Patient Care - Adult cardiac, endovascular, and thoracic aortic surgery
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A thoracic aortic aneurysm is a localized expansion of the wall of the aorta.
Aortic rupture (a tear in the aorta, which is the major artery coming from the heart) can be seen on a chest X-ray. In this case, it was caused by a traumatic perforation of the thoracic aorta. This is how the X-ray appears when the chest is full of blood (right-sided hemothorax) seen here as cloudiness on the left side of the picture.
Causes, incidence, and risk factors: Thoracic aortic aneurysms are caused by hardening of the arteries (atherosclerosis), high blood pressure (hypertension), congenital disorders such as Marfan's syndrome, trauma, or less commonly, syphilis.
Atherosclerosis is by far the most common cause.
Thoracic aneurysms occur in the ascending aorta (25% of the time), the aortic arch (25% of the time), or the descending thoracic aorta (50% of the time).
Risk factors include various connective tissue disorders (such as Marfan's syndrome), atherosclerosis, previous dissection of the aorta, prolonged hypertension, and trauma (usually falls or motor vechicle accidents).
Symptoms: Most patients have no symptoms until the aneurysm begins to leak or expand. Most non-leaking thoracic aortic aneurysms are detected by tests — usually a chest X-ray or a chest CT scan — run for other reasons. Chest or back pain may indicate acute expansion or leakage of the aneurysm.
Treatment: The treatment depends on the location of the aneurysm.
Ascending aorta or aortic arch: surgery to replace the aorta is recommended if the diameter of the aorta measures greater than 5-6 cm. The aorta is replaced with a fabric substitute in an operation that uses a heart-lung machine. If the aortic arch is involved, a specialized technique called "circulatory arrest" -- a period without blood circulation while on life support -- may be necessary.
Descending thoracic aorta: two options are available. Aneurysms that are larger than 6 cm, an operation for replacement of the aorta with a fabric substitute can be done, or the aorta can be stented.
Stenting involves the use of a tube placed inside the vessel and can be performed without a chest incision, with specialized catheters that are introduced through arteries at the groin. Not all patients with descending thoracic aneurysms are candidates for stenting, however.