Thoracic Aortic Aneurysm

Thoracic aortic aneurysms (also called TAA)

What is it?

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.

Aortic Arch Aneurysm

Descending Aortic Aneurysm

Ascending Aortic Aneurysm

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
  • Surgery
    • 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)

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).

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.