Thoracoabdominal Aortic Aneurysm

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When the aortic aneurysm occurs together both in the chest and abdomen, it is known as thoracoabdominal aneurysm (TAA).

Physicians at the University of Maryland Medical Center's Center for Aortic Disease are specially-equipped to treat thoracoabdominal aneurysms.

The exact development of thoracoabdominal aortic aneurysms is unclear and remains the focus of ongoing research at the Center for Aortic Disease. It occurs due to the weakness in the wall of the artery and most frequently seen in males older than 60. The risk factors for the development of the TAA include smoking, high blood pressure, male gender, atherosclerosis (hardening of arteries), trauma, and genetic factors.

Thoracoabdominal aortic aneurysms often show no symptoms and are usually detected incidentally during other tests such as an x-ray. It can also present as a lump (mass) in the abdomen, pulsating sensation in the abdomen, or as a stiff or rigid abdomen that is usually detected during a routine examination.

An ultrasound scan can usually detect thoracoabdominal aortic aneurysm. A CT scan or an MRI scan is more often used to confirm the presence and extent of the aneurysm.

Thoracoabdominal aortic aneurysms usually grow slowly over many years. Most people will not have any symptoms until the aneurysm is very large or until they begin to leak. When people continue to have poor control of risk factors, such as smoking and high blood pressure, it can expand rapidly. The risk of tearing also increases as the aneurysm grows. 

A tear in the aorta can result in sudden, severe sharp or tearing pain in the chest, abdomen, or back. Some of the symptoms from the tearing open of aorta are sudden, severe pain in the abdomen or back, clammy skin, dizziness, nausea and vomiting, passing out, and rapid heart rate. The leak of blood (a rupture) can often result in very low blood pressure or death if not immediately treated at a hospital.

The treatment for thoracoabdominal aortic aneurysms is determined by the size of the aneurysm, the presence and severity of symptoms, and the risk of surgery to the individual patient. If you have bleeding from the aortic aneurysm inside your body, you will need surgery right away.

Regular monitoring: Smaller aneurysms do not require surgery, but close observation is necessary to monitor its growth. Your doctor may want to check the size of the aneurysm with CT scans or MRI scans every six months or a year to determine the risk of bleeding from the aneurysm.

Surgery: Surgery is done when the aneurysm is larger than two inches (5.5 cm) across or is growing rapidly. The goal is to complete the surgery before complications can develop.

  • Conventional Surgery: An open thoracoabdominal aortic repair is done under general anesthesia. A vascular surgeon will perform this by making a large incision from your chest and abdomen and will temporarily stop the blood flow in the aorta above and below the aneurysm. 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 closed. Patients are monitored in the intensive care unit (ICU) after the surgery and require a hospital stay of at least 7-14 days.
  • Endovascular treatment: A vascular surgeon will perform this by making an incision in the groin, followed by inserting and deploying a fabric covered metal or plastic tube (a stent graft) at the site of the aneurysm. This stent will provide a new pathway for the blood flow at the site of the aneurysm. It will also prevents further expansion of the aneurysm and keeps the aorta from rupturing. Patients are closely monitored after surgery and usually have shorter hospital stays than with an open repair. This technique requires continued monitoring with CT scans every 6-12 months following discharge from the hospital to look for problems with the stent graft. However, not everyone is a candidate for endovascular treatment.

The long-term outcome for patients with thoracoabdominal aortic aneurysms depends on good control of other medical problems such as smoking and tobacco use, high levels of bad cholesterol, heart disease, and high blood pressure. For this reason, in addition to stopping smoking, taking your prescribed medication, staying healthy, and regular follow-up imaging, studies must be performed per your surgeon’s recommendations.

The outcome is often good if you have the surgery to repair the aneurysm before it ruptures. When an abdominal aortic aneurysm begins to tear or rupture, it is a medical emergency. Only 1 in 5 people survive a ruptured abdominal aortic aneurysm.