Aneurysms are often described as silent vascular conditions because they may develop and grow without causing noticeable symptoms. In many cases, an aneurysm is only discovered during an ultrasound, CT scan, or another imaging investigation performed for an unrelated medical concern.
The absence of symptoms does not necessarily mean that an aneurysm is harmless. As an aneurysm grows, the affected artery wall may become weaker, increasing the risk of a blood clot, restricted circulation, dissection, or rupture. These complications can become medical emergencies, which is why early detection and specialist monitoring are so important.
Legae Vascular assesses and manage thoracic, abdominal, and peripheral aneurysms and dissections. Our approach combines careful diagnosis, personalised risk assessment, and evidence-based treatment. Depending on the location, size, and behaviour of the aneurysm, management may involve regular monitoring, medical risk-factor control, an endovascular procedure, or open aneurysm surgery.
What Is an Aneurysm?
An aneurysm is an abnormal enlargement or bulging of an artery. It develops when part of the artery wall weakens and begins to expand under the pressure of circulating blood.
Although aneurysms can occur in different blood vessels, vascular surgeons commonly assess aneurysms affecting:
- The abdominal aorta
- The thoracic aorta
- The arteries supplying the pelvis
- The femoral arteries in the groin
- The popliteal arteries behind the knees
- Other peripheral arteries
The aorta is the body’s main artery. It carries oxygen-rich blood away from the heart and distributes it throughout the body. An aneurysm affecting this major vessel requires appropriate assessment because the consequences of a rupture or dissection may be severe.
Brain aneurysms also occur, but these are generally managed by neurological and neurosurgical specialists. Our focus at Legae Vascular is on aneurysms involving the aorta and peripheral circulation.
Why Aneurysms Are Often Difficult to Detect Early
One of the greatest challenges associated with aneurysms is that many do not cause early warning signs. A small or slowly growing aneurysm may not press on nearby structures or interfere with blood flow, allowing a person to continue with everyday activities without knowing that the condition is present.
Some aneurysms are found incidentally during imaging for back pain, abdominal discomfort, kidney concerns, lung conditions, or another health issue. Others may be identified when a healthcare professional examines a pulsating area or investigates circulation problems in a limb.
This silent progression makes risk awareness particularly important. People with known risk factors should not wait for severe symptoms before discussing their vascular health with a healthcare professional.
Early detection gives the vascular surgeon an opportunity to:
- Confirm the aneurysm’s location and size
- Assess its shape and surrounding anatomy
- Determine whether it is growing
- Identify signs of clotting, leakage or dissection
- Address controllable cardiovascular risk factors
- Plan aneurysm surgery before an emergency develops, where appropriate
A planned assessment provides considerably more opportunity for careful investigation and treatment planning than an emergency presentation.
Early Signs of an Abdominal Aortic Aneurysm
An abdominal aortic aneurysm, commonly referred to as an AAA, develops in the section of the aorta that passes through the abdomen. Most small AAAs do not produce symptoms, but larger or expanding aneurysms may cause certain warning signs.
Possible symptoms include:
- A persistent, deep pain in the abdomen
- Ongoing lower back pain
- Pain extending towards the pelvis or groin
- A pulsating or heartbeat-like sensation near the navel
- Abdominal tenderness
- Unexplained discomfort that does not improve
These symptoms can also be caused by many less serious conditions. However, persistent abdominal or back pain should not automatically be ignored, particularly when a person has cardiovascular risk factors or a family history of aneurysms.
A healthcare professional may recommend an abdominal ultrasound or more detailed vascular imaging to determine whether the aorta is enlarged.
Early Signs of a Thoracic Aortic Aneurysm
A thoracic aortic aneurysm develops in the section of the aorta that passes through the chest. Like abdominal aneurysms, thoracic aneurysms may remain symptom-free for a long time.
When symptoms occur, they may result from the enlarged artery placing pressure on nearby structures. Possible signs include:
- Persistent chest pain or tenderness
- Upper or middle back pain
- Shortness of breath
- An unexplained cough
- A hoarse, weak or scratchy voice
- Difficulty swallowing
- A sensation of pressure in the chest
Chest and back symptoms should always be assessed carefully because they may be associated with several heart, lung, muscular, or vascular conditions. Sudden severe pain requires urgent medical attention.
Thoracic aneurysms may also be associated with inherited conditions, structural abnormalities, or a family history of aortic disease. Patients with a close relative who has experienced an aortic aneurysm or dissection should inform their doctor, even when they feel completely well.
Signs of a Peripheral Artery Aneurysm
Peripheral aneurysms affect arteries outside the brain and aorta. One of the more common locations is the popliteal artery behind the knee, although aneurysms may also occur in the femoral artery in the groin or other arteries supplying the limbs.
Possible symptoms include:
- A pulsating lump behind the knee or in the groin
- Pain or aching in the affected leg
- Swelling around the aneurysm
- Numbness, tingling, or weakness
- A foot that feels unusually cold
- Changes in the colour of the foot or toes
- Wounds on the foot or lower leg that heal slowly
- Sudden worsening of circulation in the limb
Peripheral aneurysms do not only pose a rupture risk. Blood can circulate abnormally within the enlarged section of the artery, encouraging a clot to form. Part of the clot may then block blood flow further down the limb.
Prompt assessment may help protect circulation and reduce the risk of tissue damage or limb-threatening complications.
Emergency Warning Signs That Should Never Be Ignored
An aneurysm rupture or an acute aortic dissection is a medical emergency. Symptoms usually begin suddenly and may be severe.
Seek emergency medical care immediately when someone experiences:
- Sudden, intense chest, abdominal, or back pain
- Pain that feels different from previous discomfort
- Fainting or near-fainting
- Sudden weakness or confusion
- Cold, clammy, or sweaty skin
- Severe shortness of breath
- A very rapid heartbeat
- Sudden weakness, numbness, or loss of circulation in a limb
Do not attempt to drive yourself when symptoms are severe or when fainting, weakness, or sudden deterioration is present. Contact emergency medical services or go to the nearest emergency department.
Who Is at Greater Risk of Developing an Aneurysm?
An aneurysm can affect anyone, but certain factors increase the likelihood of developing aortic or peripheral arterial disease.
- Smoking: Current and previous tobacco use is one of the most important risk factors associated with abdominal aortic aneurysms. Smoking damages artery walls, contributes to atherosclerosis, and may increase the rate at which an aneurysm expands. Stopping smoking remains an important part of reducing cardiovascular risk, even after an aneurysm has already been diagnosed.
- High Blood Pressure: Uncontrolled hypertension places additional force on artery walls. Over time, this pressure may contribute to the enlargement of a weakened section of an artery and may increase the risk associated with an existing aneurysm.
- Increasing Age: Aneurysms become more common as people grow older because blood vessels naturally change over time. The cumulative effects of smoking, hypertension, cholesterol, and atherosclerosis may also become more significant with age.
- Family History: A close relative with an aortic aneurysm or dissection may indicate an inherited predisposition. Family history can be especially relevant when an aneurysm developed at a younger age or affected more than one family member.
- High Cholesterol and Atherosclerosis: High cholesterol contributes to plaque formation and damage within the arteries. Atherosclerosis is strongly linked to several vascular conditions, including peripheral artery disease and abdominal aortic aneurysms.
- Other Vascular Conditions: People with peripheral artery disease, carotid artery disease, or aneurysms in another part of the body may have a greater likelihood of developing additional aneurysms.
An individual risk assessment is more valuable than relying on one risk factor alone. A vascular surgeon considers the patient’s full medical history, symptoms, family history and imaging results.
How Aneurysms Are Diagnosed
A physical examination and discussion of symptoms are important, but imaging is usually required to confirm an aneurysm.
- Ultrasound: Ultrasound is commonly used to examine the abdominal aorta and certain peripheral arteries. It is non-invasive and can measure the diameter of the artery, evaluate blood flow, and help monitor changes over time.
- CT Angiography: CT angiography produces detailed images of the blood vessels and surrounding anatomy. It may be used to confirm the aneurysm’s exact location, size, shape, and relationship to nearby arterial branches. This information is particularly important when planning aneurysm surgery or determining whether endovascular repair may be suitable.
- Magnetic Resonance Angiography: Magnetic resonance angiography may be used in selected cases to create detailed vascular images. The choice of investigation depends on the patient’s condition, the artery involved, and the clinical information required.
- Ongoing Surveillance: Not every aneurysm requires immediate surgery. Smaller aneurysms that are not causing symptoms may be monitored through scheduled scans. Surveillance allows us to compare measurements and detect changes in growth. Patients should attend every recommended follow-up appointment, even when they continue to feel well.
Why Early Detection Can Change the Treatment Journey
Discovering an aneurysm before it causes a medical emergency creates time for a considered, personalised plan.
A vascular surgeon can assess:
- The diameter and shape of the aneurysm
- How quickly it is expanding
- Whether symptoms are present
- Whether there is evidence of a clot or dissection
- The strength and structure of nearby arteries
- The patient’s heart, lung, and kidney health
- The risks and potential benefits of treatment
- Whether open or endovascular aneurysm surgery may be more suitable
When an aneurysm is small and stable, monitoring and medical management may be safer than immediate intervention. When it becomes larger, grows quickly, causes symptoms, or presents other concerning features, repair may be recommended to reduce the risk of rupture or another serious complication.
The decision is never based on size alone. The location of the aneurysm, the patient’s anatomy, their general health, and the risks of both treatment and observation must all be considered.
Does Every Aneurysm Require Surgery?
No. Some aneurysms can be safely monitored, particularly when they are small, stable and not causing symptoms.
Non-surgical management may include:
- Regular vascular imaging
- Blood pressure management
- Cholesterol treatment
- Smoking cessation
- Diabetes management
- Appropriate physical activity
- A heart-healthy eating pattern
- Ongoing specialist reviews
These measures cannot be relied upon to reverse an aneurysm, but they can support general vascular health and may help reduce some of the factors associated with progression.
Patients should never stop, start, or change medication without discussing it with their treating healthcare professional.
When May Aneurysm Surgery Be Recommended?
Aneurysm surgery may be considered when the risk of leaving the aneurysm untreated becomes greater than the risk of repair.
Factors that may influence the recommendation include:
- A large aneurysm
- Rapid growth between scans
- Pain or other symptoms linked to the aneurysm
- Signs of leakage
- A dissection
- Restricted blood flow caused by clotting
- A high risk of rupture
- The aneurysm’s location and shape
- The patient’s age, health, and surgical risk
A ruptured aneurysm usually requires emergency treatment. Elective repair, when medically appropriate, allows the surgical team to plan the procedure and prepare the patient more thoroughly.
Types of Aneurysm Surgery
There are two broad approaches to repairing many aortic and peripheral aneurysms: endovascular repair and open surgery.
Legae Vascular provides evidence-based vascular care using endovascular and open surgical procedures. The most appropriate treatment is selected after evaluating the patient’s condition, anatomy, and overall health.
Endovascular Aneurysm Repair
Endovascular repair is a minimally invasive approach performed from inside the blood vessels. A stent graft is guided through an artery, often using access in the groin, and positioned within the affected vessel.
The graft creates a new pathway for blood flow and reduces pressure on the weakened aneurysm wall.
Endovascular aneurysm surgery may offer benefits for suitable patients, including smaller incisions and a less invasive procedure. However, it is not appropriate for every aneurysm. The shape of the aneurysm and the surrounding arteries must allow the graft to be positioned and secured safely.
Patients generally require ongoing imaging after endovascular repair to confirm that the graft remains correctly positioned and that the aneurysm is adequately excluded from circulation.
Open Aneurysm Surgery
Open aneurysm repair involves accessing the affected artery through a surgical incision and repairing or replacing the weakened section with a graft.
Open surgery may be recommended when:
- The patient’s anatomy is not suitable for endovascular repair
- The aneurysm affects important arterial branches
- A durable open reconstruction is considered preferable
- The aneurysm is complex
- An emergency complication requires open treatment
Open repair is a major operation, and careful pre-operative assessment is essential. The vascular surgeon discusses the potential benefits, risks, hospital care, and recovery considerations with the patient and their family.
What to Expect From a Specialist Assessment
A consultation for a suspected or confirmed aneurysm may include:
- A review of current symptoms and when they began
- A detailed medical and family history
- A discussion of smoking, blood pressure and cholesterol
- A vascular examination
- Review of previous ultrasound, CT, or MRI results
- Additional imaging when required
- A personalised explanation of monitoring and treatment options
We believe patients should understand their diagnosis and the reasoning behind every recommendation. Questions are encouraged, particularly when aneurysm surgery is being considered.
Our team approach may include collaboration with specialists in cardiology, internal medicine, nephrology, neurology, and radiology, together with relevant allied healthcare professionals. This supports comprehensive assessment and coordinated care for patients with complex vascular conditions.
Supporting Your Vascular Health After Diagnosis
Receiving an aneurysm diagnosis can be unsettling, but it does not always mean that emergency surgery is required. Many aneurysms can be monitored and managed through a structured specialist plan.
Patients can support their care by:
- Keeping every follow-up appointment
- Taking prescribed medication consistently
- Monitoring blood pressure as advised
- Avoiding smoking
- Discussing safe exercise with their doctor
- Reporting new or worsening symptoms
- Keeping copies of important imaging and medical information
- Making sure close relatives know about a relevant family history
The most important step is to remain engaged with ongoing care. Feeling well does not confirm that an aneurysm has remained unchanged.
Do Not Wait for an Emergency – Arrange a Vascular Assessment
Early detection gives us the opportunity to monitor an aneurysm, address cardiovascular risk factors, and plan treatment before a life-threatening complication develops.
At Legae Vascular, Dr Legae Mogase provides specialised vascular care for patients with thoracic, abdominal, and peripheral aneurysms and dissections. As a subspecialty-trained vascular surgeon, Dr Mogase is experienced in both endovascular treatment and open surgical procedures.
We serve patients through our practices in Johannesburg and Polokwane, offering attentive, evidence-based and patient-centred vascular care. Whether an aneurysm has been detected during another investigation, you have concerning symptoms, or your family history places you at greater risk, timely specialist advice can help you understand the appropriate next steps.
Contact Legae Vascular to arrange a consultation and receive a personalised assessment of your vascular health.
Frequently Asked Questions About Aneurysm Surgery
What is aneurysm surgery?
Aneurysm surgery is a procedure used to reduce pressure on a weakened section of an artery and lower the risk of rupture, clotting, or restricted blood flow. It may involve open surgical repair or a minimally invasive endovascular procedure using a stent graft.
Does every aneurysm need surgery?
No. Small, stable aneurysms that are not causing symptoms may be monitored with regular scans. Aneurysm surgery is generally considered when the aneurysm is large, growing quickly, painful, leaking, affecting circulation, or considered at significant risk of rupture.
What is the difference between open repair and endovascular repair?
Open repair involves accessing the aneurysm through an incision and replacing or bypassing the weakened section with a graft. Endovascular repair involves guiding a stent graft through the arteries and positioning it inside the affected vessel. Suitability depends on the aneurysm’s location and anatomy, as well as the patient’s overall health.
Is endovascular aneurysm surgery safer than open surgery?
Endovascular repair is less invasive and may be suitable for some patients, but it is not automatically the safest option for everyone. Each approach has specific benefits and risks. A vascular surgeon evaluates the patient’s anatomy, health and long-term needs before recommending treatment.
How is an aneurysm found before it ruptures?
Aneurysms may be detected through ultrasound, CT angiography, magnetic resonance angiography, or imaging performed for another medical concern. People with relevant risk factors or a family history should discuss whether assessment is appropriate with their healthcare professional.
What symptoms may suggest an abdominal aortic aneurysm?
Possible symptoms include persistent abdominal or lower back pain, discomfort extending towards the groin, and a pulsating sensation near the navel. Many abdominal aortic aneurysms do not cause symptoms, making imaging and risk assessment important.
What symptoms may indicate a ruptured aneurysm?
Sudden severe chest, back, or abdominal pain, fainting, clammy skin, breathlessness, rapid deterioration, or sudden loss of circulation in a limb may indicate a vascular emergency. Emergency medical care should be sought immediately.
Can an aneurysm return after surgery?
The repaired section is generally protected by a graft, but aneurysmal disease may affect other sections of the vascular system. Follow-up remains important after both open and endovascular repair. Endovascular procedures require scheduled imaging to monitor the stent graft and surrounding arteries.
Which specialist performs aortic aneurysm surgery?
A vascular surgeon assesses and treats aneurysms involving the abdominal aorta and peripheral arteries. Some thoracic aneurysms may require collaboration between vascular, cardiothoracic, and other specialists, depending on their location and complexity.
Where does Legae Vascular provide aneurysm assessments?
We provide specialist vascular services in Johannesburg and Polokwane. Our practice assesses and manages thoracic, abdominal, and peripheral aneurysms and dissections using personalised monitoring, endovascular interventions and open surgical treatment where appropriate.
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