Thoracic aortic aneurysm

Diagnosis

Detecting a thoracic aneurysm at an early stage is crucial for effective management of the condition. The likelihood of a rupture increases as the thoracic aortic aneurysm grows larger or at a faster rate, especially when it exceeds twice the normal diameter of a healthy aorta blood vessel.

However, diagnosing a thoracic aneurysm can be challenging since there are usually no noticeable symptoms, and the condition often remains undetected until a rupture occurs. If a thoracic aortic aneurysm is suspected, your physician may recommend the following diagnostic tests:

• Echocardiogram: This is an ultrasound of the heart. It can be used to detect or rule out thoracic aortic aneurysms. Sound waves are used to illustrate how blood flows through the heart and blood arteries, particularly the aorta. If a normal echocardiogram does not provide adequate information about the aorta, a transesophageal echocardiography (TEE) may be performed. This involves passing a thin tube containing an ultrasound wand down the throat and into the tube linking the mouth to the stomach.
• Computerized tomography (CT): During the procedure, a dye may be administered intravenously to improve the visibility of arteries on the X-ray.  This is often done within a doughnut-shaped X-ray machine. In a CT scans, the body is scanned in cross-section, including the aorta, using X-rays. It can identify the size and shape of an aneurysm.
• Cardiac magnetic resonance imaging (MRI): To limit radiation exposure, this test can be used instead of CT scans for those who require frequent monitoring of aneurysms. A dye may be administered intravenously during the procedure to enhance the visibility of blood vessels in an image. A cardiac MRI creates precise images of the heart and aorta using magnetic fields and radio waves. The size and location of the aneurysm can be determined using this test.

Treatment

Treatment for a thoracic aortic aneurysm is determined by its size, location, and overall health of the patient. Treatment method may include medications, surgery, and watchful waiting. The primary goal of the treatment is to prevent the aneurysm from developing and rupturing.

• Monitoring: If the thoracic aortic aneurysm is small and not causing symptoms, a doctor may recommend watchful waiting as the initial approach. The goal of watchful waiting is to monitor the aneurysm regularly to detect any changes or growth that may require intervention. The frequency of the imaging tests will depend on various factors such as the size, location, and rate of growth of the aneurysm, as well as the patient’s overall health status. Other health issues that may affect the aneurysm, such as high blood pressure, may also need to be managed to reduce the risk of rupture or other complications.
• Medications: Other health conditions related to thoracic aortic aneurysm may need to be managed. High blood pressure and high cholesterol can be treated with medication and lifestyle changes. Common medications to treat related health issues with thoracic aortic aneurysm are:
  • Beta blockers. Patients with high blood pressure will be prescribed with beta blockers to lower the general blood pressure as well as the pressure on the aneurysm’s weakest area. These medications may slow the rate at which the aorta widens, particularly in patients with Marfan syndrome. By lowering the heart rate, beta blockers lower blood pressure.
  • Angiotensin II receptor blockers. These are frequently prescribed for individuals with Loeys-Dietz syndrome regardless of increased blood pressure. Losartan, valsartan, and olmesartan are the common angiotensin II receptor blockers. These serve as alternative if beta blockers cannot sufficiently regulate blood pressure.
  • Statins. The doctor may prescribe a “statin” which is a cholesterol-lowering medicine, to keep the blood vessels healthy. Statins such as atorvastatin, lovastatin, and simvastatin. These drugs can help cholesterol level can help lower cholesterol levels and effectively minimize artery blockages, reducing the risk of aneurysm problems.

Smoking is highly discouraged to people with thoracic aortic aneurysm. Tobacco use can aggravate an aneurysm and harm one’s general health.

Surgery: For thoracic aortic aneurysms that are 1.9 to 2.4 inches (5 to 6 centimeters) or larger, surgery is generally recommended. However, even for smaller aneurysms, surgery may be suggested if you have a family history of aortic dissection or a related condition, such as Marfan syndrome.

The particular surgical procedure chosen will depend on the location of the aneurysm and your specific health condition. While open-chest surgery is typically recommended for most people with thoracic aortic aneurysms, endovascular surgery is sometimes an option, which is less invasive.Common types of surgery to treat thoracic aortic aneurysm are:

• Open-chest surgery. Addressing a thoracic aneurysm usually requires open-chest surgery, general anesthesia, and a minimum hospital stay of five days. However, full healing could take a month or longer. During the procedure, a portion of the damaged aorta segment is removed and replaced with a synthetic tube graft that is stitched into place.
• Aortic root surgery. If a thoracic aortic aneurysm is severe or causing symptoms, immediate treatment is necessary to prevent a rupture. The weakened section of the blood vessel can be surgically removed and replaced with an artificial graft. If the aneurysm is located near the aortic valve, a valve replacement may be recommended as part of the treatment. Marfan syndrome and other similar conditions can be associated with aortic aneurysms at the aortic root. If the valve is not removed during surgery, it is known as valve-sparing aortic root repair and a mechanical or biological valve can be used to replace the aortic valve.
• Endovascular aortic aneurysm repair (EVAR). The doctor may recommend an endovascular aneurysm repair instead of an open aneurysm repair. EVAR is a catheter-based technique that may result in a quicker recovery. However, not everyone may be eligible for this surgery.

Endovascular surgery is performed within the aorta using thin, long tubes known as catheters. Catheters are utilized to guide and distribute a stent-graft via the blood vessels to the site of the aneurysm by entering through small incisions in the groin. Small hooks or pins are used to secure it. The stent graft is then placed in the damaged aorta section to “reline” the aorta like a sleeve, diverting blood flow away from the aneurysm. The graft strengthens the weakened segment of the aorta, preventing aneurysm rupture. Regular imaging examinations to check for leaking in the graft may be required post-surgery.

• Emergency surgery. Regular monitoring and proper preventive surgery are critical to detecting and repairing thoracic aortic aneurysms before they rupture. Aortic dissection can cause internal bleeding, which can be life-threatening. A ruptured thoracic aortic aneurysm requires immediate open-chest surgery, which is risky and carries significant risks of complications.