What is a Thoracic Aortic Aneurysm?
An aneurysm is abnormal widening or ballooning of a portion of a blood vessel. The blood vessel wall becomes weaker in this location. Aneurysms can occur in any artery in the body, including the aorta. The aorta is the largest artery in the body and the primary blood vessel leading from the heart to the body. It carries the blood that is pumped out of the heart and distributes it to the organs of the body.
The aorta extends from the heart, down through the chest (the thoracic aorta) and into the abdomen (the abdominal aorta.)
A thoracic aortic aneurysm is a localized expansion of the wall of the aorta.
Thoracic aortic aneurysms are caused by:
- Hardening of the arteries (atherosclerosis)
- High blood pressure (hypertension)
- Congenital disorders such as Marfan's syndrome
- Or less commonly, syphilis
Atherosclerosis is by far the most common cause.
Thoracic aneurysms occur in the ascending aorta (25% of the time), the aortic arch (25% of the time), or the descending thoracic aorta (50% of the time).
Prevention measures for aortic aneurysms would be the same ones taken to prevent atherosclerosis. These would include not smoking, controlling blood pressure and blood lipid levels, and exercising daily.
The majority of patients have no symptoms at the time an aneurysm is discovered. In fact, aneurysms are often detected on tests that were performed for entirely different reasons.
Aneurysms may develop slowly over many years and often have no symptoms until they rupture. If the aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along the wall of the vessel (aortic dissection), the above symptoms may develop suddenly.
Acute symptoms of dissection or rupture can include chest or back pain (between the shoulders, or lower back). Any sudden onset of chest pain should warrant immediate medical attention.
Symptoms of rupture may include:
- Pain in the chest or back
- Severe, sudden, persistent or constant pain
- Pain may begin suddenly
- Pain in the upper, mid or lower back
- Severe, sudden, persistent, may radiate
- Rapid pulse
- Dry skin/mouth
- Excessive thirst
- Nausea and vomiting
- Fainting occurs with upright posture
- Sweating, excessive
- Skin, clammy
- Fatigue (tiredness or weariness) developing recently
- Heartbeat sensations
- Rapid heart rate (tachycardia) when rising to standing position
- Impaired ability to concentrate
Diagnosis and Prevention
Although aneurysms can be detected by physical examination, most are diagnosed today using ultrasound scans, CAT scans and MRIs, simple exams that are non-invasive and can be done as an outpatient. These exams can tell us whether an aneurysm is present and how big it is - the key elements to determine the need for treatment.
These techniques use sophisticated imaging tools to eliminate risks and discomforts of injections or invasive procedures.
A chest X-ray and chest CT scan demonstrate enlargement of the aorta. A chest CT scan identifies the diameter of the aorta and the exact location of the aneurysm.
An aortogram (a special set of X-ray images made during injection of dye into the aorta) may also identify the location and extent of the aneurysm and identify any branch arteries of the aorta that are also involved.
How can thoracic aortic aneurysms be prevented?
Prevention measures, in general, include not smoking, controlling blood pressure and blood lipid levels, and exercising daily.
View a surgical Webcast of a Thoracic Aortic Aneurysm Repair, performed at the University of Maryland Medical Center.
Minimally Invasive Thoracic Aortic Aneurysm Repair
Thoracic aortic aneurysms cause a bulge in a section of the thoracic aorta and result in a weakening of the main artery that carries blood from the heart to the body. As this bulge increases in size, the risk of rupture and internal bleeding also increases.
Until recently, patients with thoracic aortic aneurysms, pseudo-aneurysms, and injuries to the aorta from trauma, would have needed open surgery for repair -- which included a large chest incision and the temporary clamping of the aorta. Now surgeons can use just one small incision during a minimally invasive procedure to place a high-tech device inside the aorta, relieving the aneurysm from pressure.
The big advantage for patients is the faster recovery. They can typically go home from the hospital in a day or two, compared to a week or more for open surgery.
The experienced University of Maryland aneurysm team continues to come up with unique and innovative treatment options that will benefit aneurysm patients both now and in the future.
The team has performed some original work using a combination of endografts and endografts alone to solve problems -- such as replacing the aortic arch without the use of a heart-lung machine -- that required major operations in the past. Hybrid procedures have become more common where surgeons mix traditional aneurysm work with the endografts.
By making just a small incision in the groin, surgeons are able to insert a catheter and thread a special device towards the aneurysm using high-tech X-ray imaging seen on a monitor. This device, which is about 15 centimeters long and can be 40 millimeters in diameter, creates a new pathway for blood flow, taking the pressure off the aneurysm.
Symptoms of thoracic aortic aneurysms vary. Patients can experience chest, abdominal or neck pain, though some experience no pain. Typically, thoracic aortic aneurysms are diagnosed after a CT or MRI. Surgery is often a treatment option when medical management, like blood pressure medication, has not worked and when the risk of rupture is considerably high.
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This page was last updated: February 21, 2014