THORACIC AORTIC ANEURYSM

Aneurysms involving the ascending aorta, aortic arch and descending thoracic aorta are termed thoracic aortic aneurysms (TAA). Thoracic aneurysms most often occur in the descending thoracic aorta. Others may appear in the ascending aorta or the aortic arch. The most common cause of a thoracic aortic aneyrysm is hardening of the arteries.

Most thoracic aneurysms are asymtomatic. Most patients have no symptoms until the aneurysm begins to leak or expand. Most non-leaking thoracic aortic aneurysms are detected by tests - usually a chest x-ray or a chest CT scan - run for other unrelated reasons. Chest or back pain may mean sudden widening or leakage of the aneurysm.

TREATMENT

Once a TAA is diagnosed, routine, scheduled follow-up is necessary by an aortic specialist. Aneurysm size needs to be followed closely and surgery is warranted if there is rapid growth over a short period of time or if a critical size is reached. High death rate is associated with the rupture of a thoracic aortic aneurysm. Also, surgical repair of a ruptured thoracic aneurysm carries a 25-50% mortality as opposed to a 5-8% mortality when such aneurysms are treated electively.

The treatment of thoracic aortic aneurysm depends on the location of the aneurysm.

Surgery to repair an ascending aortic or arch aneurysm is indicated for patients with aneurysm larger than 5-6 centimeters. The surgery involves removing the aneurysmal portion of the aorta and replacing it with a fabric substitute. If the aortic arch is involved, a specialized technique called "circulatory arrest" - a period without blood circulation while on life support - may be necessary.

There are two options for patients with aneurysms of the descending thoracic aorta. If the aneurysm is larger than 6 centimeters, major surgery is done to replace the aorta with a fabric substitute. The other option is endovascular stenting, which is a less invasive option. A stent is a tiny metal or plastic tube that is used to hold an artery open. Stents can be placed into the body without cutting the chest. Instead, tiny, hollow tubes called catheters are inserted into the groin area. The stent is passed through the catheter and into the area of the aneurysm. Not all patients with descending thoracic aneurysms are candidates for stenting.

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