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Thoracic aortic aneurysm

Medically reviewed by Drugs.com. Last updated on Apr 25, 2023.

Overview

A thoracic aortic aneurysm is a weakened area in the body's main artery in the chest. The body's main artery is called the aorta. When the aortic wall is weak, the artery may widen. When the vessel is significantly widened, it's called an aneurysm.

A thoracic aortic aneurysm also is called a thoracic aneurysm.

Treatment of a thoracic aortic aneurysm may vary from regular health checkups to emergency surgery. The type of treatment depends on the cause, size and growth rate of the thoracic aortic aneurysm.

Complications of a thoracic aortic aneurysm include rupture of the aorta or a life-threatening tear between the layers of the aorta's wall. The tear is called an aortic dissection. Rupture or dissection can lead to sudden death.

Thoracic aortic aneurysms are less common than aneurysms that form in the lower part of the aorta, called abdominal aortic aneurysms.

Thoracic aortic aneurysm

A thoracic aortic aneurysm is a weakened area in the upper part of the aorta — the major blood vessel that feeds blood to the body. Aneurysms can develop anywhere in the aorta.

Symptoms

Thoracic aortic aneurysms often grow slowly. There are usually no symptoms, making them difficult to detect. Many start small and stay small. Others grow bigger over time. How quickly a thoracic aortic aneurysm may grow is difficult to predict.

As a thoracic aortic aneurysm grows, symptoms may include:

Symptoms that a thoracic aortic aneurysm has ruptured or dissected include:

Some aneurysms may never rupture or lead to dissection.

When to see a doctor

Most people with aortic aneurysms don't have symptoms unless a dissection or rupture occurs. An aortic dissection or aneurysm rupture is a medical emergency. Call 911 or your local emergency number for immediate help.

Causes

Aortic aneurysms can develop anywhere in the body's main artery, called the aorta. The aorta runs from the heart through the chest and belly area. When an aneurysm occurs in the chest, it's called a thoracic aortic aneurysm.

If an aneurysm forms between the upper and lower parts of the aorta, it's called a thoracoabdominal aneurysm.

A thoracic aneurysm may be round or tube-shaped.

Aneurysms can occur anywhere in the thoracic aorta, including near the heart, in the aortic arch and in the lower part of the thoracic aorta.

Causes of thoracic aortic aneurysms may include:

Aortic emergencies

In aortic dissection, a tear occurs in the wall of the aorta. This causes bleeding into and along the aortic wall. Sometimes the bleeding moves completely outside the aorta. When this happens, it's called an aortic rupture.

An aortic dissection is a potentially life-threatening emergency, depending on where in the aorta it occurs. It's important to treat an aortic aneurysm to try to prevent dissection. If dissection occurs, people can still be treated with surgery. However, they typically have a higher risk of complications.

Aortic aneurysm and aortic dissection

An aortic aneurysm occurs when a weak spot in the wall of the aorta begins to bulge, as shown in the image on the left. An aneurysm can occur anywhere in the aorta. Having an aortic aneurysm increases the risk of a tear in the aortic lining, called a dissection, as shown in the image on the right.

Risk factors

Thoracic aortic aneurysm risk factors include:

Complications

Tears in the wall of the aorta and rupture of the aorta are the main complications of thoracic aortic aneurysm. However, some small and slow-growing aneurysms may never rupture. In general, the larger the aneurysm, the greater the risk of rupture.

Complications of a thoracic aortic aneurysm and rupture can include:

Prevention

Keeping the blood vessels as healthy as possible is important in preventing an aneurysm. A health care provider may recommend these heart-healthy strategies:

There are no medicines to prevent an aortic aneurysm. However, medicines may be used to treat high blood pressure, high cholesterol and other conditions linked to aneurysm. Proper management of such conditions may lower the risk of thoracic aortic aneurysm complications.

Screening and genetic testing

Conditions that cause a thoracic aortic aneurysm may run in families. A health care provider may recommend screening if a first-degree relative — such as a parent, brother, sister, son or daughter — has a genetic disease such as Marfan syndrome or another condition linked to thoracic aortic aneurysms.

Screening means you have regular imaging tests, usually an echocardiogram, to check for an aneurysm. If an ultrasound of the heart shows an enlarged aorta or an aneurysm, another imaging test is usually done within 6 to 12 months to make sure it hasn't grown.

Genetic testing also may be recommended if you have a family history of aortic aneurysms, particularly if you're considering pregnancy.

Diagnosis

Thoracic aortic aneurysms are often found when an imaging test is done for a different reason.

If you have symptoms of a thoracic aortic aneurysm, your health care provider may ask about your family's medical history. Some aneurysms can run in families.

Tests

Imaging tests can be used to confirm or screen for a thoracic aortic aneurysm. Tests may include:

Treatment

The goal of treatment for a thoracic aortic aneurysm is to prevent the aneurysm from growing and rupturing. Treatment depends on the aneurysm's size and how fast it's growing.

Treatment for thoracic aortic aneurysm may include:

If your thoracic aortic aneurysm is small, your health care provider may recommend medicine and imaging tests to watch the aneurysm. Other health conditions will be treated and managed.

Usually, you'll have an echocardiogram, CT or magnetic resonance angiography (MRA) scan at least six months after your aneurysm is diagnosed. An imaging test also may be done at regular follow-up exams. How often you have these tests done depends on the cause and size of the aneurysm, and how fast it's growing.

Medications

Medicines may be prescribed to treat high blood pressure and high cholesterol.

These medicines could include:

If you smoke or chew tobacco, it's important that you quit. Using tobacco can worsen an aneurysm and overall health.

Surgery

Surgery is generally recommended for thoracic aortic aneurysms about 1.9 to 2.4 inches (about 5 to 6 centimeters) and larger. Surgery may be recommended for smaller aneurysms if you have a family history of aortic dissection or a condition linked to aortic aneurysm, such as Marfan syndrome.

Most people with a thoracic aortic aneurysm have open-chest surgery, but sometimes a less invasive procedure called endovascular surgery can be done.

The type of surgery done depends on the specific health condition and the location of the thoracic aortic aneurysm.

Open-chest surgery for thoracic aortic aneurysm

Open-chest surgery to repair a thoracic aortic aneurysm involves removing the damaged part of the aorta. The damaged part is replaced with a synthetic tube, called a graft, which is sewn into place.

Ascending aortic root aneurysm procedure

An ascending aortic root aneurysm procedure may be done in two ways. Valve-sparing aortic root repair (top-right image) replaces the enlarged section of the aorta with an artificial tube, called a graft. The aortic valve stays in place. In aortic valve and aortic root replacement (bottom-right image), the aortic valve and a part of the aorta are removed. A graft replaces the section of the aorta. A mechanical or biological valve replaces the valve.

Endovascular repair for thoracic aortic aneurysm

In endovascular thoracic aortic aneurysm repair, the surgeon inserts a thin, flexible tube called a catheter through an artery in the groin area and guides it to the aorta. A metal mesh tube called a graft is on the end of the catheter. The graft is placed at the aneurysm site. It's secured with small hooks or pins. The graft strengthens the weakened section of the aorta to prevent rupture of the aneurysm.

Lifestyle and home remedies

If you have a thoracic aortic aneurysm, your health care provider may tell you not to do heavy lifting and some vigorous physical activities. Such activities can increase blood pressure, putting additional pressure on your aneurysm.

If you want to participate in a particular activity, your health care provider may recommend an exercise stress test to see how exercise affects your blood pressure. Moderate physical activity is generally healthy for you.

Stress also can raise blood pressure, so find ways to help reduce emotional stress. Getting more exercise and practicing mindfulness are some ways to reduce stress.

Coping and support

Some people with a thoracic aortic aneurysm or related conditions may feel anxious, worried or depressed. You may find that connecting with others who have experienced similar situations may be helpful. Talk to your health care provider about support groups in your area.

Preparing for an appointment

If you think you may have a thoracic aortic aneurysm or are worried about your aneurysm risk because of a strong family history, make an appointment with your care provider. If an aneurysm is found early, treatment may be easier and more effective.

If you're being screened for an aortic aneurysm, your health care provider will likely ask if anyone in your family has ever had an aortic aneurysm, so have that information ready.

Because appointments can be brief and there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your health care provider.

What you can do

Your time with your health care provider is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For an aortic aneurysm, some basic questions to ask your health care provider include:

In addition to the questions that you've prepared to ask your health care provider, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you several questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your health care provider may ask:

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. Taking these steps can help prevent thoracic aortic aneurysm and its complications.

If you're diagnosed with a thoracic aortic aneurysm, ask how often you should visit your health care provider for follow-up appointments.

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