Thoracic Aortic Aneurysm
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A thoracic aortic aneurysm occurs when the part of the aorta that passes through the chest weakens and has an abnormal widening or ballooning.
Physicians at the University of Maryland Medical Center's Center for Aortic Disease are specially-equipped to treat thoracic aortic aneurysms.
The exact trigger for the development of thoracic aortic aneurysms is unclear and remains the focus of ongoing research at the Center for Aortic Disease.
However, one of the common causes of thoracic aortic aneurysm is atherosclerosis – a buildup of fatty plaque causing hardening of the arteries. This is often seen in people with high cholesterol, long-term high blood pressure and smokers.
Thoracic aortic aneurysms are also seen in patients with genetic syndromes such as Marfan syndrome, Ehlers-Danlos Syndrome, Loeys-Dietz syndrome, and Turner syndrome.
Inflammation of the aorta, injury from falls or motor vehicle accidents, and untreated syphilis are other causes. In 20 percent of all thoracic aortic aneurysm cases, thoracic aortic aneurysm occurs in the family with no other cause.
Thoracic aortic aneurysms often show no symptoms and are usually detected during other tests. In some instances, it can be detected on a routine x-ray. A CT scan or an MRI scan can provide more information.
Thoracic aortic aneurysms usually grow slowly over many years. Most people will not have any symptoms until aneurysms are very large or until they begin to leak.
A tear in the aorta (a rupture) can result in sudden, severe, sharp or tearing pain in the chest, back, neck, arm or between the shoulder blades. The leak of blood can often result in very low blood pressure or death if not immediately treated at a hospital. Other symptoms may include nausea, vomiting, clammy skin, a rapid heart rate, or a sense of impending doom. When thoracic aortic aneurysms become considerably large, it can compress nearby structures and cause hoarseness, difficulty swallowing, or difficulty breathing. The risk of rupture also increases as the aneurysm grows.
The treatment of thoracic aortic aneurysms is determined by the size of the aneurysm, the presence and severity of symptoms, and the risk of surgery to the patient.
Regular monitoring: Smaller aneurysms do not require surgery, but close observation is necessary to monitor its growth. Depending on the size of the aneurysm, a CT scan or MRI should be done every 1-2 years (depending on the direction of your vascular surgeon) to check the status and growth of the aneurysm.
Surgery: A surgical procedure is necessary when the risk of the aorta tearing open (a rupture) is greater than the risks from surgery, or when there is evidence of an impending rupture. There are two types of surgical procedures: open surgery and endovascular surgery.
- Open Surgical Repair of the Aorta: A procedure known as open thoracic aortic repair is done under general anesthesia. A cardiovascular surgeon will perform this by making an incision along the side of the chest and then use special surgical tools to stop the blood flow in the aorta above and below the aneurysm. This may require use of a heart-lung bypass machine. The section of the aorta with the aneurysm is then replaced with an artificial graft (a durable fabric tube). The graft is sewn in place with fine stitches and the incision is then closed. Patients are monitored in the intensive care unit (ICU) after the surgery and will usually require a hospital stay of at least 7-14 days.
- Endovascular treatment: A procedure known as a thoracic endovascular aortic repair (TEVAR) is done under general anesthesia. A cardiovascular surgeon will perform this by making an incision in the groin, followed by inserting and deploying a fabric-covered metal or plastic tube (called a stent) at the site of the aneurysm. This stent graft will provide a new pathway for the blood flow at the site of the aneurysm. It will also prevent further expansion of the aneurysm and will keep the aorta from rupturing. Patients are closely monitored after surgery and usually have shorter hospital stays than with an open repair. This procedure usually requires a much shorter hospital stay than conventional surgery. This technique requires continued monitoring with every 6-12 months following discharge from the hospital to look for problems with the stent graft. However, not everyone is a candidate for the endovascular treatment.
The long-term outcome for patients with a thoracic aortic aneurysm depends on control of other medical problems such as smoking and tobacco use, high level ls of bad cholesterol, heart disease, and high blood pressure.
Development of another aneurysm after the operation (elsewhere in the chest or in the abdomen) is not uncommon in people who have been treated for a thoracic aortic aneurysm. For this reason, in addition to stopping smoking, taking your prescribed medicine and staying healthy, regular follow-up imaging studies must be performed according to your cardiovascular surgeon’s recommendations.
The outcome is often good if you have the surgery to repair the aneurysm before it ruptures. When a thoracic aortic aneurysm begins to tear or rupture, it is a medical emergency. Very few people survive a rupture of the thoracic aorta.