Thoracic aortic aneurysm


Thoracic aortic aneurysm

Description, Causes and Risk Factors:

Abbreviation: TAA.

The aorta is the major artery which arises from the heart. It carries all the blood that is pumped out of the heart and distributes it via its many branches to all the organs of the body. The aorta is divided into 4 portions: 1) the ascending aorta, 2) the aortic arch, 3) the descending thoracic aorta, and 4) the abdominal aorta.

TAA affect approximately 15,000 people in The United States each year. Up to 47,000 people die each year from all types of aortic disease; more than from breast cancer, AIDS, homicides, or motor vehicle accidents (MVA), making aortic disease a silent epidemic.

TAA are most often caused by atherosclerosis, a hardening of the arteries that damages the artery's walls. While your arteries are normally smooth on the inside, as you age they can develop atherosclerosis. When atherosclerosis occurs, a sticky substance called plaque builds up in the walls of the arteries. Over time, excess plaque causes the aorta to stiffen and weaken.

Risk Factors:

    Are a heavy smoker.

  • Have high blood pressure.

  • Have high cholesterol.

  • Are overweight.

  • Have a family history of cardiovascular or peripheral vascular disease.

  • Marfan syndrome.

  • Presence of a bicuspid aortic valve.

  • Syphilis.

  • Tuberculosis (TB).

A TAA is a serious health risk because, depending on its location and size, it may rupture or dissect (tear), causing life-threatening internal bleeding. When detected in time, a TAA can often be repaired with surgery or other less invasive techniques.

Symptoms:

TAA often go unnoticed because patients rarely feel any symptoms. While only half of those with TAA complain of symptoms, possible warning signs include:

    Pain in the jaw, neck, and upper back.

  • Chest or back pain.

  • Coughing, hoarseness, or difficulty breathing.

Diagnosis:

The physical examination is often normal unless a rupture or leak has occurred.

Most TAA are detected by tests performed for other reasons, usually a chest x-ray, echocardiogram, or a chest CT scan or MRI. A chest CT scan shows the size of the aorta and the exact location of the aneurysm.

An aortogram (a special set of x-ray images made when dye is injected into the aorta) can identify the aneurysm and any branches of the aorta that may be involved and angiography (an x-ray of the blood vessels).

Treatment:

If the TAA is small and not causing any symptoms, your physician may recommend “watchful waiting.” By closely monitoring your condition with CT or MRI scans every 6-12 months, the aneurysm will be watched for signs of changes.

If you have high blood pressure, your physician will prescribe blood pressure medication to lower your overall blood pressure and the pressure on the weakened area of the aneurysm. Additionally your physician may prescribe a “statin” (or cholesterol lowering medication) to maintain the health of your blood vessels.

If the TAA is large or causing symptoms, you will need prompt treatment to prevent a rupture from occurring. The weakened section of the vessel can be surgically removed and replaced with a graft of artificial material. If the aneurysm is close to the aortic valve (the valve that regulates blood flow from the heart into the aorta), a valve replacement may also be recommended during the procedure.

Repairing the aneurysm surgically is complex and requires an experienced thoracic surgical team. However, neglecting the aneurysm presents a higher risk. Repairing a thoracic aneurysm may require open-chest surgery, general anesthesia and a minimum hospital stay of five days.

Endovascular Repair: Instead of an open aneurysm repair, your surgeon may also consider a newer procedure called an endovascular aneurysm repair (EVAR, TEVAR, TA-EVAR). Endovascular means that surgery is performed inside your aorta using thin, long tubes called catheters. By entering through small incisions in the groin, the catheters are used to guide and deliver a stent-graft through the blood vessels to the site of the aneurysm. The stent graft is then positioned in the diseased segment of aorta to “reline” the aorta like a sleeve to divert blood flow away from the aneurysm.

This endovascular approach is currently used to treat abdominal and descending thoracic aneurysms, and is being evaluated as a treatment for thoracoabdominal and arch aneurysms. While current results are positive, further research is needed to determine who the best candidates for this type of procedure may be.

Your surgeon will advise you regarding the best option for treating your thoracic aneurysm.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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