The single most important cause is atherosclerosis. The atherosclerotic process damages the arterial wall by weakening the medial muscle layer and distending the lumen. Destruction of the medial layer allows the artery to increase in size circumferentially (a fusiform shape), or the artery develops a saccular outpouching at the weakened area. Other factors that contribute include Marfan's syndrome (hereditary musculoskeletal disorder), Ehlers-Danlos syndrome (an inherited disorder of elastic connective tissue), coarctation of the aorta, fungal infections (mycotic aneurysms) of the aortic arch, a bicuspid aortic valve, aortitis, and trauma (external, blunt trauma or iatrogenic trauma that occurs during invasive diagnostic procedures).

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