdomen. Several other arteries branch off from this part of the aorta to supply blood to organs, lymph nodes, and tissue in the torso. A descending thoracic aortic aneurysm can cause back pain.
An aortic aneurysm that develops below the chest is called an abdominal aortic aneurysm. These are more common than thoracic aortic aneurysms and more common in men than in women. Small abdominal aortic aneurysms can, over time, grow quite large without causing symptoms; this type of slow-growing aneurysm rarely ruptures. An abdominal aortic aneurysm that expands quickly is more likely to cause symptoms, such as sudden abdominal or back pain, and is at risk of rupturing.
A thoracoabdominal aortic aneurysm spans from the thoracic to the abdominal portions of the aorta. It rarely causes symptoms but can expand enough to tear or rupture. Because it crosses through parts of the aorta that connect to arteries that supply blood to the liver, kidneys, intestines, and spine, repairing this type of aneurysm can be more complicated than other types. Treatment often involves creating bypasses around the affected parts of the aorta. NYU Langone doctors are also experts in endovascular aortic aneurysm repair (EVAR), a minimally invasive approach that allows surgeons to access the aneurysm by advancing a custom-made stent through the femoral artery and to the site of the aneurysm. The stent reinforces the aorta, and the aneurysm is able to shrink over time.
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