A thoracic aortic aneurysm, an abnormal bulge in a weakened wall of the aorta in the chest area, can cause a variety of symptoms and often life-threatening complications. Due to the serious risks it presents, timely diagnosis and treatment of a thoracic aneurysm are critical.

Is a thoracic aortic aneurysm serious?
Thoracic aortic aneurysms affect about 15,000 people in the United States each year, and are the 13th leading cause of death. Research has shown that patients with untreated large thoracic aneurysms are more likely to die of complications associated with their aneurysms than from any other cause.

What is the best treatment for a thoracic aortic aneurysm?
The decision on how to best treat a thoracic aneurysm depends on its size and rate of its growth, location and your overall health. The risk of rupture increases when the aneurysm is larger than about twice the normal diameter of a healthy aorta blood vessel.

Medical Management
If a thoracic aneurysm is small and causes no symptoms, your physician may recommend “watchful waiting,” which includes:

• Close monitoring of the aneurysm with CT or MRI scans every 6 months
• Blood pressure medication to control high blood pressure, and decrease pressure on the weakened area of the aneurysm
• Restriction of some physical activities. Heavy lifting should be avoided due to increased pressure on the aorta, which may put an aneurysm at risk of rupture

The aorta To understand how surgery is used to treat a thoracic aneurysm, it is best to know where the aorta is located and how it functions. The aorta is shaped like an old-fashioned walking cane with the stem of the curved handle coming out of the heart and curling through the aortic arch, which supplies branches of vessels to the head and arms. Once the aorta descends through the chest cavity into the abdomen, it separates off to provide blood to the abdominal organs and both legs. Click here for larger view

Surgery
The decision to treat a thoracic aneurysm with surgery is determined by many factors, including:

• The presence of symptoms, including chest and back pain, and pain in the jaw, neck and upper back
• If the aneurysm is growing more than 1 centimeter (cm) per year
• Signs of an aortic dissection, including sudden, severe sharp tearing pain in the chest or back
• The age of the patient and the patient’s overall medical condition

New evidence has shown that the size of the aneurysm in addition to a patient’s height plays an important role in the decision for surgery. While 5 centimeters is the size most aneurysms are considered for surgery, Cleveland Clinic surgeons have compiled years of experience and published studies to find that a patient’s height and their aneurysm’s size strongly correlates with the need for surgery. For instance, a patient who is over 6 feet tall with a 5 centimeter aneurysm would be recommended for surgery. Yet, a patient who is 5 feet 7 inches with a thoracic aneurysm of 4.7 centimeters is a candidate for surgery due to their individual risk of rupture.

Due to highly individualized characteristics guiding the decision for surgery, it is best that a physician closely monitor your thoracic aneurysm on a regular basis.

How is a thoracic aortic aneurysm treated with surgery?
The current standard surgical treatment of a thoracic aortic aneurysm is the open-chest approach. The main purpose of open-chest surgery to treat a thoracic aneurysm is to replace the weakened portion of the aorta with a fabric tube, called a graft.

Repairing a thoracic aneurysm is surgically complicated and requires an experienced thoracic surgical team. However, neglecting the aneurysm presents a higher risk.

Cleveland Clinic surgeons have considerable experience in complex aortic operations, performing over 1,000 aortic procedures in 2005. Procedures include ascending aorta, aortic arch, descending aorta, thoracoabdominal repairs, and thoracic aorta endovascular stent graft procedures.

The aorta The aorta is the largest artery in the body and is the blood vessel that carries oxygen-rich blood away from the heart to all parts of the body. The section of the aorta that runs through the chest is called the thoracic aorta and, as the aorta moves down through the abdomen it is called the abdominal aorta. Click here for larger view

What is a thoracic aortic aneurysm?
When an artery wall in the aorta weakens, the wall abnormally expands or bulges as blood is pumped through it, causing an aortic aneurysm. The bulge or ballooning may be defined as a:

• Fusiform: Uniform in shape, appearing equally along an extended section and edges of the aorta.
  Saccular aneurysm: Small, lop-sided blister on one side of the aorta that forms in a weakened area of the aorta wall.

An aneurysm can develop anywhere along the aorta:

• Aneurysms that occur in the section of the aorta that runs through the abdomen (abdominal aorta) are called abdominal aortic aneurysms.
• Aortic aneurysms that occur in the chest area are called thoracic aortic aneurysms and can involve the aortic root, ascending aorta, aortic arch or descending aorta.
• Aneurysms that involve the aorta as it flows thru both the abdomen and chest are called thoracoabdominal aortic aneurysms. 

Up to 47,000 people die each year from all types of aortic disease; more than from breast cancer, AIDS, homicides, or motor vehicle accidents, making aortic disease a silent epidemic.

Is a thoracic aortic aneurysm serious?
A thoracic aortic aneurysm is a serious health risk because, depending on its location and size, it may rupture or dissect (tear), causing life-threatening internal bleeding. When detected in time, a thoracic aortic aneurysm can often be repaired with surgery or other less invasive techniques.

Complex Aorta Surgery

• atherosclerosis (hardening of the arteries)
• hypertension (high blood pressure)
• genetic conditions (such as Marfan Syndrome)
• connective tissue disorders (such as Ehler-Danlos disorder, polychondritis, scleroderma, osteogenesis imperfecta, polycystic kidney disease, and Turners Syndrome)
• injury

An aortic dissection, usually caused by high blood pressure, is a condition that forces the layers of the wall of the aorta apart through increased blood flow. Over time, the pressure of the blood flow can cause the weakened area of the aorta to bulge like a balloon, stretching the aorta, causing severe, sharp, tearing pain in your chest and back.

• Aneurysms that occur in the section of the aorta that runs through the abdomen (abdominal aorta) are called abdominal aortic aneurysms.
• Aortic aneurysms that occur in the chest area are called thoracic aortic aneurysms and can involve the aortic root, ascending aorta, aortic arch or descending aorta.
• Aneurysms that involve the aorta as it flows thru both the abdomen and chest are called thoracoabdominal aortic aneurysms.