Thoracic Aortic Aneurysm
An aneurysm is a bulge in an artery caused by a weakening of the blood vessel wall. A thoracic aortic aneurysm occurs within the largest artery of the body, known as the aorta, in some location within the chest. A thoracic aortic aneurysm is typically caused by atherosclerosis, which is a hardening of the arteries. Atherosclerosis is a condition that involves a gradual buildup of fats and cholesterol along the artery walls that harden into a substance called plaque. As the amount of plaque increases, it slowly narrows the diameter of the artery, often resulting in an aneurysm and contributing to other cardiovascular disorders.
There are also a number of other known risk factors for developing a thoracic aortic aneurysm, which include certain connective tissue disorders, a family history of aneurysms, high blood pressure, smoking and trauma involving injury to the chest.
Thoracic Aortic Aneurysm Symptoms
In the majority of patients, a thoracic aortic aneurysm develops gradually over a long period of time. There are frequently no noticeable symptoms, unless the aneurysm rapidly expands, starts to leak or ruptures. These complications are potentially deadly and require immediate medical intervention, as the aorta is responsible for supplying much of the blood to the body. However, it is much more common for a thoracic aortic aneurysm to remain intact and go undetected, frequently until imaging scans of the chest are performed as part of an evaluation for another condition.
When patients do experience symptoms from a thoracic aortic aneurysm, they typically manifest as pain in the chest or upper back. In some people, the neck and throat may be affected, resulting in difficulty swallowing, a hoarse voice, wheezing and swelling around the neck region. If the aneurysm has ruptured or is leaking, symptoms are generally much more pronounced, and may take the form of intense chest or back pain, nausea, rapid heart beat, sweatiness and loss of consciousness.
Diagnosing Thoracic Aortic Aneurysm
Several imaging tests may be performed to determine the presence of a thoracic aortic aneurysm, including an X-ray, CT or MRI scan and echocardiogram. In order to establish the location and extent of the aneurysm, a test called an aortogram may be necessary. During an aortogram, a healthcare professional will inject a dye into the aorta that can be viewed from a specialized type of X-ray for a more detailed examination of the aneurysm.
Thoracic Aortic Aneurysm Treatment
Treatment for a thoracic aortic aneurysm will vary depending on many factors, including its size, location and severity as well as the overall health of the patient. Small, asymptomatic aneurysms may be regularly monitored and treated conservatively with medication aimed at lowering blood pressure and reducing the risk of a rupture. Beta blockers, angiotensin II receptor blockers and statins are most commonly prescribed to lower the risk of complications from a thoracic aortic aneurysm.
In other cases, particularly if the aneurysm is at least five to six centimeters long, surgery may be the most effective treatment option. Performed under general anesthesia, an open procedure requires that the surgeon make an incision in the chest. The affected portion of the aorta will be removed and a synthetic graft will be attached to replace it, repairing and strengthening the weakened blood vessel wall. This is a major surgical procedure that may require a week’s stay in the hospital as well as several months of recovery.
Certain patients may be eligible for minimally invasive treatment methods instead. One of these commonly used procedures is known as endovascular stenting. This technique involves placing a stent, which is a small metal tube, within the artery to help it remain open. The stent is placed using special instruments that are inserted through tiny incisions in the groin area and directed through the blood vessels toward the aneurysm by a catheter. Since the chest is not opened, the recovery process is significantly shorter and more comfortable for most patients.
Surgery to treat a thoracic aortic aneurysm bears certain risks for the patient. Some of the potential complications that may develop include heart attack, infection, bleeding, paralysis and stroke. Therefore, it is important to discuss your treatment options thoroughly with your physician to evaluate both the risks and benefits involved pertaining to the specifics of your condition.