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An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.
A thoracic aortic aneurysm occurs in the part of the body's largest artery (the aorta) that passes through the chest.
Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic
The most common cause of a thoracic aortic aneurysm is hardening of the arteries (atherosclerosis). This condition is more common in people with high cholesterol, long-term high blood pressure, or who smoke.
Other risk factors for a thoracic aneurysm include:
Aneurysms develop slowly over many years. Most patients have no symptoms until the aneurysm begins to leak or expand. The aneurysm may be found only when imaging tests are done for other reasons.
Symptoms often begin suddenly when:
If the aneurysm presses on nearby structures, the following symptoms may occur:
Other symptoms may include:
The physical examination is often normal unless a rupture or leak has occurred.
Most thoracic aortic aneurysms are detected by tests performed for other reasons, usually a chest x-ray, echocardiogram, or a chest CT scan or MRI. A chest CT scan shows the size of the aorta and the exact location of the aneurysm.
An aortogram (a special set of x-ray images made when dye is injected into the aorta) can identify the aneurysm and any branches of the aorta that may be involved.
There is a risk that the aneurysm may open up (rupture) if you do not have surgery to repair it.
The treatment depends on the location of the aneurysm. The aorta is made of three parts:
For patients with aneurysms of the ascending aorta or aortic arch:
For patients with aneurysms of the descending thoracic aorta:
The long-term outlook for patients with thoracic aortic aneurysm depends on other medical problems, such as heart disease, high blood pressure, and diabetes, which may have caused or contributed to the condition.
Serious complications after aortic surgery can include:
Death soon after the operation occurs in 5 - 10% of patients.
Complications after aneurysm stenting include damage to the blood vessels supplying the leg, which may require another operation.
Tell your doctor if you have:
To prevent atherosclerosis:
Tracci MC, Cherry KJ. The aorta. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 62.
Cheng D, Martin J, Shennib H, et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease: a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol. 2010:55(10):986-1001.
Isselbacher EM. Diseases of the aorta. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 78.