Thoracic Aortic Aneurysm

The aorta is the largest artery in the body, and it carries blood away from the heart to all the parts of the body. The part of the aorta that runs through the chest is called the thoracic aorta. When a weak area of the thoracic aorta expands or bulges, it is called a thoracic aortic aneurysm (TAA).

Risks include: bleeding and infection, small myocardial infarction, risk of paraplegia, very small risk of stroke, and very small risk of death.

Thoracic aneurysms affect approximately 15,000 people in the United States each year. Some patients may have more than one TAA or may also have an aneurysm in the abdominal aorta. Only about 20 to 30 percent of patients who get to the hospital with a ruptured TAA survive. For this reason, it is crucial to treat large aneurysms early, in order to prevent their rupture.

Symptoms

Very few patients with TAA notice symptoms.

Possible symptoms include:

  • Pain in the jaw, neck, and upper back
  • Chest or back pain
  • Coughing, hoarseness, or difficulty breathing
  • The risk of developing TAA increases with age. TAA is more common in men than in women. Larger TAA, or the rapidly growing TAA are more likely to rupture. The chance of rupture increases when the aneurysm is larger than about twice the normal diameter.

Aortic Dissection

An aortic dissection occurs when blood flow forces the layers of the wall of the aorta apart, which weakens the aorta. The separation can extend from your thoracic aorta through the entire aorta and block arteries to the legs, arms, kidneys, bowel, brain, spinal cord, and other areas. Another problem associated with aortic dissection is that over time, the pressure of blood flow can cause the weakened area of your aorta to bulge and form an aneurysm.

Symptoms

Very few patients with TAA notice symptoms.

Thoracic Aortic Trauma

Severe blunt injury to the chest can cause traumatic aortic injuries and patients require urgent medical care after such an injury. It is mostly lethal with only a small percentage of patients reaching the hospital. All of these injuries require urgent diagnosis and prompt management.

Diagnosis

  • Physical Examination
  • Chest x-ray
  • Echocardiography (an ultrasound of the heart)
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scan
  • Angiography
  • Intra vascular ultrasound (IVUS)

Treatment

If the aneurysm is small then serial CT Scans are done every 6 -12 months to monitor growth of the aneurysm. However, if the TAA is large or causing symptoms, active and prompt treatment is necessary to prevent rupture.

Open Surgical Repair

During open aneurysm repair, an incision is made in the chest and the diseased part of the aorta is replaced with a synthetic graft. The graft is stronger than the weakened aorta and allows blood to pass through it without causing a bulge.

Endovascular Stent Graft Repair

Endovascular means that the treatment is performed inside your body using long, thin tubes called catheters. The catheters are inserted in small incisions in the groin and are guided through the blood vessels. During the procedure, the surgeon will use live x-ray pictures viewed on a video screen to guide a stent-graft to the site of the aneurysm. The stent-graft allows blood to flow through the aorta without putting pressure on the damaged wall of the aneurysm. This keeps the aneurysm from rupturing.

Over time, the aneurysm usually will shrink. Endovascular stent-graft repair requires a shorter recovery time than open aneurysm repair, and the hospital stay is reduced to 2 of 3 days.

Endovascular repair of thoracic aortic pathology including both aneurysms and dissections are now used extensively. It is considered standard of care for thoracic aortic aneurysm disease and thoracic aortic trauma.