Thoracic Aortic Aneurysm
What is a thoracic aortic aneurysm?
The aorta is the main artery that supplies fresh, oxygen-rich blood to the body. It extends up (ascending aorta) from the aortic valve in the heart and then curves down (descending aorta) through the chest (thoracic cavity), abdomen and pelvis, branching off into the major leg arteries. The thoracic aorta includes the ascending aorta, the arch, and the descending aorta to approximately the middle of the back. A thoracic aneurysm occurs when the walls of the aorta weaken and the blood vessel wall balloons out. While the condition is rare, it is life threatening if the aneurysm ruptures. Large, fast-growing thoracic aortic aneurysms are more likely to rupture than small, slow-growing ones.
Many cases of thoracic aortic aneurysms are tied to family history of the condition. Smokers, people with high blood pressure, people with high cholesterol, and people older than 65 are more likely to get thoracic aortic aneurysms. The condition has also been linked to some genetic syndromes, most commonly Marfan syndrome, which is a condition that affects the body’s connective tissue.
Because thoracic aortic aneurysms are often small and slow-growing over many years, they may never cause any symptoms. You may only discover the condition when you have imaging tests for another reason. If the aneurysm is large and fast-growing, it may rupture or tear the artery walls, which is dissection. This may cause a sudden, sharp pain in your upper back. A ruptured or dissected artery is an emergency, so call 911 immediately if you think this has happened.
What are the symptoms of a thoracic aortic aneurysm?
You may not experience or notice thoracic aortic aneurysm symptoms if the aneurysm is small and slow-growing. A large thoracic aortic aneurysm could press on nearby structures in the chest, such as the esophagus and airways, causing hoarseness, difficulty swallowing, or shortness of breath. However, if the aneurysm is large and fast-growing, it may cause sudden symptoms and require immediate medical attention. A ruptured or dissected artery wall can cause life-threatening internal bleeding. Call 911 immediately if you experience these symptoms.
Symptoms of a ruptured or dissected thoracic aortic aneurysm
- Sudden, sharp, severe pain in your upper back or between your shoulder blades
- Pain in your chest, jaw, neck or arms
- Difficulty breathing or coughing
What causes a thoracic aortic aneurysm?
Thoracic aortic aneurysms are usually caused by hardening of the arteries, called atherosclerosis. This condition damages the walls of the artery, and they become weaker and less flexible. If the pressure of blood against the artery wall is greater than the strength of the wall, an aneurysm can develop.
Other thoracic aortic aneurysm causes:
- Marfan syndrome and other genetic connective tissue disorders
- A bicuspid aortic valve, which means the valve has two cusps rather than three cusps of a normal tricuspid valve
- Inflammatory diseases
- Rarely, an infection such as syphilis or salmonella
- Rarely, a serious injury, such as trauma from a car crash or fall
What are the risk factors for a thoracic aortic aneurysm?
Not all people with risk factors will get thoracic aortic aneurysm. Risk factors for thoracic aortic aneurysm include:
- Older age, typically people older than 65
- High blood pressure
- High cholesterol
- Marfan syndrome
Reducing your risk of thoracic aortic aneurysm
While you can’t change your age or genetic background, you may be able to lower your risk of thoracic aortic aneurysm and other vascular conditions in other ways, such as:
- Eating healthy and getting regular moderate exercise
- Avoiding emotional stress, strenuous exercise, heavy lifting, and other arduous activities that temporarily increase your blood pressure
- Keeping your blood pressure and cholesterol at healthy levels
- Stopping smoking
- Treating infections
- Knowing your family’s medical history and getting screened for genetic conditions that can cause thoracic aortic aneurysm
If you are concerned about aortic aneurysms, talk with your doctor about your personal risk, aortic aneurysm screening tests, and preventive medical care to reduce your risk.
How is a thoracic aortic aneurysm treated?
After a thoracic aortic aneurysm diagnosis via imaging, your doctor will discuss treatment options, which may include active monitoring or surgery. Thoracic aortic aneurysm treatment options depend on your age and overall health, as well as the size of the aneurysm.
If your doctor discovers a small, slow-growing aneurysm, he or she may recommend a wait-and-watch plan without other treatment. You may need to have imaging tests once or twice a year to monitor the aneurysm’s growth. If you have high blood pressure or high cholesterol, your doctor will recommend lifestyle changes and possibly medication to treat those conditions.
If the aneurysm is bigger than five or six centimeters, your doctor may recommend surgery. This involves an incision in the breastbone or the left side of your chest to remove that portion of aorta with the aneurysm and replace it with a plastic or fabric vascular graft. Like with open heart surgery, you will need general anesthesia and a heart-lung machine, as well as several days in the hospital for recovery.
Your doctor may recommend a less invasive option called thoracic endovascular aortic repair (TEVAR). This treatment involves only a small incision in the groin to fit a catheter. Through the catheter, the doctor will place a small metal or plastic device called a stent graft inside the aorta to support and strengthen the area. Recovery time is much quicker than with open chest surgery, but this is a newer treatment and typically only used on abdominal and descending thoracic aortic aneurysms. It may be an option for other types of thoracic aortic aneurysms in the future.
What are the potential complications of a thoracic aortic aneurysm?
If the aneurysm ruptures or if the aorta dissects, you could experience life-threatening internal bleeding. If this happens, you will need emergency surgery. Call 911 immediately for signs and symptoms of an aortic aneurysm. Do not hesitate.
After surgery, you may experience other complications from bleeding or loss of blood flow to vital organs, such as the brain and kidneys. In some cases, complications are fatal.