The aorta is the main blood vessel that travels from the heart delivering arterial blood to all the extremities and organs in the body. A thoracic aortic aneurysm (TAA) refers to when the diameter or size of the aorta located in the chest becomes enlarged. As the wall of the aorta weakens, this “bulge” in the aorta can become larger from pressurized blood passing through it. TAAs can form in any of the following locations:
Ascending aorta
Aortic arch
Descending thoracic aorta (most common)
The decision to treat TAAs is based on several factors, the most important of which is size. The general recommendation is to repair TAAs when they reach 5.5 cm in diameter as the risk of rupture becomes significant.
Causes & Risk Factors
The most common cause of thoracic aortic aneurysms is atherosclerosis, which is a hardening of the arteries caused by plaque buildup. Over time, this plaque can cause the walls of the aorta to become stiff and weak, creating the potential for an aneurysm to form.
Some factors that increase your risk for atherosclerosis (and increase your risk for developing a thoracic aortic aneurysm) are:
Smoking
High blood pressure
High cholesterol
Being overweight
A family history of cardiovascular disease
Other factors that increase your risk for developing a thoracic aortic aneurysm are:
Age (greater than 55)
Gender (occurrence in males is more prevalent than females)
Family history of aneurysms
Diabetes
Genetic disorders that effect connective tissue such as Marfan Syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome.
Infections such as syphilis or tuberculosis
Symptoms
It is common for TAAs to form without symptoms but some can include:
Pain in the jaw or neck
Chest or back pain
Coughing or shortness of breath
Hoarseness
Difficulty swallowing
Diagnosis
In addition to your physician getting your complete medical history and doing a physical exam, they may order any of the following tests:
Chest X-Ray
Computed Tomography (CT) Scan
Magnetic Resonance Imaging (MRI)
Echocardiogram (also known as an Echo)
Arteriogram (Angiogram)
Treatment
In consideration of your medical history, health status, risk factors, and current state of the disease, your doctor will explain and recommend the most suitable option. Treatment can include medical management and surgical procedures, including:
Open repair Open repair of a TAA is a procedure that has been performed for many decades. It involves making an incision on the sternum (sternotomy) or side of the chest (thoracotomy) in order to visualize and replace the diseased segment of aorta with a new tube (e.g., a synthetic graft).
Thoracic Endovascular Aortic Repair (TEVAR) TEVAR is a minimally invasive method used to treat aortic disease. Through small incisions in the groin, wires and catheters are inserted into the aorta using X-rays and contrast/dye to deploy a stent-graft within the diseased segment of aorta effectively excluding the aneurysm from pressurized arterial blood. Specific anatomic requirements are necessary to safely utilize this technology. Some complex stent-grafts have holes (fenestrations) in them to permit blood flow to critical branches that originate off the aorta arch supplying the brain and arms. In addition, endovascular repairs require long-term follow-up with CT scans.
A multidisciplinary team led by George Arnaoutakis, M.D., an assistant professor in the Division of Thoracic and Cardiovascular Surgery at the University of…