A thoracic aortic aneurysm can be fatal if it ruptures, but knowing the risk factors, symptoms and treatment options can allow you to react quickly if necessary.
An aneurysm of the aorta or aortic aneurysm (AA) is a general term for a fixed enlargement (dilatation) of the aorta, up to more than 1.5 times the normal size, and which affects all three layers of the vessel.
A thoracic aortic aneurysm is when part of the aorta expands through the chest. The aorta is the largest artery in the body. It starts from the heart and goes down in the thorax to the abdomen where it divides to irrigate the legs.
A thoracic aortic aneurysm is considered serious. The dilation of the thoracic aorta increases steadily, and normal blood pressure can lead to its rupture. This causes severe pain and massive internal bleeding.
It is not known exactly what causes a thoracic aortic aneurysm. Bloating can be caused by a weakness in the wall of the aorta at a point where it is dilated.
Some doctors believe that this inflammation may be due to clogged arteries (also called hardening of the arteries or atherosclerosis) but it can also be associated with smoking, obesity, heredity, injury or disease. other illnesses.
Most people who have a thoracic aortic aneurysm have no symptoms. Often, aneurysms grow slowly and go unnoticed. Many of them never reach the breaking point; others rapidly increase in volume.
When an aneurysm enlarges, you may experience chest pain, lower back pain, coughing, hoarseness or difficulty breathing. Most aneurysms are detected during routine medical examinations, including x-rays performed for other reasons.
Risk factors for thoracic aortic aneurysms are similar to those that contribute to clogged arteries:
- smoking or a history of smoking;
- high blood pressure;
- high cholesterol (hypercholesterolemia).
The risk of developing a thoracic aortic aneurysm increases with age. Family history, chest injuries, and other illnesses can also be risk factors. Some patients with a thoracic aortic aneurysm also have an abdominal aortic aneurysm.
If your doctor sees signs of a thoracic aortic aneurysm, they may schedule special tests to confirm the diagnosis, including viewing your chest with fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT scan), ultrasound, and by angiography.
The images produced by these methods help your doctor see inside your aorta, other blood vessels, and other organs in your body to check for the presence of a chest aneurysm.
TREATMENT OPTIONS FOR THORACIC AORTIC ANEURYSM
Discuss with your doctor which treatment option is best for you.
Not all thoracic aortic aneurysms require surgery. If your aneurysm is small, your doctor may decide to wait and monitor the progress of the aneurysm. If your blood pressure is high, your doctor may prescribe medication to lower it. If you smoke, your doctor may suggest that you seek help to quit.
Your doctor may also ask you to change your diet or exercise habits. If the doctor thinks there is a risk of a ruptured aortic aneurysm, they may recommend one of two methods of treatment: open surgical intervention or endovascular treatment.
OPEN SURGERY TREATMENT
Open surgery is the reference treatment for replacing the part of the artery where the aneurysm has formed. It is performed under general anesthesia. A surgeon first makes a lateral incision. Then the aneurysm is replaced with a fabric prosthesis which is sewn in place. Patients usually spend one night in an intensive care unit and then remain hospitalized for 5 to 7 days.
An alternative to open surgery is endovascular treatment. An endovascular prosthesis (fabric prosthesis with a metal frame) is placed inside the thoracic aneurysm without surgical opening of the surrounding tissues. The procedure takes place under local or general anesthesia and lasts from one to three hours. Patients leave the hospital one or two days after the procedure.
ABOUT ENDOVASCULAR TREATMENT
A stent is like a small metal “mesh” placed inside your aorta. It supports the weakened area, allowing you to return to your normal activities.
A stent is a synthetic fabric tube with a metal support structure (stent). The stent excludes the area of the aorta weakened by the aneurysm to prevent its rupture.
The stent is designed so that it can be placed inside the damaged area of your aorta without surgically opening the blood vessel and removing tissue.
BENEFITS AND RISKS
Consult your physician for a complete list of benefits, indications, precautions, clinical results, and other important medical information related to endovascular therapy.
Diagram of aortic aneurysm. Figure A shows a normal aorta. Figure B shows a thoracic aortic aneurysm (which is located behind the heart). Figure C shows an abdominal aortic aneurysm located below the arteries that supply blood to the kidneys. en:National Institutes of Health, Public domain, via Wikimedia Commons
AAs can be classified according to their anatomical location:
Aneurysms of the aortic root (also called aneurysms of the sinuses of Valsalva)
They are rare and usually have a congenital origin. As a general rule, they originate in the right coronary sinus (≥90% of cases) and their rupture is towards the ipsilateral ventricle or atrium . Rupture in the pericardial cavity of an aneurysm of the left sinus is exceptional.
Aneurysms of the ascending aorta
They extend from the root of the vessel to the origin of the brachiocephalic artery. They are the second most common subtype of AA, after abdominal. Their predominant etiology is arteriosclerosis (most of them are diagnosed in patients aged 60-70 with a history of arterial hypertension and smoking), although they are also seen in patients with degenerative diseases of the connective tissue or bicuspid aortic valve . In these cases, the diagnosis is usually made at an earlier age and many times as a result of the chance detection of an aortic valve murmur. Surgery is indicated in people with Marfan syndrome or when the diameter of the aneurysm is ≥ 55 mm.
Aneurysms of the aortic arch
The aortic arch is the segment of the thoracic aorta that extends from the proximal origin of the brachiocephalic trunk to the distal portion of the origin of the left subclavian artery. It is an important arterial zone, since the aortic branches that supply the head and upper limbs arise from it . Anatomically it can be divided into a proximal arch, related to the exit of the brachiocephalic trunk and a distal arch that includes the exits of the carotid arteryleft and of the left subclavian artery. These aneurysms account for only 10% of thoracic aortic aneurysms, but have a high risk of rupture. The morphology of the arch and the dynamic interactions between the blood flow and the elasticity of the vessel are factors that favor this circumstance. They tend to be saccular and – if the patient does not present symptoms – surgery is recommended if their diameter exceeds 55 mm.
They are the consequence of the extension of an aneurysm from the descending aorta to the abdominal aorta. They can affect sections of the vessel between the origin of the left subclavian artery and the aorto-iliac bifurcation. Indications for surgical intervention include rupture, dissection, compression of adjacent organs, growth greater than ≥1 cm/year, and absolute size >6.5 cm or >6.0 cm in patients with disorders of the connective tissue Depending on their characteristics they may require open surgery,  endovascular or a hybrid repair.
They are grouped into five variants:
I: From the left subclavian artery to the abdominal adrenal aorta.
II: From the subclavian to the aorto-iliac bifurcation.
III: From the distal thoracic aorta to the aorto-iliac bifurcation.
IV: Limited to the abdominal aorta immediately below the diaphragm .
V: From the thoracic aorta distal to the origin of the superior mesenteric and celiac arteries, but without affecting the renal arteries.
They arise in the aortic section located in the abdomen and are the most frequent AAs. Its prevalence varies depending on the geographical area, sex, age and the criteria used to define them; but several screening studies estimate a prevalence of between 4 and 7.9% in men and 1.2% in women, within the range of 60-80 years, and some meta -analyses estimate that it affects a 4, 8% of the general population. Despite having a diverse etiopathogenesis , the arteriosclerotic etiology is the predominant one.
Many of them are detected during an examination related to another type of pathology. On palpation, a pulsating mass usually located in the left hypochondrium or the epigastric area can be seen . The diagnosis of certainty and the detailed characteristics of AAAs are obtained by means of an ultrasound or a CT scan. AAAs with a diameter greater than 5 cm have a high risk of rupture and must be evaluated immediately by a vascular surgeon . In the face of aneurysms between 3 and 5 cm, an expectant behavior can be adopted, if the patient does not present symptoms.
Most individuals with an AAA also have peripheral vasculopathy. Adominal aneurysms have a wide typology, but 3 main locations can be highlighted:
- Infrarenal: Aneurysms located below the renal arteries.
- Juxtarenal: Aneurysms located below and adjacent to the renal arteries.
- Infrarenal: Aneurysms at or above the renal arteries and below the superior mesenteric artery.
Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.